Equitable health services

61st World Health Assembly: Progress on immunisation reported by many countries
World Health Organization, 22 May 2008

More than 40 delegations at the WHA described the status of immunization in their countries, their efforts, future plans and successes. The 68% reduction in measles deaths globally in just six years of accelerated activities points to the potential for such achievements in other areas of immunisation. Constraints raised by governments included financial support especially for new, more expensive life-saving vaccines and for low middle-income countries who are not eligible for support from the GAVI Alliance. The importance of high data quality and injection safety were also of concern to Member States.

A basic package of health services for post-conflict countries: Implications for sexual and reproductive health services
Roberts B, Guy S, Sondorp E and Lee-Jones L: Reproductive Health Matters, 16(31):57–64, May 2008

Health systems in countries emerging from conflict are often characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations, which all undermine health services. One response is to improve health service delivery in post-conflict countries by jointly contract non-governmental organisations to provide a Basic Package of Health Services for all the country's population. The approach is novel because it is intended as the only primary care service delivery mechanism throughout the country, with the available financial health resources primarily allocated to it. The aim is to scale up health services rapidly. This paper describes the Basic Package of Health Services contracting approach and discusses some of the potential challenges this approach may have for sexual and reproductive health services, particularly the challenges of availability and quality of services, and advocacy for these services.

A comparison of the behavioral and emotional disorders of primary school-going orphans and non-orphans in Uganda
Musisi S, Kinyanda E, Nakasujja N, Nakigudde J: African Health Sciences 7(4): 202-213

The authors investigated the emotional and behavioral problems of orphans in Rakai District, Uganda and suggested interventions. Most lived in big poor families with few resources, faced stigma and were frequently relocated. Community resources were inadequate. Compared to non-orphans, more orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy, insecure, poor, exploited, abused or neglected. Most lived in poverty with elderly widowed female caretakers. But they showed high resilience in coping. To comprehensively address these problems, we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families, a National Child Protection Agency for all Children, Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children.

A doctor in your pocket
The Economist: 2009

This special report on health care and technology describes how developing countries are using mobile phones to provides personalised medicine. Drawing from experiences of various countries, the authors demonstrate how new technologies help to tackle the health problems of the world’s poorest. The authors argue that given their ubiquity, personal convenience and interactivity, mobile phones offer an innovative way to reach reticent HIV sufferers. With demonstrated success in the use of mobiles for health (mHealth) in the likes of Uganda, Kenya, Rwanda and Mexico, the authors recommend that the visible face of any mHealth or e-health scheme, regardless of where it operates, needs to be as simple and user-friendly as possible, whereas the hidden back end should use sophisticated software and hardware. The authors conclude that the poor clearly benefit from technical improvements that cut the cost of manufacturing medical devices, make drugs more effective, or eliminate the need for refrigerating vaccines, as well as through big technical breakthroughs that save many millions of lives. Mobile phones, as demonstrated from the examples in this report, can aid early detection, effective early responses, and remote medicine.

A health systems development agenda for developing countries: Time to be clear and visionary
Global Health Watch

This discussion paper argues for the development of an advocacy agenda to promote comprehensive health systems development in developing countries. It aims to promote discussion amongst health policy experts and civil society organisations (CSOs) about the need for and content of a health systems advocacy agenda. This document is intended to stimulate discussion and is accompanied by a pro-forma document to facilitate your comments, opinions and recommendations in shaping the content of a health systems development agenda and the way forward for appropriate health care systems development.

A mid-term assessment of progress towards the immunisation coverage goal of the Global Immunisation Vision and Strategy (GIVS)
Brown DW, Burton A, Gacic-Dobo M, Karimov RI, Vandelaer J and Okwo-Bele J: BMC Public Health 11(806), 14 October 2011

The Global Immunisation Vision and Strategy (GIVS 2006-2015) aims to reach and sustain high levels of vaccine coverage, provide immunisation services to age groups beyond infancy and to those currently not reached, and to ensure that immunisation activities are linked with other health interventions and contribute to the overall development of the health sector. The objective of this study was to examine mid-term progress (through 2010) of the immunisation coverage goal of the GIVS for 194 countries or territories with special attention to data from 68 countries which account for more than 95% of all maternal and child deaths. The study presents national immunisation coverage estimates for the third dose of diphtheria and tetanus toxoid with pertussis (DTP3) vaccine and the first dose of measles-containing vaccine (MCV) during 2000, 2005 and 2010. Results show that globally DTP3 coverage increased from 74% during 2000 to 85% during 2010, and MCV coverage increased from 72% during 2000 to 85% during 2010. A total of 149 countries attained or were on track to achieve the 90% coverage goal for DTP3 (147 countries for MCV coverage). The researchers conclude that progress towards GIVS goals highlights improvements in routine immunisation coverage, yet they voice concern that some priority countries showed little or no progress during the past five years. These results highlight that further efforts are needed to achieve and maintain the global immunisation coverage goals.

A national audit of home and community-based care (HCBC) organisations in South Africa
Ogunmefun C, Friedman I, Mothibe N and Mbatha T: AIDS Care, October 2011

The main objective of the study was to conduct an audit of home and community-based care (HCBC) organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. Of the 2,001 HCBC organisations that participated in the audit, most were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. Most of the organisations were faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa.

A population based survey in Ethiopia using questionnaire as proxy to estimate obstetric fistula prevalence: results from demographic and health survey
Biadgilign S, Lakew Y, Reda AA and Deribe K: Reproductive Health 10(14), 25 February 2013

The aim of this study was to describe the prevalence and factors associated with obstetric fistula in Ethiopia. A total of 14,070 women of reproductive age group were included in the survey, of whom only 23.2% had ever heard of OF. Among 9,713 women who had given birth, 103 (1.06%) had experienced OF in their lifetime. Those women who are circumcised or lived in urban areas had higher odds of reporting the condition. Women who gave birth 10 or more also had higher odds of developing OF than women with one to four children. It is estimated that in Ethiopia nearly 142,387 obstetric fistula patients exist. The authors conclude that OF is a major public and reproductive health concern in Ethiopia and they call for increased access to emergency obstetric care, expansion of fistula repair service and active recruitment of women through a campaign of ending obstetric fistula.

A progressive decline in the burden of malaria in north-eastern Tanzania
Mmbando BP, Vestergaard LS, Kitua AY, Lemnge MM, Theander TG and Lusingu JPA: Malaria Journal 9(216), 23 July 2010

In this study, malaria prevalence and morbidity were monitored in two villages in north-eastern Tanzania – a lowland village and a highland village from 2003 to 2008. Trained village health workers treated presumptive malaria with the Tanzanian first-line anti-malarial drug and collected blood smears that were examined later. The prevalence of malaria parasitaemia across years was monitored through cross-sectional surveys, and was found to decrease in the lowland village 78.4% in 2003 to 13.0% in 2008, while in the highland village, prevalence dropped from 24.7% to 3.1% in the same period. Similarly, the incidence of febrile malaria episodes in the two villages dropped by almost 85%, with a marked reduction in anaemia in young children in the lowland village. According to the study, this decline is likely to be due to a combination of factors that include improved access to malaria treatment provided by the trained village helpers, protection from mosquitoes by increased availability of insecticide-impregnated bed nets and a reduced vector density. If this decline in malaria morbidity is sustained, it will have a marked effect on the disease burden in this part of Tanzania.

A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa
Murphy K; Chuma T; Mathews C; Steyn K; Levitt N: BioMed Central 15(303), 1 August 2015

Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. This study explored patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change. The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status. The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care. In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers.

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