Equitable health services

Kenya: Study says drugs availability low
Ndegwa A: The East African Standard, March 2006

The availability of drugs to treat two leading killer diseases in the country's public health facilities still falls below the internationally recommended benchmark, a survey shows. On average, the availability of two anti-retrovirals meant to treat HIV/Aids and that of the newly launched anti-malarial drug fell at least 10 marks below the recommended 75 per cent.

Limitations to practising holistically in the public sector in a rural sub-district in South Africa
Gaede B, Mahlobo S, Shabalala K, et al: Rural and Remote Health 6 (online) 607, 2006

The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term ‘holism’ was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts. Over the past two decades the term has entered into many academic disciplines as well as popular culture. As part of a larger research study, the limitations to working holistically in the public sector in a rural sub-district in South Africa were explored. This study used a participatory action research design that allowed participants a large degree of influence over the direction of the study. The close relationship between difficulty in providing a holistic healthcare service and burnout was an important finding that deserves further exploration.

Parliamentarians and activists from across the world gather to combat maternal and newborn deaths
World Health Organisation, 13 March 2007

Influential women from all over the globe have come together in London to urge the world to redouble efforts and boost investments to reduce the global burden of maternal and newborn death. The policy makers and parliamentarians from developing and developed countries are meeting to mark UK Mother's Day on 18 March 2007. Key participants include Cherie Blair, wife of the UK Prime Minister and international lawyer, Hilary Benn, MP, Secretary of State, Department for International Development, UK, Liya Kebede, Supermodel and World Health Organization Goodwill Ambassador for Maternal, Newborn and Child Health, and the First Lady of Lesotho, Mrs Mathato S. Mosisilli. A Global Plan of Action agreed at the meeting calls for a universal right to health for mothers and their babies by ensuring equitable skilled care. The plan calls on governments to take the lead in fighting maternal and newborn illness and death.

Social determinants of health and health inequalities: what role for general practice?
Furler J: Health Promotion Journal of Australia 17:264-5, 2006

This paper argues that general practice is potentially an important social determinant of health and health inequalities. The way it is influential is consistent with models of causal pathways in the way social and societal factors influence health. General practice clinical care can be thought of as a material resource. Evidence exists at many levels that this resource is inequitably distributed. But encounters in general practice are profoundly social processes, embedded in wider society. Debating and reflecting on the values underpinning relations between GP and patient may help challenge and illuminate wider inequitable processes in society that sustain inequalities in health.

TB control programmes in East Africa inadequate according to WHO report
Integrated Regional Information Networks, 2007

Several countries in eastern Africa have a high incidence of tuberculosis but have yet to develop effective national strategies to curtail the disease, the United Nations World Health Organization said in its 2007 global TB report, ‘Global tuberculosis control - surveillance, planning, financing’. Citing Democratic Republic of Congo, Kenya and Tanzania as among the 22 countries with a high tuberculosis burden, WHO said their national plans were not effective enough to combat it. Nigeria and Mozambique are the other African countries on the list. While noting the provision of free TB the report cites constraints in plans for human resource development made by national TB control programmes, inadequate screening of HIV-positive people for TB, and limited facilities for diagnoses and treatment of multi-drug resistant TB.

Call to Action: Health System Strengthening through the Global Fund
The Global Fund

Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which launches March 1, 2007, offers an important opportunity to fund health system strengthening, including the health workforce. To prepare for Round 7, health workers, ministry of health officials, and other individuals and institutions that have an interest in their countries' health systems are strongly encouraged to consider utilizing this opportunity for strengthening health systems. If interested, you should immediately contact members of your country's Country Coordinating Mechanism to discuss this potential, as well as the national process and timeline for developing these proposals. The proposals are expected to be due to the Global Fund in early July 2007.

Further details: /newsletter/id/32113
SOUTH AFRICAN HEALTH REVIEW 2006 - Maternal, Womens and Child Health - the unfinished agenda
Health Systems Trust, 22 February 2007

Great strides have been made in improving maternal care in South Africa over the last decade. A record high of ninety percent of pregnant women attend antenatal care and 92% of deliveries of babies are conducted by skilled health workers. Despite such achievements in access to care, maternal deaths are on the increase, mostly fuelled the HIV and TB epidemics.

The cost of uncomplicated childhood fevers to Kenyan households: implications for reaching international access targets
Larson BA, Amin AA, Noor AM, Zurovac D, Snow RW: BMC Public Health 6:314, 29 December 2006

We assemble data developed between 2001 and 2002 in Kenya to describe treatment choices made by rural households to treat a child's fever and the related costs to households. Using a cost-of-illness approach, we estimate the expected cost of a childhood fever to Kenyan households in 2002. We develop two scenarios to explore how expected costs to households would change if more children were treated at a health care facility with an effective antimalarial within 48 hours of fever onset.

Global health organisation prepares to name leader
Donnely J: The Boston Globe, 9 January 2007

The next leader of a global organisation that fights major infectious diseases, including AIDS, may come from a group that includes the former health minister of Mexico, France's AIDS ambassador, the former leader of UNICEF, and several leaders of the World Health Organization, according to a list of names obtained by the Globe. The board overseeing the organization, Global Fund to Fight AIDS, Tuberculosis and Malaria, failed to select a new executive director last November and now hopes to name one at a meeting in Geneva early next month.

Political economy from a clinical perspective
Hart JT: Policy Press, 2007

Hart describes the background of the creation of NHS and its history. Although NHS was relatively under-funded in the 1960s and 1970s, it was still extremely efficient: The UK was under a long period of time the OECD country with the lowest government allocation for health. Despite this, the outcome was impressive: Equal health care for all, evenly distributed throughout the country. The cost for administration was unbeatable: Initially it was 2%, but increased to 6% when the conservative government introduced the principles of ”New Public Management”. Since NHS became subject to privatisation and the introduction of internal markets, the administration cost has risen to 12%. One of Hart’s points is that public health care is cheap, partly because the administration cost is low.

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