Equitable health services

Better breast cancer services urgently needed
Health-e, 31 October 2007

At the close of breast cancer awareness month, cancer organisations say proper testing and treatment services for breat cancer are completely inadequate. Breast cancer organisations are concerned that early detection and treatment services are severely lacking in South Africa where over 3 000 women die from this disease annually. The Breast Cancer Advocacy Coalition have sent a memorandum to the South African health department asking it to improve services. The coalition calls for a comprehensive breast health service that is equitable, available, affordable and accessible to all women in South Africa.

Birth preparedness among antenatal clients
Mutiso SM, Qureshi Z and Kinuthia J: East African Medical Journal 85(6):275–283, 2008

This paper set out to evaluate birth preparedness and complication readiness among antenatal care clients at Kenyatta National Hospital, Nairobi, Kenya. A total of 394 women attending antenatal care were systematically sampled to select every third interviewee for the study. The paper found that over 60% of the respondents were counselled by health workers on various elements of birth preparedness and many were aware of their expected date of delivery, had set aside funds for transport to hospital or for emergencies and knew at least one danger sign in pregnancy. Level of education positively influenced birth preparedness. However, education and counselling on different aspects of birth preparedness was not provided to all clients, especially about danger signs in pregnancy, birth preparedness and plans for emergencies.

Botswana confirms first case of XDR-TB
Motseta S, Nullis C: Mail and Guardian Online, 17 January 2008

Health authorities reported the first known cases of virtually untreatable tuberculosis in Botswana, following fears that the highly contagious strain has spread beyond South Africa. For the past few months, health professionals have warned that XDR-TB, although only confirmed in South Africa, had spread to other Southern African nations like Swaziland and Lesotho hard hit by the AIDS pandemic, but hadn't been diagnosed because of lack of laboratory facilities.

Breaking the boundaries of depression
Langa L: Health-e News, 21 April 2010

The Perinatal Mental Health Project in Cape Town, which offers counselling to mothers throughout their pregnancy, is playing a role by tackling depression in the initial stages of the pregnancy. While most programmes only tackle cases of depression among pregnant women after the birth of the baby, the Perinatal Mental Health Project (PMHP) at the University of Cape Town intervenes during the early stages of pregnancy. Simone Honikman, director of the project said severe cases of depression could be treated more successfully if detected early. According to PMHP, South Africa’s postnatal depression (PND) prevalence is three times that in developed countries. For over eight years the PMHP has screened about 8,000 pregnant women for mental health conditions, while up to 1 234 women have been counselled as part of this free service. The PMHP model is one of integration. Mental health care is provided on site together with antenatal care services. This means that the mothers needing help can access this service at the same service point where they receive other health care related to the pregnancy.

Breathing life into DRC's sick hospital
Winter J: BBC News International, 8 August 2006

This story describes the experience of Professor Stanis Wembonyama as director of the main hospital in Democratic Republic of Congo's second city, Lubumbashi, last year. Gecamines, the state-owned mining monopoly used to be in charge - theoretically - of the Jason Sendwe Hospital, but the institution had been left to rot. Most of the beds had been either stolen or stripped down and sold as scrap metal. Doctors and nurses had not been paid their salaries for five years and so they earned their living by demanding cash before treating their patients. The story outlines the steps to clean up the hospital and instil management discipline.

Bridging the gap between biomedicine and traditional healing
Buisnessinafrica, 17 April 2006: Etkind J

Nearly 18 months ago, South Africa’s Traditional Health Practitioners Bill made a triumphal passage through parliament, raising hopes in the hearts of the 300 000 or so practising traditional healers in South Africa that they might at last begin to ply their trade on an equal footing with their biomedical counterparts. The legislation included allowing traditional healers’ patients to claim through medical aid schemes, giving them access to government hospitals and clinics and demanding the same respect and courtesy accorded to general practitioners, surgeons and other biomedical professionals.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique
Versteeg M, du Toit L, Couper I and Mnqapu M: Global Health Action 6(19522), 24 January 2013

Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. Therefore, the objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. The top five priorities identified by participants were aligned to three of the World Health Organisation’s health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel made the following policy recommendations: a focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.

Call to Action: Health System Strengthening through the Global Fund
The Global Fund

Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which launches March 1, 2007, offers an important opportunity to fund health system strengthening, including the health workforce. To prepare for Round 7, health workers, ministry of health officials, and other individuals and institutions that have an interest in their countries' health systems are strongly encouraged to consider utilizing this opportunity for strengthening health systems. If interested, you should immediately contact members of your country's Country Coordinating Mechanism to discuss this potential, as well as the national process and timeline for developing these proposals. The proposals are expected to be due to the Global Fund in early July 2007.

Further details: /newsletter/id/32113
Cancer care in sub-Saharan Africa – urgent need for population-based cancer registries
Okobia MN: Ethiopian Journal of Health Development, 2007

This article reviews literature on cancer statistics in sub-Saharan Africa, and assesses the need for population-based cancer registries to enhance cancer care and prevention within the region. The article finds that there are few cancer registries in sub-Saharan Africa and most of these are hospital based. This is partly because in many countries cancer is a low priority as more emphasis is placed on the control of communicable diseases and improving environmental sanitation.

Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa
Carlson S; Duber H; Achan J; Ikilezi G; Mokdad A; Stergachis A; Gollum A; Bushman G; Roth G: Heart, doi: http://dx.doi.org/10.1136/heartjnl-2016-310913, 2017

Heart failure is a major cause of disease burden in sub-Saharan Africa. The authors aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions. They analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya) and report on the availability of cardiac diagnostic technologies and select medications for heart failure. Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities). Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter. Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. The authors’ findings call for increased investment in cardiac care to reduce the growing burden of heart failure.

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