Access to improved sanitation is a matter of human rights, says the UN. There is compelling evidence that sanitation brings the single greatest return on investment of any development intervention (roughly $9 for every $1 spent). Yet it remains the most neglected and most off-track of the Millennium Development Goal (MDG) targets. Sanitation has been considered as the most important medical advance since 1840 – beating antibiotics, vaccines and anaesthesia. Access to sanitation is essential for people to live in dignity, yet 40% of the world still does not have basic sanitation. The scale of the crisis is enormous, according to the United Nations, which reports that 2.5 billion people do not have access to proper sanitation.
Equitable health services
Investing in sanitation is investing in human dignity, says UN expert
United Nations: November 2008
Resolutions by the Community Working Group on Health (CWGH) from the 15th National Conference in Harare
Community Working Group on Health: 23 October 2008
The CWGH made a number of resolutions after the 15th National Conference in Harare, including a demand that the right to health be included in the National Constitution. It committed itself to strengthening primary health care and district systems by lobbying for incentives and resources for community health workers from government, getting health institutions to remove high charge barriers and lobbying government for policies to retain health workers. It will also lobby the government to provide free access to safe water as a human right, as well as lobby the Parliamentary Portfolio Committee on health for increased health funding and government for the fair allocation of resources at national level. Community participation should also be promoted. That CWGH will develop a proactive agenda on health issues and forge and strengthen strategic partnership locally and regionally to take this forward, capacitate its districts to enable them to advance and monitor the implementation of these resolutions and ensure that the health delivery system is not used for partisan politics.
Zimbabwe Cholera and health situation - 1 December 2008
World Health Organisation
Zimbabwe’s overall health service has been steadily declining for the last five years. The Zimbabwean health service today is wracked by critical shortages of essential drugs and skilled and experienced personnel. Another challenge is there has been no comprehensive assessment of Zimbabwe’s health system since 2006, making it difficult to assess its true state. Also, its disease surveillance and early warning system, which depends on a weekly epidemiological system, has been compromised in terms of timeliness and completeness of data, which is only around 30%. Universal access to basic health services is compromised due to deteriorating infrastructure, staffing and financial resources. Reactivating primary health care services should keep being addressed as a matter of emergency. Zimbabwean health facilities face a massive gap – estimated this year at 70% – in required medicines due to reduced local manufacturing capacity, which has been weakened by a lack of foreign currency. This is despite support received from different partners through UNICEF’s procurement systems. A large cholera outbreak is affecting most regions of the country, with more than 11 700 cases and 473 deaths recorded between August and 30 November. This represents a case fatality rate (CFR) of 4.0% nationally, but reached 50% in some areas during the early stages of the outbreak. The CFR benchmark should be below 1%. Cholera outbreaks in Zimbabwe have occurred annually since 1998, but previous epidemics never reached today’s proportions. The last large outbreak was in 1992 with 3000 cases recorded. Cholera cases have also been reported either side of Zimbabwe’s border with South Africa, Botswana and Mozambique, demonstrating the subregional extent of the outbreak.
Future health systems: Why future? Why now?
Bloom G and Standing H: Science Direct (66)10 2067–2075, September 2008
Health policy has tended to export models of health systems from developed nations to low-income countries without questioning their appropriateness and adaptability. Debates about the roles of public and private providers are meaningless in poor countries that do not have the institutional framework to govern a market economy and where government has little capacity to regulate providers of health services. The lack of appropriately contextualised debate and language hampers national and international efforts to address major health challenges. Health systems, like other systems of producing social goods, are ways of producing and organising access to expert knowledge and the technologies that derive from it. Their failure, in many contexts, to serve the interests of the poor means we should also be exploring different ways of producing and delivering services rather than simply intensifying efforts to recreate existing ones.
Global Malaria Action Plan launched
World Health Organisation: 25 September 2008
Government, business and civil society leaders gathered at the United Nations to launch a global campaign to reduce malaria deaths, currently at more than 1 million each year, to near zero by 2015, with an initial commitment of nearly a $3 billion. The Global Malaria Action Plan (GMAP) aims to cuts deaths and illness by 2010 to half their 2000 levels by scaling up access to insecticide-treated bed nets, indoor spraying and treatment, and achieve the near-zero goal through sustained universal coverage. Ultimately it seeks to eradicate the disease completely with new tools and strategies.
Hypertension and diabetes: Poor care for patients at community health centres
Steyn K, Levitt D, Patel M, Fourie JM, Gwebushe N, Lombard C and Everett K: South African Medical Journal 98(8) 618–622, 2008
This report aimed to identify health-care and provider-related determinants of diabetes and hypertension patients attending public sector community health centres (CHCs). A random sample of eighteen CHCs in the Cape Peninsula, South Africa, providing hypertension and diabetes care was selected. Twenty-five diabetes and 35 hypertension patients were selected per clinic and interviewed by trained fieldworkers and their medical records audited. Knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the diabetes and 11.4% of the hypertension patients. Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This highlights the urgent need to improve health care for patients with these conditions in the public sector of the Cape Peninsula.
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: An overview of systematic reviews
Lewin S, Lavis JN, Oxman A, Bastías G, Chopra M, Ciapponi A, Flottorp S, Martí SG, Pantoja T, Rada G, Souza N, Treweek S, Wiysonge CS and Haines A: The Lancet 372:928–939, 2008
Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care (PHC) and achieving the vision of the Alma-Ata Declaration. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to PHC in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.
Use more modern malaria methods, urges Medecins Sans Frontieres
Thom A, Health-e: 1 October 2008
Medecins Sans Frontieres (MSF) has made an urgent call for the wider implementation of the newer and more effective anti-malaria strategies in an effort to save lives. Malaria still kills a child every 30 seconds worldwide while nine out 10 of these deaths occur in sub-Saharan Africa, predominantly among young children. According to the World Health Organisation, one in every five childhood deaths is due to the effects of malaria. An MSF report released in Johannesburg on 31 September shows that unnecessary illness and death can be avoided with simple, affordable treatment and diagnostic tools that are currently available. The report follows the launch of an ambitious new Global Malaria Action Plan aimed at reducing the number of malaria deaths to near zero by 2015, with world leaders committing nearly US$3-billion to ensure it succeeds.
WHO tells governments to focus on basic health care
MacInnis L: Reuters, 14 October 2008
Nearly 60 million women will give birth without any medical assistance this year, the World Health Organisation (WHO) has said in a report calling for an overhaul of how health care is financed and managed globally. The United Nations agency said in its annual World Health Report that the billions of aid dollars devoted to fight specific epidemics like AIDS had distracted attention from providing comprehensive care to mothers and children. The difference in life expectancy between the richest and poorest countries still exceeds 40 years, said the report, whose launch coincided with a global financial crisis that could freeze aid flows and squeeze government budgets for health care. Increasingly specialised and technical medicine in wealthy nations has also excluded and impoverished millions of patients, exposing failures of ‘laissez-faire’ governance in health. WHO is encouraging countries to go ‘back to the basics’.
An evaluation of infant immunisation in Africa: Is a transformation in progress?
Arevshatian L, Clements CJ and Lwanga SK: Bulletin of the World Health Organisation, International Journal of Public Health, 2007
This paper assesses the progress towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunisation between 2001 and 2005. These goals include: to interrupt the circulation of wild polio virus in all countries; eliminate maternal and neonatal tetanus in all high-risk districts; 80% of the countries to have reached at least 80% diphtheria-tetanus-pertissus-3 (DTP-3) coverage; and measles to be controlled and eliminated in Southern Africa. The paper finds that although more infants had been immunised by 2005, most of the targets had been missed by at least half of the region’s countries. The authors estimate that DTP-3 coverage increased from 54% in 2000 to 69% in 2004, and as a result the number of non-immunised children declined from 1.4 million in 2002 to 900,000 in 2004. Reported measles cases dropped from 520,000 in 2000 to 316,000 in 2005 and mortality was reduced by approximately 60%. The paper concludes that the rates of immunisation coverage are improving dramatically in the WHO African region. The huge increases in spending on immunisation and the related improvements in programme performance are linked predominantly to increases in donor funding.