Nearly 60 million women will give birth without any medical assistance this year, the World Health Organisation (WHO) has said in a report calling for an overhaul of how health care is financed and managed globally. The United Nations agency said in its annual World Health Report that the billions of aid dollars devoted to fight specific epidemics like AIDS had distracted attention from providing comprehensive care to mothers and children. The difference in life expectancy between the richest and poorest countries still exceeds 40 years, said the report, whose launch coincided with a global financial crisis that could freeze aid flows and squeeze government budgets for health care. Increasingly specialised and technical medicine in wealthy nations has also excluded and impoverished millions of patients, exposing failures of ‘laissez-faire’ governance in health. WHO is encouraging countries to go ‘back to the basics’.
Equitable health services
Hundreds of thousands of cases of drug-resistant tuberculosis (TB) can be prevented and as many as 134 000 lives saved through the implementation of a two-year response plan, published/launched by WHO and Stop TB Partnership. The Global MDR-TB and XDR-TB Response Plan 2007-2008 sets out measures needed now to prevent, treat and control extensively drug-resistant TB (XDR-TB) and multidrug-resistant TB (MDR-TB). The plan also sets in motion actions to reach a 2015 goal of providing access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients, saving the lives of up to 1.2 million patients.
Many developing countries stressed the importance of access to medicines and of addressing the social determinants of health in order to prevent and control non-communicable diseases. Interventions also called for more funding and political commitment, better private sector regulation and policy-making free of conflict of interests. Several Member States also supported the inclusion of mental health in the context of NCDs. This was at the 64th World Health Assembly (WHA) meeting in Geneva on 16-24 May, during a discussion on the prevention and control of non-communicable diseases (NCDs) that considered the WHO Secretariat report on the matter and adopted a resolution sponsored by 61 Member States including EU member countries. The article reports on the debates and the resolution.
The 67th World Health Assembly (WHA) in May 2014 mandated the WHO Secretariat “to develop a draft global action plan to combat antimicrobial resistance, including antibiotic resistance, which addresses the need to ensure that all countries, especially low and middle income countries. The Global Action Plan (GAP) is to be submitted to the 68th WHA through the 136th Session of the Executive Board meeting which will take place on 26 January to 3 February 2015 in Geneva. The author argues that the draft GAP fails to provide bold solutions especially where the pharmaceutical transnational corporations (TNCs) and their home countries have vested interests. The areas where the plan is argued to raise concern are: on the mechanism to ensure access to antimicrobial medicines at affordable prices, including local production capabilities of antimicrobial medicines and diagnostics, technology transfer and public procurement. Another major area of strategic silence is the research and development (R&D) of new AMR medicines including antibiotics and diagnostics. Other important omissions are the explicit mention of promotion of rational use of antimicrobial medicines and the management of conflict of interests.
Médecins Sans Frontières welcomes the World Health Organization’s (WHO) proposed Global Immunization Vision and Strategy, which encourages a rebalancing of the global vaccine strategy so that support for the introduction of the newer vaccines does not mean momentum is lost as regards the need to ensure basic immunisation. New vaccines such as pneumococcal vaccines have the potential to avert millions of deaths worldwide, but MSF argues that the need for their medical teams to intervene in several measles outbreak responses illustrates the weak coverage of traditional vaccines, and is a clear indication of the failure of routine basic immunisation, despite the global decrease in measles morbidity and mortality. National immunisation programmes should be supported to leverage every interaction with young children to provide ‘catch-up’ vaccinations. The report lacks strategies and concrete actions to bring vaccine prices down, according to MSF, despite the fact that the WHO admits that vaccine prices continue to be a major obstacle. MSF notes that the current funding crisis at the GAVI Alliance is partly due to overpriced vaccines. Too much emphasis has been put on incentivising multinational pharmaceutical companies, at the expense of investing in support to emerging producers that can produce quality vaccines at dramatically reduced prices.
The authors of this study synthesised the findings of all relevant qualitative studies reporting on the views and experiences of women in low- and middle-income countries (LMICs) who received inadequate antenatal care. The synthesis revealed that centralised, risk-focused antenatal care programmes may be at odds with the resources, beliefs, and experiences of pregnant women who underuse antenatal services. These findings suggest that there may be a misalignment between current antenatal care provision and the social and cultural context of some women in LMICs. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences is likely to be underused, especially when attendance generates increased personal risks of lost family resources or physical danger during travel, when the promised care is not delivered because of resource constraints, and when women experience covert or overt abuse in care settings.
Despite Malawi government’s policy to support women to deliver in health facilities with the assistance of skilled attendants, some women do not access this care. This study explored the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. A total of 12 in- depth interviews were conducted with women that had delivered at home in the period December 2010 to March 2011. Results indicated that onset of labour at night, rainy season, rapid labour, socio-cultural factors and health workers’ attitudes were related to the women delivering at home. The participants were assisted in the delivery by traditional birth attendants, relatives or neighbours. Most women went to the health facility the same day after delivery. This study reveals beliefs about labour and delivery that need to be addressed through provision of appropriate perinatal information to raise community awareness. There is a need for further exploration of barriers that prevent women from accessing health care.
In today’s globalised world, rapid urbanisation, mechanisation of the rural economy, and the activities of transnational food, drink and tobacco corporations are associated with an increased risk of chronic non-communicable diseases (NCDs). As a result, population health profiles are rapidly changing. Many low and middle income countries (LMICs) are undergoing rapid changes associated with developing high rates of NCD while concomitantly battling high levels of communicable diseases. This review synthesises evidence on the overlap and interactions between established communicable and emerging non-communicable disease epidemics in LMICs. The review focuses on HIV, TB and malaria and explores the disease-specific interactions with prevalent NCDs in LMICs. The authors highlight the complexity, bi-directionality and heterogeneity of these interactions and discuss the implications for health systems. It is argued to require breaking down barriers between departments within
health ministries that have traditionally designed services and
programs for communicable and NCD separately and integrated multi-sectoral action addressing determinants across the life course.
Feasible universal health coverage in South Africa seems ever more remote, according to this article, as a dysfunctional Department of Public Works continues to stymie vital public hospital revitalisation projects, and five provinces have proved grossly incapable of spending their health budgets. Meanwhile, hospitals fall into disrepair and programmes are not expanded. Health Minister, Aaron Motsoaledi told parliament that the national ‘failure to spend’ was due to delays in the awarding of tenders, rolling over of budgets, poor performance of contractors (and the consequent termination of contracts and ensuing court challenges). Against this background, Dr Olive Shisana, Chairperson of the NHI ministerial advisory task team, argued that quality-based health facility accreditation is pivotal to the South African national health insurance (NHI) model. Dr Ravindra Rannan-Eliya, Director for Health Policy in Colombo, Sri Lanka, added that for an NHI to succeed in South Africa, public sector service quality and availability would need to ‘at least’ reach current medical scheme levels.
The University of the Witwatersrand in South Africa has announced the formation of the Wits Research Institute for Malaria, (WRIM), strengthening research into one of Africa’s deadliest diseases. The Institute combines three existing research groups from the School of Public Health who are working on malaria vectors, parasites and pharmacology. Africa has very few research institutes that have the capacity to address a host of issues and make an impact on the disease. The WRIM aims to produce leading research and researchers to benefit malaria control in Africa.