In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions. In this study, researchers used a monitoring framework recommended by World Health Organisation and the United States’ Centres for Disease Control and Prevention to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. Findings showed improvements in the performance of IDSR, including: improved reporting at the district level (49% in 2001; 85% in 2007); an increase and then decrease in timeliness of reporting from districts to central level; and an increase in analysed data at the local level. The case fatality rate for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
Equitable health services
Those who are against privatisation of public services are often confronted with the objection that there is no alternative. This book takes up that challenge by establishing theoretical models for what does (and does not) constitute an alternative to privatisation, and what might make them ‘successful’, backed up by a comprehensive set of empirical data on public services initiatives in over 40 countries. This is the first such global survey of its kind, providing a rigorous and robust platform for evaluating different alternatives and allowing for comparisons across regions and sectors. The book helps to conceptualise and evaluate what has become an important and widespread movement for better public services in the global South. The contributors explore historical, existing and proposed non-commercialised alternatives for primary health, water/sanitation and electricity. The objectives of the research have been to develop conceptual and methodological frameworks for identifying and analysing alternatives to privatisation, and testing these models against actually existing alternatives on the ground in Asia, Africa and Latin America. Information of this type is urgently required for practitioners and analysts, both of whom are seeking reliable knowledge on what kind of public models work, how transferable they are from one place to another and what their main strengths and weaknesses are.
Despite extensive scientific and policy innovations in quality of care, the authors raise a gap in quality in resource-limited areas that undermine effective access to healthcare for poor people. In this perspective piece, the authors propose six actions to address this: revise global health investment mechanisms to value quality; enhance investment in the role of health persinnel for improving quality; scale up data capacity; deepen community accountability and engagement initiatives; implement evidence-based quality improvement programmes; and develop an implementation science research agenda.
In this presentation given at the Second Global Symposium on Health Systems Research in November 2012, researchers presented the results of a study in which they evaluated the effectiveness of daily observation of drug consumption at tuberculosis (TB) clinics in South Africa. They conducted 1,200 patient exit interviews with patients in 30 different TB facilities, as well as 17 in-depth interviews to understand patient access barriers. Findings indicated that the requirement for daily observation of drug consumption at clinics imposes substantial costs on patients, and this may impact adversely on adherence. In multivariate regressions, patients that visited the facility on a daily basis (versus other) were more than twice as likely to report missing their TB medication (after controlling for other factors). Qualitative findings suggest that long travel distances to facilities, the cost of transport, and the opportunity cost of clinic attendance were some of the factors influencing adherence. Less frequent clinic visits may be a win-win for TB treatment because of: improved efficiency through reduced provider costs; higher adherence; and lower patient access barriers to care.
Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many regions with high maternal mortality. In this study, the authors combined a detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana. They estimated journey-time for all women of childbearing age (WoCBA) to their nearest health facility. Findings indicated that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. The authors conclude that their approach, using detailed data assembly combined with geospatial modeling, can provide accurate nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes, they argue, because they fail to take account of the location and accessibility of services relative to the women they serve.
The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services amongst women living in rural villages in Bugesera District, Eastern Province, Rwanda. Using census data, researchers selected 30 villages for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Their analysis of 3,106 lifetime deliveries from 859 respondents showed a sharp increase in the percentage of health facility deliveries in recent years. The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health centre.
In response to a high incidence of cervical cancer, Tanzania implemented “visual inspection of the cervix after acetic acid application” (VIA) as a regional cervical cancer screening strategy in 2002. With the aim of describing risk factors for VIA positivity and determinants of screening attendances in Tanzania, this research paper presents the results from a comparative analysis performed among women who are reached and not reached by the screening programme. Researchers studied 14,107 women aged 25–59 enrolled in a cervical cancer screening programme in Dar es Salaam in the period 2002–2008. The women underwent VIA examination and took part in a structured questionnaire interview. Results indicated that women who are widowed/separated, of high parity, of low education and married at a young age are more likely to be VIA positive and thus at risk of developing cervical cancer. Although women who participated in the screening were more likely to be HIV positive in comparison with women who had never attended screening, the authors point out that this may be due to a referral link that exists between the HIV programme and the cervical cancer screening programme, which means that HIV positive were more likely to participate in the cervical cancer screening programme than HIV negative women.
When Southern African Development Community (SADC) member states signed the SADC Protocol on Health in 2008, they committed themselves to dealing with communicable diseases - particularly HIV, tuberculosis (TB) and malaria - in a harmonised manner. However, until now, the key regional strategic frameworks and minimum standards developed to guide action in the control of these three diseases did not adequately cover children and adolescents. To address this shortcoming, SADC commissioned a regional assessment in the 14 active SADC Member States between October 2011 and July 2012. On the basis of this data, the SADC Secretariat developed the SADC Minimum Standards for Child and Adolescent HIV, TB and Malaria Continuum of Care. It establishes the minimum package of services that member states should have in place to achieve a common response in the region. Because of the bi-directional links between the HIV, TB and malaria and child vulnerability, it is crucial that access to services such as health, education, social and child protection, food security and nutrition and psychosocial services are adequately integrated into this response, as established in the SADC Strategic Framework and Programme of Action for Orphans and Vulnerable Children and Youth.
Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade – in 2001 and again in 2006. The authors of this study assessed health workers‟ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: children below 5; older children and adults; and pregnant women. A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. Results showed that following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that factors other than providers’ attitude may have more influence in their personal treatment practices.
The authors of this study assessed barriers related with long-lasting insecticide treated net (LLIN) use at the household level in Ethiopia from October to November 2010. A total of 2,867 households were selected and data were collected by interviewing women, direct observation of LLINs conditions and use, and in-depth interviewing of key informants. Results indicated that only about one third of LLIN owned households are actually using at least one LLIN for protection against mosquito bite. Thus, most of the residents are at higher risk of mosquito bite and acquiring of malaria infection. Households living in fringe zone are not benefiting from the LLIN protection. Further progress in malaria prevention can be achieved by specifically targeting populations in fringe zones and conducting focused public education to increase LLIN use, the authors recommend.