Equitable health services

Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition
Oni T; Unwin N: International Health 7(4), June 2015

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.

Will our public healthcare sector fail the NHI?
Bateman C: South African Medical Journal November 102(11): 817-818, November 2012

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.

Wits launches Institute for Malaria
Health-e News: 18 March 2013

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.

Women need safer access to health care in war situations
International Committee of the Red Cross: 5 March 2009

In the run-up to International Women's Day, 8 March, the International Committee of the Red Cross (ICRC) warned that the specific health-care needs of women are often ignored or insufficiently taken into account in war situations. ‘People wounded in fighting are given priority for medical treatment, but women, even pregnant mothers, are often given scant attention despite their special needs,’ said the ICRC's adviser on issues relating to women and war. In the world’s least developed countries, many of which are at war, women are 300 times more likely to die in childbirth or from pregnancy-related complications than in developed countries, according to UNICEF. In war time, women are particularly at risk of rape and other forms of sexual violence and they have no means of transportation to reach a health-care facility so as to give birth safely.

Working to overcome the global impact of neglected tropical diseases
World Health Organization: 2010

Despite lack of resources, activities undertaken to mitigate the impact of neglected tropical diseases are so far producing unprecedented results, according to this report. It points to a number of successes: treatment with preventive chemotherapy reached 670 million people in 2008, while dracunculiasis, also called guinea worm disease, is on course to becoming first disease eradicated not by a vaccine, but by health education and behaviour change. Reported cases of sleeping sickness have also dropped to their lowest level in 50 years. The report notes opportunities for strengthening delivery systems, such as by targeting primary schools to treat millions of children for schistosomiasis and helminthiasis in Africa. In addition, better co-ordination is argued to be needed, such as with veterinary public health and to respond to changing disease patterns resulting from climate change and environmental factors.

World Health Assembly finds way forward on pandemic flu
Mara K: Intellectual Property Watch, 22 May 2009

Responsibility to take forward a still in-progress framework to cope with global influenza pandemics is now in the hands of the World Health Organization Director General Margaret Chan. The framework is intended to set forth guidelines for the sharing of viruses, vaccines, and other benefits related to pandemic strains of influenza. This includes mechanisms for tracing and reporting outbreaks, as well as for capacity building, technology transfer, and stockpiles of vaccines. It also includes a model binding contract for entities sharing viruses with pandemic potential.

World Health Organisation: What is people-centred care?
World Health Organisation: WHO, Geneva, 2017

This video from WHO introduces the concept of people-centred care. Globally, one in 20 people still lack access to essential health services that could be delivered at a local clinic instead of a hospital. And where services are accessible, they are often fragmented and of poor quality. WHO is supporting countries to progress towards universal health coverage by designing health systems around the needs of people instead of diseases and health institutions, so that everyone gets the right care, at the right time, in the right place.

World Malaria Report 2010
World Health Organisation: 2011

This report released by the World Health Organisation (WHO) reveals that a third of 306 anti-malarial medicines collected and tested from six African countries failed to meet international quality standards. Reasons for this failure include insufficient active pharmaceutical ingredient (API), an excess of degradation substances, and poor dissolution. In fact in two samples one of the APIs was totally absent. The countries surveyed were Cameroon, Ethiopia, Ghana, Kenya, Nigeria and Tanzania. The quality of anti-malarial medicines varied across countries, from Ethiopia – where no samples failed quality testing – to Nigeria, where the highest incidence of failure occurred (64%). This result implies that a patient in Nigeria is more likely to be treated with a substandard anti-malarial than a patient in a country that complies with international quality standards. Failure rates were noticeably low for WHO-prequalified medicines available in these countries (less than 4%) as well as for imported products manufactured by well-established manufacturers. The report concludes that WHO prequalification is a highly effective mechanism for verifying the quality of medicines.

Yellow fever vaccination coverage following massive emergency immunisation campaigns in rural Uganda, May 2011: a community cluster survey
Bagonza J, Rutebemberwa E, Mugaga M, Tumuhamye N and Makumbi I: BMC Public Health 13(202), 7 March 2013

This paper reports on yellow fever vaccination coverage following massive emergency immunisation campaigns in the Pader district, northern Uganda, in 2010. A total of 680 respondents were included in the sample and vaccination status was assessed in a survey using self reports and vaccination card evidence. Of the 680 respondents, 654 (96.3%) reported being vaccinated during the last campaign but only 353 (51.6%) had valid yellow fever vaccination cards. Of the 280 children below five years of age, 96.1% were vaccinated. The main reasons for not being vaccinated were: having travelled out of Pader district during the campaign period (40%), lack of transport to immunisation posts (28%) and sickness at the time of vaccination (16%). These results show that actual yellow fever vaccination coverage was high and met the desired minimum threshold coverage of 80% designated by the World Health Organisation. Active surveillance is necessary for early detection of yellow fever cases.

Yellow fever vaccine supply: a possible solution
Monath T; Woodall J; Gubler D; Yuill T; Mackenzie J;Martins R; Reiter P; Heymann D: The Lancet 387;10028; 1599–1600, 2016

The authors note the emerging epidemic of yellow fever in Angola and spread of similar Aedes aegypti mosquito-borne viruses including dengue, chikungunya, and now Zika, albeit with differences noted. Yellow fever was first identified as a viral infection in 1900, has been reported from more than 57 countries and yellow fever outbreaks have case fatality rates as high as 75% in hospitalised cases. There has been an effective yellow fever vaccine since the late 1930s, but with outbreaks in unvaccinated populations in 1987 in urban Nigeria, despite a mass vaccination campaign. According to WHO, the current yellow fever outbreak is in more than six of Angola's 18 provinces, and there has been movement of unvaccinated travellers from Angola to neighbouring Democratic Republic of the Congo, but also to further states, including Mauritania, and China. Southeast Asian countries are now considered at risk because the Aedes vector is present and the population is unvaccinated. However should yellow fever outbreaks occur elsewhere in Africa, in Latin America, or in Asia, the authors note that the current global supplies of yellow fever vaccine may be inadequate.