Governments at the recent World Health Assembly have committed to a higher level of action to combat antibiotic resistance that is an increasing public health threat across the world. On 24 May, a resolution was approved by health ministers on “Combating antimicrobial resistance, including antibiotic resistance” after an important exchange of country positions and one amendment put forward by Mexico with regard to conflict of interests. India supported the antimicrobial resistance (AMR) resolution subject to the understanding that its concerns would be included in the proposed global plan of action. These included financial access of developing countries patients to new antibiotics, news ways of funding research and development based on the delinkage principle in the context of developing countries, and the special needs of developing countries and their capacity building to take on relevant activities. India’s proposal was in lieu of making changes in the resolution text itself which was its first preference. The United Kingdom in its statement also acknowledged the legitimate concern of developing countries on access to antibiotics, and the importance of support for technical capacities and affordable drugs. All Member States agreed on the importance and magnitude of antimicrobial resistance and broad support was heard in the statements made by all delegations on the paramount need to take action. Both developing and developed countries agreed that this is of global magnitude and urged the WHO to develop the action plan and for Member States to build up their own national plans. Developing countries stressed on the urgency of the problem but also on the importance of ensuring access to new antibiotics for developing countries and the mobilization of resources so that they can implement action plans and surveillance.
Equitable health services
The African Health Initiative (AHI) has yielded many lessons about how to support health systems within complex and changing geographic, social and political contexts. This has been organised into a series of essays from the field on “What We’re Learning". The first in this series is reported here, with information to support an understanding of the nuances of how health services that result in improvements in population health are delivered.
Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda. Mixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents. This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% of the survey respondents used these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities. Complex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, the authors find that governments should strengthen health systems to cater for increasing urban populations.
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.
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.