This editorial considers the neonatal deaths occurring in South Africa that are due to limited availability of intensive care beds or inadequate referral systems and problematic transport systems. The editor proposes simple, cost-effective preventative measures to decrease the mortality rate outside of tertiary care centres, including resuscitation training of primary health care providers, breastfeeding and kangaroo mother care (KMC) programmes, using polyethylene wrappings for neonates less than 1200g and increasing the number of neonatal beds available and the number of staff to care for these patients. Community education programmes on healthy pregnancies are proposed to improve help-seeking behaviour, improve clinic attendance and increase awareness of the benefits of free interventions, such as breastfeeding and KMC. While many other countries in the region have reduced their maternal mortality, South Africa has made limited progress. The authors call on government to prioritise the implementation of sustainable measures to improve neonatal mortality, and ultimately reducing under-5 mortality.
Equity in Health
This outcome statement summarises views from stakeholders from a total of 53 African countries, represented by governments, Regional Economic Communities, civil society organisations including youth and women’s organisations, parliamentarians, academic institutions and the private sector. Noting the relatively slow progress made by African countries towards the Millennium Development Goals (MDGs) and recognising the capacity deficits and disabling initial conditions prevailing in a number of countries, participants unanimously agreed that the post-2015 development agenda should: 1. Emphasise inclusive economic growth and structural transformation. 2. Re-orient the development paradigm away from externally-driven initiatives toward domestically- inspired and funded initiatives that are grounded in national ownership. 3. Prioritise equity and social inclusion and measure progress in terms of both the availability and quality of service delivery. 4. Pay greater attention to vulnerable groups such as women, children, youth, the elderly, people with disabilities, displaced persons 5. Take into account the initial conditions of nation states and recognise the efforts countries have made towards achieving the goals as opposed to exclusively measuring how far they fall short of global targets. 6. Incorporate the Rio+20 outcomes and the outcomes of Africa-wide initiatives, national and regional consultations as well as UN forums such as ICPD +20. 7. Focus on development enablers as well as development outcomes.
The objective of this study was to investigate the underlying circumstances of maternal deaths in Botswana. Fifty-six case notes from the 80 reported maternal deaths in 2010 were reviewed. Five clinicians reviewed each case independently and then together to achieve a consensus on diagnosis and underlying cause(s) of death. Results indicated that 60% of deaths occurred in Botswana’s two referral hospitals. Cases in which death had direct obstetric causes were fewer than cases in which cause of death was indirect. The main direct causes were haemorrhage (39%), hypertension (22%), and pregnancy-related sepsis (13%). Thirty-six (64%) deaths were in HIV-positive women, of whom 21 (58%) were receiving antiretroviral (ARV) therapy. Nineteen (34%) deaths were attributable to HIV, including 4 from complications of ARVs. Twenty-nine (52%) deaths were in the postnatal period, 19 (66%) of these in the first week. Case-note review revealed several opportunities for improved quality of care, such as: better teamwork, communication and supportive supervision of health professionals; better supply management; and joint management between HIV and obstetric clinicians. The authors argue that integrating HIV management into maternal healthcare is essential to reduce maternal deaths in the region, alongside greater efforts to improve quality of care to avoid direct and indirect causes of death.
In this paper the author described age- and sex-specific rates of child homicide in South Africa. A cross-sectional mortuary-based study was conducted in a sample of 38 medico-legal laboratories operating in 2009. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Findings showed an estimated 1,018 child homicides occurred in 2009, or 5.5 homicides per 100,000 children under 18 years. The homicide rate was much higher in boys than in girls. Child abuse and neglect had preceded nearly half of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys was nearly five times higher than among girls. South Africa’s child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, the authors recommend that parenting skills should be a key part of primary prevention efforts.
Universal health coverage has been set as a possible umbrella goal for health in the post-2015 development agenda. In this editorial, the authors discuss the relationship between universal coverage and universal access. They argue that addressing the broader social determinants of health will also improve access to health services; differences in access in particular will be ameliorated by reducing poverty and income inequalities. These actions alone, however, will not guarantee that all people obtain the health services they need. Even if the services exist and people have access to them, they might not use them. Universal health coverage cannot be attained unless both health services and financial risk protection systems are accessible, affordable and acceptable. In turn, universal access, although necessary, is not sufficient. Coverage builds on access by ensuring actual receipt of services. Thus, universal health coverage and universal access to health services are complementary ideas. Without universal access, universal health coverage becomes an unreachable goal.
In this paper, the author examines the problems and prospects for including meaningful indicators of equity into the city based regional planning efforts unfolding around the globe. The central focus of the paper is on the challenges that environmental justice (EJ) activists face as they attempt to frame the problem of equity in ways that the general public would see as not only informative, but compelling. After reviewing examples of successful efforts to reframe debates about equity, the author concludes with a discussion of a set of EJ concerns and indicators that have the greatest potential for capturing public attention and commitment despite mounting resistance to the use of redistributive policies in support of sustainability goals.
A United Nations Economic and Social Council (ECOSOC) panel discussion on universal health coverage (UHC) on 3 July 2013 highlighted the importance of science, technology and innovation for achieving UHC, especially in the context of the post-2015 development agenda. Speakers discussed the meaning and scope of UHC as well as the financing and promotion of UHC in various country contexts. World Health Organisation Director General Margaret Chan pointed to political commitment, investment, clear policy goals and tracking mechanisms as necessary conditions for UHC, but also emphasised state ownership in developing and implementing UHC. She argued that each state should develop its own healthcare system according to the needs of its population. She said that no major breakthrough, such as the introduction of vaccines, is possible without innovation; however, innovation has become expensive, at the cost of access for most people. On the matter of social innovation Chan remarked that often innovation is thought of as sophisticated science, but looking forward, the future of healthcare should be people-centred, integrated and based on primary healthcare and prevention.
This report outlines five main goals for the post 2015 agenda: ending poverty by 2030; promote gender quality; improve access to quality education, water and sanitation; promote good governance; and build strong effective institutions. It posits five transformative shifts as crucial for achieving all five goals: leave no one behind; put sustainable development at the core; transform economies for jobs and inclusive growth; build peace and effective, open and accountable institutions for all, and forge a new global partnership. Like the Millennium Development Goals, the report suggests that targets would not be binding, but should be monitored closely. The indicators that track them should be disaggregated to ensure no one is left behind and targets should only be considered ‘achieved’ if they are met for all relevant income and social groups. The Panel recommends that any new goals should be accompanied by an independent and rigorous monitoring system, with regular opportunities to report on progress and shortcomings at a high political level. It also calls for a data revolution for sustainable development, with a new international initiative to improve the quality of statistics and information available to citizens.
In Ghana, the United Nations Development Program (UNDP) estimates that the country is largely on track in achieving the MDG 1. Poverty has reduced from over 50 percent in 1992 to 28.5% in 2006, indicating that the poverty target could be achieved well ahead of time. Similarly, the proportion of people living below the extreme poverty line declined from 36% to 18% over the same period. But the author of this blog argues that these figures do not take into account regional disparities: hunger is still rife in Ghana's three northern regions. A key theme emerging from his own research suggests that policy makers tend to tout the aggregate "success story" and become preoccupied with hitting statistical targets rather than improving the overall welfare of all constituents. This highlights the risks when policy-makers focus too much on targets, implying that complex processes can be over-simplified and priorities skewed when policies aim solely at targets. The author argues that the use of targets can encourage a reductionist approach to complex problems, privilege quantitative indicators at the expense of qualitative ones, distort resource allocation, and undermine professional motivation and responsibility. He concludes that, while Ghana’s progress has been remarkable, much work still needs to be done in the northern regions.
During her opening address at the 8th Global Conference on Health Promotion in Helsinki, Finland on 10 June, WHO Director-General Dr. Margaret Chan stated that inequalities, between and within countries, in income levels, opportunities, and health outcomes, are now greater than at any time in recent decades. The rise of non-communicable diseases threatens to widen these gaps even further. she noted that public health must contend with Big Tobacco, Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics. For WHO, formulation of health policies must be protected from distortion by commercial or vested interests. She referred to the Finnish government as an example to follow, as it has been a leading proponent of the need for all sectors of government to consider the health impact of their policies. Finland put the health-in-all-policies approach under the spotlight during its presidency of the European Union in 2006. Such an approach makes perfect sense, she argued. The determinants of health are exceptionally broad. Policies made in other sectors can have a profound, and often adverse, effect on health. The globalisation of unhealthy lifestyles is by no means just a technical issue for public health. It is a political, trade and foreign affairs issue.