In this article, the authors describe five children who died of clinical rabies in a three month period (September to November 2011) in the Queen Elizabeth Central Hospital. From previous experience and hospital records, this number of cases is higher than expected. The authors express concerned that difficulty in accessing post-exposure prophylaxis (PEP) rabies vaccine may be partly responsible for this rise. They make three recommendations: prompt course of active immunisation for all patients with significant exposure to proven or suspected rabid animals; the use of an intradermal immunisation regime that requires a smaller quantity of the vaccine than the intramuscular regime and gives a better antibody response; and improved dog rabies control measures.
Equity in Health
These two challenge papers were commissioned by DANIDA to address two key questions. First, how has the development challenge changed, and how could it be understood for the future? Second, what are the implications for development agencies and development partnerships? Paper 1 by Andrew Norton, aims to support high-level discussion on the challenges facing global development. He reviews four key challenges: persistent poverty; globalisation and socio-economic transitions; sustainable development in the context of climate change; and human security, violence and conflict. He identifies major potential risks as shocks in the world economy, civil conflict and fragility, long-term resource scarcities and climate change. As a result, policy needs to engage with change, he argues, focusing on the supra-national level to deliver global public goods. Paper 2 by Andrew Rogerson picks up the themes emerging from Paper 1 to address the policy and institutional responses that are needed for inclusive and sustainable development. Like Norton, he calls for collective action within the complex institutional space occupied by many actors, policies and instruments. He further outlines three main options available to development agencies: concentrate on being an efficient disburser of official development assistance (ODA); become brokers and managers of ODA and ODA-like funds; or become deal-makers and brokers across government and internationally.
In Kenya, the Jua Kali (“hot sun,” in Swahili) industry is a major economical component of the urban informal sector, consisting primarily of outdoor manufacturing and repair shops. In August 2005, a cross-sectional survey was conducted in a large Jua Kalii area in Eldoret, Kenya. Most of the interviewees described their working conditions as poor, with about 30% of the subjects without easy access to toilets. They identified the three occupational risks as: breathing difficulties due to exposure to smoke, fumes or gases; work accidents; and eye injuries. In many of the work facilities, tools and practices require major improvements in order to provide appropriate working conditions in compliance with modern scientific knowledge and current legislation in Kenya. Changes in these areas require major financial investments and administrative commitments that are probably not easily achievable, the authors warn. But in such areas as institutional training, safety practices, and prevention, much can be accomplished with limited, affordable resources, including the provision of safe drinking water, accessible clean toilets, changes in working conditions (chairs, tables, lighting), training in safe work practices, the provision of basic protective devices such as goggles, gloves and aprons, improved methods of handling hazardous materials, and assistance in training to update work skills in light of changing technologies in their areas of employment.
In a new discussion paper prepared for the UN consultation on health in the post-2015 development agenda, WHO makes the case for using Universal Health Coverage as single overarching health goal. The current MDGs were conceived as a compact between what developing countries aspired to achieve and what the developed world needed to do to ensure progress. Future goals are argued to be more likely to be framed in terms of global challenges that require shared solutions.WHO argues that health is central to development: it is a precondition for, as well as an indicator and an outcome of progress in sustainable development. Nevertheless, while there is no doubt that health must have a place in the next generation of development, a convincing case needs to be made for how a health goal should be framed. In contrast to the current set of health-related MDGs, there is now a greater recognition of the need to focus on means as well as ends: health as a human right; health equity; equality of opportunity; global agreements (International Health Regulations, Pandemic Influenza Preparedness framework) that enhance health security; stronger and more resilient health systems; innovation and efficiency as a response to financial constraints; addressing the economic, social and environmental determinants of health; and multi-sectoral responses that see health as an outcome of all policies. In the current context promoting a long list of competing health goals will be counterproductive. The alternative is to build the case that health is a concern to all people, and is influenced by and as well contributing to policies across a wide range of sectors. The challenge then becomes one of deciding how “health” in this broad sense can be characterized in a way that is measurable and generates political traction and public understanding. The goal of achieving UHC is argued to have two inter-related components – coverage with needed health services (prevention, promotion, treatment and rehabilitation) and coverage with financial risk protection, for everyone. Universal Health Coverage is argued to be a dynamic process. It is not about a fixed minimum package, it is about making progress on several fronts: the range of services that are available to people; the proportion of the costs of those services that are covered; and the proportion of the population that are covered. Few countries reach the ideal, but all – rich and poor – can make progress. It is thus argued to have the potential to be a universal goal.
According to this article, most urban informal sector workers in Kenya live in slums, and they lack basic health and welfare services and social protection, and work in an unhealthy and unsafe work environment. Many small-scale workers operate in ramshackle structures, lack sanitary facilities or potable water, and have poor waste disposals. As their home and workplace are often the same place, this increases their vulnerability to diseases and poor health by combining undesirable living and working conditions. The blurring of the distinction between working and living conditions is related to broader problems of poverty and underdevelopment, the author argues. The major challenge is sustaining continuous improvement and making improvements that are long-lasting. He calls for greater collaboration among the different government agencies concerned with small-scale enterprises and the informal sector, such as the Department of Small and Micro-enterprises, the Ministry of Trade and Industry, and the Directorate of Occupational Safety and Health Services (DOSHS). The DOSHS should continue to collect, analyse and disseminate consistent, disaggregated statistics on safety, health and welfare in the informal economy. These statistics will enable and promote the identification of specific policies and programmes aimed at ensuring that the informal economy provides more decent jobs, as well as bringing the informal economy into the mainstream formal economy.
As the 2015 deadline for the Millennium Development Goals (MDGs) approaches, development experts are debating a new question: What comes next? In this article, the writer suggests any new global agreement that follows the MDGs should focus more on rich countries’ responsibilities, an issue that was absent from the original MDGs. It should emphasise policies beyond aid and trade that have an equal, if not greater, impact on poor countries’ development prospects. A short list of such policies would include: carbon taxes and other measures to ameliorate climate change; more work visas to allow larger temporary migration flows from poor countries; strict controls on arms sales to developing nations; reduced support for repressive regimes; and improved sharing of financial information to reduce money laundering and tax avoidance. Most of these measures are actually aimed at reducing damage that results from rich countries’ conduct. While rich countries are certain to resist any new commitments, the author notes that most of these measures do not cost money, and, as the MDGs have shown, setting targets can be used to mobilise action from rich-country governments.
This 2012 progress report examines trends in child mortality estimates since 1990, and shows that major reductions have been made in under-five mortality rates in all regions and diverse countries. Data shows that the number of children under the age of five dying globally fell from nearly 12 million in 1990 to an estimated 6.9 million in 2011. Recommendations from the report include increasing efforts among high-burden populations, focusing on high-impact solutions and creating a supportive environment for child survival by addressing poverty, geographic isolation, educational disadvantage, child protection violations and gender exclusion. Governments should take bold steps that prioritise both efficiency and mutual accountability, and harness the growing consensus that economic and social progress should be equitable.
Many commentators, including the World Health Organisation (WHO), have advocated progress towards universal health coverage on the grounds that it leads to improvements in population health. In this report, the authors reviewed the most robust cross-country empirical evidence on the links between expansions in coverage and population health outcomes, with a focus on the health effects of extended risk pooling and prepayment as key indicators of progress towards universal coverage across health systems. The evidence suggests that broader health coverage generally leads to better access to necessary care and improved population health, particularly for poor people. However, the available evidence base is limited by data and methodological constraints, and further research is needed to understand better the ways in which the effectiveness of extended health coverage can be maximised, including the effects of factors such as the quality of institutions and governance.
According to this report, substantial progress has been made towards achieving Millennium Development Goal (MDG) 4, namely to reduce global child mortality by two-thirds by 2015. The number of under-five deaths worldwide has declined from nearly 12 million in 1990 to 6.9 million in 2011. Since 1990 the global under-five mortality rate has dropped 41% and the annual rate of reduction in under-five mortality has accelerated from 1.8% a year over 1990–2000 to 3.2% over 2000–2011, but it remains insufficient to reach MDG 4. Globally, more than a third of under-five deaths are attributable to undernutrition. The highest rates of child mortality are still in sub-Saharan Africa, where 1 in 9 children dies before age five and Southern Asia (1 in 16). As under-five mortality rates have fallen more sharply elsewhere, the disparity between these two regions and the rest of the world has grown. By 2050, 1 in 3 children will be born in sub-Saharan Africa, and almost 1 in 3 will live there, so the global number of under-five deaths may stagnate or even increase without more progress in the region.
South Africa is one of the countries in which neonatal mortality has remained the same or increased over the last 20 years. The major causes of neonatal deaths are related to prematurity and intrapartum hypoxia. In this paper, the authors discuss a number of interventions that have been shown to reduce neonatal deaths and, if implemented on a wider scale, could reduce neonatal deaths significantly. These interventions include providing basic and comprehensive emergency obstetric care, use of antenatal steroids for women in preterm labour, training in immediate care of the newborn and neonatal resuscitation, and post-resuscitation management and ongoing neonatal care (e.g. CPAP), especially to babies who are born preterm.