This book provides an in-depth, comprehensive assessment of the benefits and risks when health care becomes a global commodity. The collection includes contributions from leading scholars in law and public policy, medicine and public health, bioethics, anthropology, health geography, and economics. Contributors examine how government agencies, medical tourism companies, international hospital chains, and other organisations promote medical tourism and the globalisation of health care. The topics explored include the legal remedies available to medical tourists when procedures go awry; potential consequences when patients cross borders for medical procedures that are illegal in their home countries; the relationship of medical tourism to international spread of infectious disease; and the lack of adequate transnational policies and regulations governing the global market for health services.
Equitable health services
Based on research in education, health, water and sanitation, the authors of this paper sought to identify how politics and governance can constrain or enable equitable and efficient service delivery in developing countries, including Malawi, Rwanda and Uganda. Some of these constraints reflect the nature of the wider governance system, and may have similar effects across sectors, for example in how financial resources are used or how human resources are allocated. The authors’ focus was on the interactions at regional, district and community level between local government officials, service providers and users – the ‘missing middle’ of the service delivery chain. Their analysis of four aid programmes suggests that aid-funded activities can facilitate government efforts to address governance constraints in public service delivery. However, it also indicates that the way in which programmes are designed and implemented matters to whether they are able to gain domestic traction and support institutional change. The authors advocate for ‘arm’s length’ aid models, which work through organisations that offer advisory services directly to governments and other public bodies in developing countries and have had some success as brokers of collective action and facilitators of change.
The University of the Witwatersrand in South Africa has announced the formation of the Wits Research Institute for Malaria, (WRIM), strengthening research into one of Africa’s deadliest diseases. The Institute combines three existing research groups from the School of Public Health who are working on malaria vectors, parasites and pharmacology. Africa has very few research institutes that have the capacity to address a host of issues and make an impact on the disease. The WRIM aims to produce leading research and researchers to benefit malaria control in Africa.
The aim of this study was to describe the prevalence and factors associated with obstetric fistula in Ethiopia. A total of 14,070 women of reproductive age group were included in the survey, of whom only 23.2% had ever heard of OF. Among 9,713 women who had given birth, 103 (1.06%) had experienced OF in their lifetime. Those women who are circumcised or lived in urban areas had higher odds of reporting the condition. Women who gave birth 10 or more also had higher odds of developing OF than women with one to four children. It is estimated that in Ethiopia nearly 142,387 obstetric fistula patients exist. The authors conclude that OF is a major public and reproductive health concern in Ethiopia and they call for increased access to emergency obstetric care, expansion of fistula repair service and active recruitment of women through a campaign of ending obstetric fistula.
Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. Therefore, the objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. The top five priorities identified by participants were aligned to three of the World Health Organisation’s health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel made the following policy recommendations: a focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.
In 2010 and 2011, Tanzania ran a universal coverage campaign to distribute long-lasting insecticidal nets (LLINs) nationally and free-of-charge. Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. A total of 18.2 million LLINs were delivered at an average cost of US$ 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one insecticide-treated net (ITN) increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Close collaboration among the Ministry of Health and Social Welfare, external funders, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. The authors predict that, through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania.
This review indicates that universal health coverage (UHC) interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status. The effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes. Regarding UHC design features, there are several common features across countries and regions, such as the coexistence of UHC schemes, heterogeneity in design and organisation, a widespread effort to include the poor in the schemes, and the prevalence of mixed financing sources (contributions plus taxes). Yet, in most cases, evidence is scarce and inconclusive on the impact of specific UHC design features on their intended outcomes. Four lessons are highlighted: affordability is important but may not be enough; target the poor, but keep an eye on the non-poor; benefits should be closely linked to target populations' needs; and highly focused interventions can be a useful initial step toward UHC.
This paper reports on yellow fever vaccination coverage following massive emergency immunisation campaigns in the Pader district, northern Uganda, in 2010. A total of 680 respondents were included in the sample and vaccination status was assessed in a survey using self reports and vaccination card evidence. Of the 680 respondents, 654 (96.3%) reported being vaccinated during the last campaign but only 353 (51.6%) had valid yellow fever vaccination cards. Of the 280 children below five years of age, 96.1% were vaccinated. The main reasons for not being vaccinated were: having travelled out of Pader district during the campaign period (40%), lack of transport to immunisation posts (28%) and sickness at the time of vaccination (16%). These results show that actual yellow fever vaccination coverage was high and met the desired minimum threshold coverage of 80% designated by the World Health Organisation. Active surveillance is necessary for early detection of yellow fever cases.
This film examines the barriers that people face in accessing healthcare in rural Mozambique, specifically the rural area of Tsangano in the province of Tete, a huge region in the centre of the country. In the film, you can see how the examples of Tsangano and Tete clearly show that all parts of a health system need to come together in order for the system as a whole to function. The film advocates for an end to out-of-pocket payments by health service users. To ensure this, the ‘key ingredients’ that will make user fee removal a success must also be addressed – the financing for the system as a whole and ensuring increased investment in transport and infrastructure – particularly in rural areas – a bigger, stronger health workforce, universal access to medicines and better information for the population to demand their right to health.
In this study, researchers aimed to estimate the prevalence, awareness, management and control of hypertension and associated factors in an adult population in Dande, Northern Angola. They conducted a community-based survey of 1,464 adults, following the World Health Organisation's Stepwise Approach to Chronic Disease Risk Factor Surveillance, and selected a representative sample of subjects, stratified by sex and age (18–40 and 41–64 years old). Prevalence of hypertension was 23% in the sample. A follow-up consultation confirmed the hypertensive status in 82% of the subjects who had a second measurement on average 23 days after the first. Amongst hypertensive individuals, 21.6% were aware of their status. Only 13.9% of those who were aware of their condition were under pharmacological treatment, of which approximately one-third were controlled. Greater age, lower level of education, higher body mass index and abdominal obesity were found to be significantly associated with hypertension. The authors conclude that there is an urgent need for strategies to improve prevention, diagnosis and access to adequate treatment in Angola, where massive economic growth and its consequent impact on lifestyle risk factors could lead to an increase in the prevalence of hypertension and cardiovascular disease.