Malaria is one of the main reasons why people use health services in sub-Saharan Africa, placing a considerable burden on primary health care. The Affordable Medicines Facility-malaria (AMFm) is a supply-side intervention designed to reduce malaria mortality by improving the availability and affordability of effective treatment. It also aims to delay the development of drug resistance through the use of artemisinin, in combination with other medicines, rather than as a monotherapy. Access to artemisinin-based combination therapies by people living in poverty – those without public facilities and unable to afford artemisinin-based combination therapies at subsidised prices – is a concern. The AMFm will support an enhanced public sector and NGO distribution of artemisinin-based combination therapies, often without charge but supplementary initiatives at PHC level, such as home-based management of malaria, will still be needed.
Equitable health services
Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS, in Arumeru and Karatu districts, Tanzania. Information sought included the capacity to offer TB service and availability of qualified staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed, 86 (77.5%) in Arumeru and 25 (22.5%) in Karatu. Only 23.4% (26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38%) of them were government owned. Thirty eight (44.7%) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0%) of health facilities which do not provide any TB services had qualified clinical officers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004, 187 (60.7%) had treatment outcome available, 124 (66.3%) were cured and 55 (29.4%) completed treatment. In Karatu 638 cases were notified in 2004, 305 (47.8%) had treatment outcome available, 68 (22.3%) cured and 165 (54.1%) completed treatment. In conclusion, the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20% and 30% for clinical and laboratory components of DOTS, respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community- based DOTS in Tanzania.
This research paper reviews individual case histories of children who have died of pneumonia in rural Uganda and investigates why these children did not survive. The research was conducted in the Lganga/Mayuge region in Uganda, where 67,000 people were visited once every three months for population-based data. Children aged 1-59 months from November 2005 to August 2007 were included in the study. The paper finds that of the pneumonia deaths that were registered, half occurred in hospital and one-third at home. Median duration of pneumonia illness was seven days, and median time taken to seek care outside the home was two days. Most children first received drugs at home: 52% antimalarials and 27% antibiotics. The paper concludes that many children with fatal pneumonia experienced mistreatment with antimalarials, delays in seeking care and low quality of care. To improve access to and quality of care, the feasibility and effectiveness of training community health workers and drug vendors in pneumonia and malaria management with prepacked drugs should be tested.
With a view to developing health systems strategies to improve reach to high-risk groups, this research has been conducted on health and survival from household and health facility perspectives in five districts of southern Tanzania. The researchers documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. The researchers conclude that relatively short distances to health facilities, high antenatal and vaccine coverage show that peripheral health facilities have huge potential to make a difference to health and survival at household level in rural Tanzania, even with current human resources.
This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB), and treatment seeking behaviour, among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. Fifty-nine (84.1%) patients had good knowledge on the transmission of TB. The majority (75%) of the respondents were of the opinion that the incidence of TB was on the increase mainly due to the AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60%) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68%) visited public health facilities for treatment as their first action. Overall, 83.8% respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Most of the respondents said they were well attended by service providers. Half and 59.3% of the males and females, respectively, mentioned good patient-service provider relationship as an important reason for satisfaction of the service. Twenty-nine respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. There is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care.
This report presents finding of a nationwide Expenditure Tracking and Service Delivery Survey in Mozambique from August to Ocotober 2002. The study focuses on the primary health care system, which is often the only source of health care for most Mozambicans. The data offers a unique perspective on interactions between different levels of the health system, particularly related to financing, allocation, distribution and use of resources. The report covers a broad set of issues including institutional context, budget managemet, cost recovery, drug allocation and distribution, human resources, infrastructure and equipment, and service outputs.
Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunisation services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Mothers of children under two years of age (N = 668) were interviewed in a cross-sectional study. The Road-to-Health card was utilised to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. The researchers found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, specially in those countries where health services do not have 100% of coverage.
This paper highlights and promotes the enormous potential that exists between these two initiatives that seek to address closely related issues and targeting the same populations at risk within a fairly well defined geographical setting. It also attempts to argue that malaria control, just like HIV-Aids control be given high priority in the New Partnership for Africa's Development (NEPAD) health agenda, as current statistics indicate that malaria is again on the rise. While much attention and billions of dollars have rightly been given to HIV and Aids research, treatment and prevention, malaria, and not Aids, is the region's leading cause of morbidity and mortality for children under the age of five years. This is the bad news. The good news is that unlike Aids, malaria treatment and prevention are relatively cheap. In addition, there is a payback to fighting malaria; support aimed directly at improving health, rather than poverty reduction, may be a more effective way of helping Africa to thrive. Robust and sustained growth may come to Africa through a mosquito net, Artemisinin-based Combination Therapies (ACTs) or a malaria vaccine, rather that a donor's cheque for economic development initiatives.
This Code of Conduct for Health Systems Strengthening offers guidance on how international non-governmental organisations (NGOs) can work in host countries in a way that respects and supports the primacy of the government’s responsibility for organising health system delivery. The code is intended to be clear, direct, succinct and action-oriented. There are six areas where NGOs can do better: 1) hiring policies; 2) compensation schemes; 3) training and support; 4) minimising the management burden on government due to multiple NGO projects in their countries; 5) helping governments connect communities to the formal health systems; and 6) providing better support to government systems through policy advocacy.
The study seeks to improve understanding of maternity health seeking behaviours in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.