Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
Monitoring equity and research policy
Third District Health Barometer
Health Systems Trust, 7 March 2008
District health barometer
Health System Trust, 21 February 2008
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
Do international health research programmes do enough to develop research systems and skills in low and middle income countries?
Council on Health Research for Development (COHRED), 2007
Research plays a crucial role in developing solutions to the health problems suffered by the populations of low and middle income countries. Most health research for and in low and middle income countries is funded from external sources. And most of this externally funded research takes the form of 'vertical' - condition-specific - programmes. This paper begins by highlighting four important problems that result from reliance on this type of funding; including an unduly narrow focus of research on conditions for which international funding is available (mostly HIV and AIDS, tuberculosis, and malaria); lack of interest in leaving behind sustainable capacity in research after the research projects have ended; and loss of interest in the local programme at the time when research findings should be translated into action.
Research to action to address inequities: the experience of the Cape Town Equity Gauge
Scott V, Stern R, Sanders D, Reagon G and Mathews V: International Journal for Equity in Health 7(6), 4 February 2008
While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description in this study looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. In two very different, but connected projects, the authors demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.
Utilisation Survey on the District Health Barometer
Monticelli F: Health System Trust, 21 February 2008
This report and summary deals with the findings of the survey that deal with the District Health Barometer (DHB) publication. The DHB aims at improving the quality of and access to primary health care through monitoring important aspects of the health system at a district level by analysing and comparing a carefully selected range of health indicators.
Analysing Health Equity Using Household Survey Data: A Guide to techniques and their implementation
O'Donnell O, van Doorslaer E, Wagstaff A, Lindelow M: The World Bank
Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques can provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer program Stata.
Databases as policy instruments: About extending networks as evidence-based policy
de Bont A, Stoevelaar H and Bal R: BMC Health Services Research 7(200), 7 December 2007
This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result, databases may have a profound effect on controlling clinical practice. Three case studies were undertaken to reconstruct the development and use of databases as policy instruments. Our results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. Further analysis revealed that these databases facilitated self-regulation and quality assurance by (national) bodies of professionals, resulting in restrictive prescription behavior amongst physicians. The databases fulfill control functions that were formerly located within the policy realm. The databases facilitate collaboration between policy makers and physicians, since they enable quality assurance by professionals. Delegating regulatory authority downwards into a network of physicians who control the use of pharmaceuticals seems to be a good alternative for centralized control on the basis of monitoring data.
DSS and DHS: longitudinal and cross-sectional viewpoints on child and adolescent mortality in Ethiopia
Byass P, Worku A, Emmelin A and Berhane Y: Population Health Metrics 5(12), 27 December 2007
In countries where routine vital registration data are scarce, Demographic Surveillance Sites (DSS: locally defined populations under longitudinal surveillance for vital events and other characteristics) and Demographic and Health Surveys (DHS: periodic national cluster samples responding to cross-sectional surveys) have become standard approaches for gathering at least some data. This paper aims to compare DSS and DHS approaches, seeing how they complement each other in the specific instance of child and adolescent mortality in Ethiopia. Data from the Butajira DSS 1987-2004 and the Ethiopia DHS rounds for 2000 and 2005 formed the basis of comparative analyses of mortality rates among those aged under 20 years, using Poisson regression models for adjusted rate ratios. Patterns of mortality over time were broadly comparable using DSS and DHS approaches. DSS data were more susceptible to local epidemic variations, while DHS data tended to smooth out local variation, and be more subject to recall bias. Both DSS and DHS approaches to mortality surveillance gave similar overall results, but both showed method-dependent advantages and disadvantages. In many settings, this kind of joint-source data analysis could offer significant added value to results.
National audit of critical care resources in South Africa – research methodology
Scribante J, Bhagwanjee S: South African Medical Journal Vol. 97 (12): 1308-1310, 2007
This article provides an in-depth description of the methodology that was followed and the quality control measures that were implemented during the audit of national critical care resources in South Africa.
Systematic review of effectiveness of school-based sexual health interventions in sub-Saharan Africa
Paul-Ebhohimhen VA, Poobalan A and van Teijlingen ER: BMC Public Health 8(4); 7 January 2008
The AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions.