During a national immunisation campaign in Mozambique, vouchers, which were to be redeemed at a later date for free insecticide-treated nets (ITNs), were distributed in Manica and Sofala provinces. A survey to evaluate ITN ownership and usage post-campaign was conducted. Four districts in each province and four enumeration areas (EAs) in each district were selected using probability proportional to size. Valid interviews were completed for 947 of the 1,024 selected households (HHs). HH ownership of at least one bed net of any kind was, in Manica and Sofala respectively, 20.6% and 35.6% pre-campaign and 55.1% and 59.6 post-campaign. The researchers conclude that ITN distribution increased bed net ownership and usage rates. Integration of ITN distribution with immunisation campaigns presents an opportunity for reaching malaria control targets and should continue to be considered.
Equitable health services
This research was set in public primary care services in Cape Town, South Africa and aims to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004. A subsequent evaluation of 16 clinics was done in February 2006. While the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training. Weaknesses were identified in quality of care and continuity of care (only 24% of clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility. This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.
This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Provider and patient interviews at both of the sites in the study indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. The paper noted that integrating vertical anti-retroviral therapy and outpatient services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalisability.
This paper inputs to the debate on use of DDT in Africa. Its use has been promoted due to its effectiveness in controlling malaria at population level, with significant mortality declines. The author of this paper notes that DDT is used for malaria control in high-risk areas such as KwaZulu-Natal and Limpopo and that high levels of DDT and one of its byproducts, DDE were found in the water, sediment, soil, vegetables, chicken and fish meat in Limpopo, a province bordering Zimbabwe and Mozambique, with possible health and cancer risks. According to the Limpopo Malaria Control Programme, this area has been sprayed with DDT annually since 1966. The article recommends further research to focus on human exposure and health effects in communities where DDT is currently being sprayed for malaria control. Noting the effetiveness of spraying as a means of cintrol he argues for more research into the development of safe and effective alternatives to DDT.
The objective of the Health Systems Strengthening Project, which is funded by the world Bank, is to deliver the Uganda National Minimum Health Care Package (UNMHCP) to Ugandans, with a focus on maternal health, newborn care and family planning. This will be achieved through improving human resources for health; physical health infrastructure; and management, leadership and accountability for health service delivery. There are four components to the project, the first component being improved health workforce development and management. The objective of this component is to improve development and management of the health workforce. The second component is the improved infrastructure of existing health facilities. The objective of this component is to improve infrastructure of existing health facilities. Emphasis will be placed on providing minimum quality standards of health care services, especially in the areas of maternal and child health, through: renovation of selected health facilities; provision of medical equipment; improved capacity for operations and maintenance; and strengthening the referral system. The third component is the improved leadership, management, and accountability for health service delivery. The objective of this component is to strengthen management, leadership, and accountability for health service delivery. Finally, the fourth component is the improved maternal, newborn and family planning services. The objective of this component is to improve access to, and quality of, maternal health, newborn care, and family planning services.
UNICEF and the World Health Organisation (WHO) have appealed for the participation of all sectors of the Angolan society to ensure the vaccination of about 5.6 million children under five years against polio from 10–12 September 2010. The two United Nations agencies said the exercise was aimed at protecting children in the country against the crippling disease, and a forerunner to Angola's plans to carry out a national vaccination campaign in 2011. It is also part of the Emergency Plan of the Angolan government to eradicate poliomyelitis. According to Angola's Ministry of Health, the country has recorded 17 cases of poliomyelitis in 2010 in the provinces of Luanda, Bengo, Huambo, Bié, Lunda Norte and Lunda Sul. The Ministry warned that the disease is spreading and affecting children who live in the border regions of the Democratic Republic of Congo. The Angolan government has so far committed to releasing US$9.3 million to support vaccination in the 32 main districts in order to increase the coverage to at least 90%.
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.
This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey of 708 households; 24 focus group discussions; semi-structured interviews with 34 health workers; and 359 patient exit interviews. The paper found that multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40% of individuals who self-treated using shop-bought drugs and 42% who visited a formal health facility reported not having enough money to pay for treatment and other factors influencing affordability included seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organisation of health care services, drug and staff shortages.
In July and September 2006, 3.4 million long-lasting insecticide-treated bed nets (LLINs) were distributed free in a campaign targeting children 0-59 months old (CU5s) in the 46 districts with malaria in Kenya. A survey was conducted one month after the distribution to evaluate who received campaign LLINs, who owned insecticide-treated bed nets and other bed nets received through other channels, and how these nets were being used. In targeted areas, 67.5% of all households with CU5s received campaign LLINs. Including previously owned nets, 74.4 % of all households with CU5s had an ITN. Over half of CU5s (51.7%) slept under an ITN during the previous evening. Nearly 40% of all households received a campaign net, elevating overall household ownership of ITNs to 50.7%. The campaign was successful in reaching the target population, families with CU5s, the risk group most vulnerable to malaria. Targeted distribution strategies will help Kenya approach indicator targets, but will need to be combined with other strategies to achieve desired population coverage levels.
To date, no study has yet looked at the effect of incentives on the use of insecticide-treated nets (ITNs). This study aims to fill the research gap. It took the form of a cluster randomised controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar. The study took place from July 2007 until February 2008. Twenty-one villages were randomised to either intervention or control clusters. At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups, but net use was substantially higher in the intervention group (99% vs. 78%). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%). The study concludes that providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.