Mobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed. The authors systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. The search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa. They report that there is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa and present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care to guide approaches to fill evidence gaps in this area.
Governance and participation in health
The author reports her concern that WHO’s so-called reform will side-line those who work in the spirit of ‘Health for All’ and expand the influence of business corporations and venture philanthropies over global public health matters as well as reinforce the trend towards fragmented, plutocratic, global governance. In October 2013, after a change of terminology, WHO presented a Discussion paper on WHO engagement with non-State actors and draft outline of WHO’s plan to ensure Due diligence, management of risks & transparency at an informal consultation with Member States, NGOs and commercial actors. WHO leadership quashed considered criticisms by NGOs. Member States and public interest NGOs found both papers wanting and requested changes. The successor of the October papers, the Background document, was discussed in March 2014 in a second consultation, open to Member States only. Ten days before the 2014 World Health Assembly, the WHO Secretariat issued the latest version of the policy Framework on engagement of non-State actors (A67/6). The author observes that the previous shortcomings were not addressed and expresses concern that the reform will open the floodgates to corporate influence on global and national decision-making processes in public health matters.
Concerns about public health are widespread in sub-Saharan Africa, and there is considerable support in the region for making public health challenges a top national priority. In particular, people want their governments to improve the quality of hospitals and other health care facilities and deal with the problem of HIV/AIDS. A Pew Research Center survey, conducted March 6, 2013 to April 12, 2013 in six African nations, also finds broad support for government efforts to address access to drinking water, access to prenatal care, hunger, infectious diseases, and child immunization. A median of 76% across six countries surveyed say building and improving hospitals and other health care facilities should be one of the most important priorities for their national government. The percentage of the public who holds this view ranges from 85% in Ghana to 64% in Nigeria. Similarly, a median of 76% believe preventing and treating HIV/AIDS should be one of government’s most important priorities, ranging from 81% in Ghana to 59% in Nigeria. A median of at least 65% also say the other issues included on the poll — ranging from access to drinking water to increased child immunization — should be among the most important priorities. In fact, majorities hold this view about all seven issues in all six nations.
A drafting group has been set up to finalize the draft framework for the World Health Organization’s engagement with non-state actors (NSA framework). This decision made by WHO Member States at the 67th session of the World Health Assembly (WHA) was due to the divergent opinions with regard to the way forward on the NSA framework. The session is meeting from 19 to 24 May at the WHO headquarters in Geneva. Many developing countries such as Brazil, Bolivia, India, Pakistan, and the Union of South American Nations (UNASUR) expressed the view that the draft policy does not contain details to address concerns related to conflict of interest issues, modalities in accepting resources from NSAs, or staff secondment from NSAs.
Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4%. Social cohesion was associated with consistent condom use in the past week and with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing and using condoms with non-paying partners and was inversely associated with reported verbal or physical harassment as a result of selling sex. Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.
Although infrastructure typically refers to physical characteristics, in this article it refers to social-cultural properties within which health decisions and communication may occur. An understanding of agency and identities is incomplete without situating them in social-cultural networks of relationships that give meaning to health behaviors and sociocultural practices. Airhihenbuwa (2007) describes social-cultural infrastructure as systems and mechanisms of culture that nurture social strengths by rendering them assets in containing epidemics. The focus on physical infrastructure in addressing the development levels offers a useful perspective on the nature and relationship people have with themselves, their people, and their environment (Beune, Haafkens, Schuster, & Bindels, 2006), but does not adequately explain how choices are made and have social impact. Understanding how choices are made offers insight into how individuals are able to maintain optimum health and function in spite of limitations on their social and cognitive capabilities. In this commentary, the authors offer a perspective on the continually changing and conflicting global agenda to reduce the disease burden by improving health and health care practices in Africa (Sambo et al., 2011). They argue for a discourse that can accommodate complexity, plurality, and contradictions and is anchored in sociocultural rather than physically referenced impulses in a framework for future strategies for African health and development.
As public health professionals devoted to global health equity, the authors express our deep concern with the The Lancet Commission Global health 2035: a world converging within a generation (Dec 7, p 1898),1 a re-run of the 1993 World Development Report, whose policies contributed to the shrinkage of government institutions and massive privatisation and fragmentation of health-care systems, effectively decreasing coverage and accessibility. The authors observe that its recommendations are based on the principle of return on investment, not on health equity, while creating a double standard: one for the rich and another for the rest of us. Any policy for the poor is by definition a poor policy. The Lancet Commission's recommendations are argued to not represent the global health community and are fundamentally flawed by neglecting the principle of the right to health. The report analyses Millennium Development Goals progress without reference to stagnant levels of health inequity: 20 million deaths each year, more than a third of all deaths, are avoidable and caused by socio-economic injustice—a number and a proportion that have not changed for the past 40 years. Every individual, organisation, or government working to promote heath equity and WHO's objective of enjoyment by all peoples of the best attainable level of health should be on their guard.
This study aims to assess patient satisfaction and factor of importance on the service they receive at the primary health care facility in Botswana. The study was a cross sectional study in which 360 systematically selected participants completed 5 point likert scale self-administered questionnaire to rate their satisfaction level as well as factors of importance where best service was provided. Results showed that pharmacy received the highest satisfaction level while the nurse got the least level of satisfaction in terms of services rendered. 14.4% of participants still think time is not important to them as factor as long as they got what they wanted. Participants mentioned that an increase in personnel and staff training stood out as areas that need to be significantly considered
for improvement.
Their ubiquity in South Africa makes cellphones an easily accessible tool to use in participatory approaches to addressing HIV and AIDS issues, particularly in school contexts. In this article the authors explore a participatory visual approach undertaken with a group of rural teachers, using cellphones to produce 'cellphilms' about youth and risk in the context of HIV and AIDS. Noting that the teachers brought highly didactic and moralistic tones into the cellphilms, the authors devised a “speaking back” approach to encourage reflection and an adjustment to their approaches when addressing HIV and AIDS issues with learners. They draw on the example of condom use in one cellphilm to demonstrate how a “speaking back” pedagogy can encourage reflection and participatory analysis, and contribute to deepening an understanding of how teachers might work with youth and risk in the context of HIV and AIDS.
Male partner participation is a crucial component to optimize antenatal care/prevention of mother to child transmission of HIV(ANC/PMTCT) service. Involving male partners during HIV screening of pregnant mothers at ANC is key in the fight against mother to child transmission of HIV(MTCT). This study aimed to determine the level of male partner involvement in PMTCT and factors that affecting it. A Cross-sectional study was conducted among 473 pregnant mothers attending ANC/PMTCT in Mekelle town health facilities in January 2011 to identify factors that affect male involvement in ANC/PMTCT. Twenty percent of pregnant mothers have been accompanied by their male partner to the ANC/PMTCT service. Knowledge of HIV sero status, maternal willingness to inform their husband about the availability of voluntary counselling and testing services in ANC/PMTCT and previous history of couple counselling were found to be the independent predictors of male involvement in ANC/PMTCT service. Male partner involvement in ANC/PMTCT was found to be low and the authors argue that comprehensive strategies should be put in place to sensitize and advocate the importance of male partner involvement in ANC/PMTCT and reach out male partners.