Equitable health services

Emergency care in 59 low- and middle-income countries: a systematic review
Obermeyer Z; Abujaber S; Makar M; Stoll S; Kayden SR; Wallis LA; Reynolds TA; the Acute Care Development Consortium: Bulletin of the World Health Organization 93 (8), August 2015

This systematic review of emergency care in low- and middle-income countries (LMICs) analysed reports published from 1990 onwards. The authors identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings.

Mental illness sufferers shunned and isolated
Integrated Regional Information Network, 7 September 2007

Rising rates of mental and emotional illness in Zambia are being met with growing levels of stigma and discrimination, with sufferers often isolated by their communities. Nora Mweemba, a health information promotion officer for the World Health Organisation (WHO) in Zambia, told IRIN, "Mental health problems are on the increase among the population in Zambia, mostly because of the socio-economic difficulties that exist in this country - HIV/AIDS, poverty, joblessness - they all precipitate mental problems."

Non-Communicable Disease on the rise in Uganda; Who is to blame?
Nsereko I: CEHURD newsletter December 2014

A recent survey carried out by the Center for Health, Human Rights and Development (CEHURD) with support from United Nations Development Program (UNDP) Uganda country office on the prevalence of risk factors for non communicable diseases among university students in and around Kampala found that up to 67% of the respondents did not know what NCDs were, 12% of students have used drugs, particularly Marijuana, 15% were current tobacco smokers, 9% smoked Shisha. More than 40% of the respondents were staying with parents who smoke, 10% have friends who smoke, 60% have smoked for less and 57% exposed to pro-cigarette advertisements. In areas where NCD services are available, these are often hampered by access to essential medicines.
A recent visit by the author to communities of Nyenga and Najja sub-counties of Buikwe district revealed that a huge percentage of the community members find no point in visiting health facilities for early screening for NCDs. The author suggests that government strengthen existing health facilities by providing essential NCD medicines and NCD screening services for at least all health center IVs.

Not enough research to treat TB-HIV properly
Thom A: Health-e, 2 November 2007

Health systems cannot properly diagnose, treat, or contain the co-epidemic of HIV and tuberculosis (TB) because not enough is known about how the two diseases interact. A report by leading global health experts warned that the largely “unnoticed collision” of the global epidemics of HIV and TB has exploded to create a deadly co-epidemic that is rapidly spreading in sub-Saharan Africa. About one-third of the world’s 40 million people with HIV/AIDS are co-infected with TB, and the mortality rate for HIV-TB co-infection is five-fold higher than that for tuberculosis alone.

Rural Health Care Access and Policy in Developing Countries
Strasser R; Kam S; Regalado S: Annual Review of Public Health 37, 395-412, 2016

Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status, and a shortage of health professionals. This article explores rural areas of Sub-Saharan Africa (SSA). Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from under-serviced areas to deliver quality health care in rural community settings.

"I just answer 'yes' to everything they say": Access to health care for deaf people in Worcester, South Africa and the politics of exclusion
Kritzinger J, Schneider M, Swartz L and Braathen SH: Patient Educ Couns. 14. pii: S0738-3991(13)00520-X. December 2013

This paper explored whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology applied semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, over-protectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.

"Scared of going to the clinic’: Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities
Duby Z; Nkosi B; Scheibe A; et al: Southern African Journal of HIV Medicine 19(1), doi:https://doi.org/10.4102/sajhivmed.v19i1.701, 2018

This study examined the context of access to healthcare experienced by men who have sex with men, female sex workers and people who use drugs in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province. In-depth interviews were conducted to explore healthcare workers’ perceptions, beliefs and attitudes. Focus group discussions were also conducted with members of these groups exploring their experiences of accessing healthcare. Healthcare workers demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing these social groups. Men who have sex with men, female sex workers and people who use drugs described experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. The findings suggest that the uptake and effectiveness of health services amongst these three groups is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers.

10 Ways to improve the quality of care in health facilities
World Health Organisation: WHO Geneva, 2017

In this article, a photo story is used to describe some of WHO’s recommendations on how countries can improve quality of care in their health facilities and prevent maternal and newborn deaths, based on its standards for improving quality of maternal and newborn care in health facilities. The photo story shows that health facilities must have an appropriate physical environment and that communication with women and their families must be effective and respond to their needs. The story shows further that women and newborns who need referrals should obtain them without delay, no woman should be subjected to harmful practices during labour, childbirth and the early postnatal period, and that health facilities need well-trained and motivated staff consistently available to provide care. Lastly, the story presents images showing that every woman and newborn should have a complete, accurate, and standardised medical record.

2010 global award to reduce mother-to-child transmission of HIV for South African programme
Health-e News: 18 June 2010

A Cape Town-based health programme, mothers2mothers (m2m), has received the 2010 Award for Best Practices in Global Health for initiatives to reduce mother-to-child transmission (MTCT) of HIV. The Award is given annually to highlight the efforts of individuals dedicated to improving the health of disadvantaged and disenfranchised populations, and it recognises programmes that demonstrate the links between health, poverty and development. The m2m programme began in 2001 and has grown from one site in South Africa to more than 645 sites in South Africa, Kenya, Lesotho, Malawi, Rwanda, Swaziland and Zambia. It employs over 1,600 HIV-positive women who conduct more than 200,000 client interactions per month. In the programme, HIV-positive mothers are trained as mentors for HIV-positive pregnant mothers seeking health care. By effectively professionalising their role alongside overburdened doctors and nurses, these ‘mentor mothers’ fill health care delivery gaps in the prevention of MTCT of HIV and help breakdown stigma and other treatment barriers, as they are perceived as role models in clinics and their communities.

60th World Health Assembly: Prevent maternaL and child deaths
World Health Organisation, 15 May 2007

Health ministers at the 60th World Health Assembly were urged to focus on reducing maternal, newborn and young child deaths. A Global Business Plan for the partnership for maternal, newborn and child health was outlined, aiming to spearhead political impetus at the highest level to save lives and achieve MDGs 4 &5. The plan is being developed with The Partnership and other partners, including Chancellor Gordon Brown, UK, the Gates Foundation, Tanzania, Indonesia and Mozambique.