Cervical cancer is the leading cause of cancer death among women in Ghana, West Africa. The cervical cancer mortality rate in Ghana is more than three times the global cervical cancer mortality rate. Pap tests and visual inspection with acetic acid wash are widely available throughout Ghana, yet less that 3% of Ghanaian women get a cervical cancer screening at regular intervals. This exploratory study identified psychological barriers to cervical cancer screening among Ghanaian women with and without cancer using a mixed methods approach.Semi-structured interviews were conducted with 49 Ghanaian women with cancer and 171 Ghanaian women who did not have cancer. The results of the quantitative analysis indicated that cancer patients were not more likely to have greater knowledge of cancer signs and symptoms than women without cancer. Analysis of the qualitative data revealed several psychological barriers to cervical cancer screening including, common myths about cervical cancer, misconceptions about cervical cancer screening, the lack of spousal support for screening, cultural taboos regarding the gender of healthcare providers, and the stigmatization of women with cervical cancer.
Equitable health services
This paper presents discussion on impact of training traditional birth attendants (TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and new-born mortality in rural settings in sub-Saharan Africa. The author argues that trained TBAs in sub-Sahara Africa can have positive impact on reducing maternal and new-born mortality if the programme is well implemented with systematic follow-up after training. This could be done through joint meeting between health workers and TBAs as feed and learning experience from problem encountered in process of providing child delivery services. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes. However projects targeting TBAs should not be of hit and run; but gradually familiarize with the target group, build trust, transparency, and tolerance, willing to learn and creating a better relationship with them. In this paper, some case studies are described on how trained TBAs can be fully utilized in reducing maternal and new-born mortality rate in rural areas. The author suggests that what is needed is to identify TBAs, map their distribution and train them on basic primary healthcare related to child deliveries and complications which need to be referred to conventional health facilities immediately.
here is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. The authors explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. they found that health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms.
According to a WHO study published in Global health: science and practice in August last year, about one in four health facilities in 11 countries in sub-Saharan Africa has no access to electricity and most facilities that do have access have an unreliable supply. This paper describes the use of portable solar power kits containing a small photovoltaic (PV) solar panel, battery charger and outlets for energy-efficient LED (light-emitting diode) lights at clinics in African countries, installed 26 units in clinics in Malawi, Uganda and the United Republic of Tanzania, as well as a mini-grid in the Malawian village of Ndaula, where a PV solar system powers the health clinic, school, a water pumping station and a drip irrigation system. It also raises the work to systematically evaluate needs and interventions for “green” health facilities and energy access in health clinics.
Recent analyses have drawn attention to the weaknesses of health care systems in low- and middle-income countries. In response to such deficiencies in the health care system, a number of countries have been introducing new approaches to financing, organizing, and delivering health care. This article briefly reviews the main weaknesses of health care systems in low- and middle-income countries, lists the most common responses to those weaknesses, and then presents three of the most popular responses for further review. These responses, which have attracted considerable controversy, involve the questions of whether to pay for health care through general taxation or contributory insurance funds to improve financial protection for specific sections of the population, whether to use financial incentives to increase health care utilization and improve health care quality, and whether to make use of private entities to extend the reach of the health care system. This review raises that the specific circumstances of individual countries strongly influence both decisions about which approaches might be relevant and their success, so the author cautions that any generalizations made from health systems research in particular countries must be carefully considered. It is unlikely that there is one single blueprint for an ideal health care system design or a magic bullet that will automatically remedy deficiencies. The strengthening of health care systems in low- and middle-income countries must be seen as a long-term developmental process.
The district strategy is the backbone of nearly every national health system in Africa; countries are covered by health facilities – organized in a tier system – whose activity packages focus on priority services. The Community of Practice “Health Service Delivery” convened a regional conference in Dakar, Senegal, from 21 to 23 October 2013 gathering 20 country delegations and 170 experts who shared their experiences in organizing primary-health-care services at the local level. The meeting identified that market liberalization means that African health authorities need to use new policy instruments enhanced by information and communication technology; implement the district strategy pragmatically; and ensure inclusiveness, openness to dialogue and support of innovation and learning at the organizational level. The meeting also noted that Primary health care remains as relevant today as it was in 1978.
This paper explored whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology applied semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, over-protectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.
Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining. This study evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. It aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy. The wired mothers' mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services, more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred. Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource-limited settings.
Health system weaknesses in Africa are well known, constraining progress in reducing the burden of both communicable and non-communicable disease. This paper used a focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care in Kenya. The discussions found weaknesses in the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, especially in district level targets, resulting in the exclusion of mental health from such district level supervision and a lack of awareness in the district management team about mental health. Generic health system weaknesses in Kenya are reported to impact on efforts for horizontal integration of mental health into routine primary care practice, and to frustrate health worker efforts. The authors report that a major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels.
Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres HCs) to scale up the provision of antiretroviral therapy (ART). This paper compares outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.