This policy brief looks at the challenges of implementing the Integrated Management of Childhood Illness (IMCI) strategy in Kenya. It shows that Kenya has made some progress in rolling out the IMCI strategy; however, implementation remains highly inadequate. The three main challenges to implementation are low training coverage, health workers not following guidelines and barriers to accessing services. These challenges reflect a range of IMCI-specific and broader health system constraints. The authors outline recommendations for increasing IMCI coverage and implementation. They argue that urgent action is needed to review pre-service training, scale up in-service training, address facility-level implementation challenges, improve IMCI supervision and build support for the strategy.
Equitable health services
Public health facilities in Africa currently stock only about half of a core set of essential medicines, such as those used to treat malaria, pneumonia, diarrhoea, HIV, TB, diabetes and hypertension, which are among the highest causes of death in Africa. The Stop the Stock-outs Campaign is calling on governments and health departments to end stock-outs by providing financial and operational autonomy to the national medicines procurement and supply agency, giving representation of civil society on the board of the agency, ending corruption in the medicine supply chain to stop theft and diversion of essential medicines, providing a dedicated budget line for essential medicines, living up to commitments to spend 15% of national budgets on health care and providing free essential medicines at all public health institutions.
The objective of this paper was to document the inclusion of key medicines for children in national essential medicines lists (EMLs) and standard treatment guidelines, and to assess the availability and cost of these medicines in 14 countries in central Africa. Surveys were conducted in 12 public and private sector medicine outlets in each country’s capital city. Data was collected on medicine availability on the survey day and on the cost to the patient of the lowest-priced medicine in stock. It found that there was considerable variation in prices, which tended to be higher in retail pharmacies, and the availability of key essential medicines for children was poor. Better understanding of the supply systems in the countries studied and of the pattern of demand for medicines is needed before improvements can be made.
In the run-up to International Women's Day, 8 March, the International Committee of the Red Cross (ICRC) warned that the specific health-care needs of women are often ignored or insufficiently taken into account in war situations. ‘People wounded in fighting are given priority for medical treatment, but women, even pregnant mothers, are often given scant attention despite their special needs,’ said the ICRC's adviser on issues relating to women and war. In the world’s least developed countries, many of which are at war, women are 300 times more likely to die in childbirth or from pregnancy-related complications than in developed countries, according to UNICEF. In war time, women are particularly at risk of rape and other forms of sexual violence and they have no means of transportation to reach a health-care facility so as to give birth safely.
This research report analyses the Integrated Management of Childhood Illness (IMCI) policy in Tanzania. Two districts in North-Western Tanzania, Bunda and Tarime, in Mara region, were picked to examine the issues around introduction, planning and implementation by district health managers and at facility levels. The authors found that the percentage in health workers trained in IMCI case management varies between districts, probably due to differing levels of early sensitisation of key actors, a higher health budget per capita, local facilitators and strong external support. However, the cost of case management training is high and it is difficult for districts to finance more than one training session per year. IMCI suffers from poor visibility and challenges of monitoring impact compared to vertical programmes, reducing the potential for attracting donor investment. Therefore, the status of IMCI vs other health programmes at district and national levels needs to be enhanced and key managers need to be equipped with better resources to monitor overall implementation. Strengthening health systems remains a pillar for success of IMCI. Without required drugs, effective supervision, sufficient numbers of health workers with appropriate skill-mix and geographical distribution, it will be difficult to effectively deliver IMCI. Communities need to participate to enable them to know what to expect from facilities and their role in completing IMCI.
Growing awareness of the need for health systems and GHIs to operate in ways that are mutually supportive has prompted those who are responsible for health systems to actively adopt measures that can help integrate and maximise the impact of global health initiatives (GHIs). This report looks at a number of country-specific interventions. In sub-Saharan Africa, political commitment and creativity have helped Malawi to negotiate a successful collaboration with GHIs to strengthen and expand human resources for health – a key element of the health system. Faced with a severe HIV epidemic and crippling health workforce shortages, Malawi has collaborated with GHIs and other donors to overcome fiscal constraints and to implement an Emergency Human Resource Plan. Through task shifting, training and salary top-ups Malawi has been able to expand the health workforce to deliver HIV services and has also been able to meet new demand for a range of health services at the community level. There are widespread concerns around the effects of the proliferation of actors in global public health and the complexity of the channels and systems through which funds and commodities are now provided. The need for coordination, harmonisation and alignment is strongly felt. In particular, countries face the challenges of excessive reporting requirements, conflicting time frames in planning and funding cycles and parallel bureaucracies.
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.
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.