This report provides an update of the cholera situation in the region from the United Nations Office for the Coordination of Humanitarian Concerns (OCHA). According to OCHA, cholera and acute watery diarrhea cases (AWD) increased by 23,485 cases and there have been 649 deaths (CFR 2.7%) reported since 23 January 2009. Zimbabwe and South Africa remain the most affected with more than 67,500 and 6,000 cases respectively. Concerns remain on under-reporting. An additional 24,202 cholera cases and 683 deaths (CFR 2.8%) were reported from 23 January to 5 February 2009. Of the nine countries affected by cholera, Malawi (49 additional cases), South Africa (1,343 additional cases) and Zimbabwe (19,322 additional cases) have reported a significant increase compared to the last OCHA report issued on 23 January 2009. Three countries reported an increase in the number of cholera related deaths; these include Botswana, Namibia and Zimbabwe. The total numbers of people affected by cholera in Botswana and Namibia are reported to be low.
Equitable health services
This paper reports on a cross-sectional study conducted between May and August,2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult)were interviewed using a structured questionnaire. The study calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. It found that adolescent mothers showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatisation and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. The authors propose that adolescent-friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.
This report from the Global Alliance for Vaccines and Immunisation (GAVI) Alliance looks at how failing or inadequate health systems are one of the main obstacles to scaling up effective distribution of life-saving interventions such as drugs, vaccines and other preventative treatments. The report describes health system strengthening (HSS) as improving governance and leadership, health financing, human resources management, information and knowledge strategies, service delivery and technology and infrastructure. All GAVI-eligible countries (those with a gross national income per capita of less than US$ 1000 in 2003) can apply for health system strengthening funds. Applications for these funds should be coordinated by the national health sector coordination committee (which should involve health sector stakeholders including civil society) and must be approved by ministries of health and finance.
This paper discusses some of the approaches to technical support for health systems strengthening taken to date, and looks at problems and possible solutions. It finds that the growing resources available for health system strengthening are not accompanied by resources and commitment to providing technical support. Furthermore, the global market for technical support is complex: multiple agencies use different approaches for providing support, and a number of issues, including institutional roles, affect the supply and demand for high quality technical assistance. The paper concludes that the provision of technical support for health systems strengthening needs to be scaled up considerably, but in ways that best fit country realities on the ground. Technical support approaches need to take into account the complexity of a country’s national health system and the context within which it operates.
In 2000, WHO published its first attempt to assess the performance of the world’s health systems in The World Health Report 2000. This report generated enormous interest but, in many ways, the scientific progress was overshadowed by the political debate related to the estimates of country-level performance and the associated league tables. Since then, the WHO European and Eastern Mediterranean Regional Offices have maintained health system observatories, with detailed descriptions of country systems. The considerable interest in measuring the performance of health systems worldwide is illustrated by the recent European Ministerial Conference on Health Systems, which culminated in the Tallinn Charter entitled Health systems for health and wealth. In developed countries, primary concerns include costs, quality of care, aging and chronic diseases. In developing countries, health system constraints have restricted progress towards the UN Millennium Development Goals.
The aim of this study was to describe the implementation process of a national anti-tuberculosis drug resistance survey in Tanzania, in relation to the study protocol and standard operating procedures. Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well-organised National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling. Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential.
Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 21 randomly selected districts. National IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 and 38% for second dose in 2005 but 30% in 2007. There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit.
Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to destabilise and challenge established general practice and primary care. The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. This 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, by offering integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.
An intellectual property (IP) model intended to preserve the structure of patent protection while adding balance for developing countries, has been proposed to provide incentives for innovators to contribute toward the alleviation of suffering in developing countries in dire need of patented medicines largely owned by rich countries. This IP model, which would increase the role of the World Health Organization (WHO) in the process, was presented recently by Amir Khoury, an intellectual property law and international trade specialist at the law faculty of Tel Aviv University. The proposal would put greater decision-making authority on the use of compulsory licensing to obtain cheaper versions of patented medicines in the hands of the WHO. Currently, that activity occurs under the World Trade Organization.
The Community Working Group on Health (CWGH) in Zimbabwe, with a membership of about 35 civil society organisations representing a wide range of constituent groups, has called on the World Health Organisation to address the severe decline in heath and in the health system in Zimbabwe. It recognises that the current health crisis does not emanate from the health sector but from wider economic collapse. The CWGH urges WHO and partners to more widely address what needs to be done and what resources and support are needed to rebuild health systems from primary health care level upwards, and to involve communities in deliberations and plans on the way forward. Zimbabweans, they indicate, are not numbers of cholera cases or fatalities but people who have responded to an increasingly difficult situation, who are entitled to health as a right and who should be central in any response and rehabilitation of the health system.