Three global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) for 2016-2021 were adopted by the 2016 World Health Assembly, outlining key actions to be undertaken by countries and WHO, along five strategic directions, over the course of the next six years. The HIV strategy aims to achieve "fast-track" targets by 2020 towards ending AIDS by 2030. The hepatitis strategy – the first of its kind - introduces the first-ever global targets, including the target to eliminate viral hepatitis as a public health threat by 2030. For the HIV strategy, a central element for success will be country efforts to implement "Treat All" recommendations.
Equitable health services
New health sector strategies on HIV, viral hepatitis and sexually transmitted infections
World Health Organisation: Geneva, June 2016
No health security without health systems
Kamal-Yanni M: Global Health Check, May 2016
The Ebola outbreak shocked the world of global health. Even while Ebola lingers in West Africa the future of health security and the organisation of health systems are being debated. There have been many conferences held and reports published to provide “lessons learned from the Ebola crisis. A thread running through all of these events has been an agreement on the need to build resilient health systems. Yet building such a system requires planning, investment and serious long term commitment. Short term investment does not produce the necessary workforce needed for a functioning health system. Dhillon and Yates identified 5 key areas that require immediate attention in order to rebuild health systems: community based systems; access to generic medicines; restoring preventive measures; integrating surveillance into health systems and strengthening management. The author identifies 6 critical foundations for resilient health systems: An adequate number of trained health workers, including non-clinical staff and Community Health Workers (CHWs), available medical supplies, including medicines, diagnostics and vaccines, robust health information systems, including surveillance, an adequate number of well-equipped health facilities including access to clean water and sanitation, adequate financing and a strong public sector to deliver equitable, quality services. The author argues that building resilient systems that protect people’s health and deal with outbreaks has to address all the six elements of the system simultaneously and systematically and that a long term global commitment for building health systems must start now.
In Tanzania, 22.8% of Teen Girls Are Mothers
Mwijarubi M: VITAL, 16 May 2016
In this blog, the author reports that in Tanzania, less than one in 10 (9%) of sexually active youth who want to avoid pregnancy use modern contraceptives and that 22.8% of young women between the ages of 15 and 19 are mothers, according to the Tanzania Demographic and Health Survey 2010. Tanzanian women, the survey shows, have an average of 5.4 children each. Early childbearing and high rates of fertility put stress on the health and education systems, on the availability of food and clean water, and on natural resources, according to the country's National Family Planning Costed Implementation Plan. Tanzania has committed to Family Planning 2020 (FP2020), to ensure that, in line with the United Nations secretary general's global strategy for women, children, and adolescent health, all women have access to contraceptives by 2020. The aut5hor indicates that its needed: 47% of Tanzania's population is 15 years or younger. In Tanzania, family planning has been synonymous with child spacing for married men and women, as typified by posters and brochures featuring monogamous couples with their three distinctly spaced children. But the term "family planning" doesn't resonate with young people because they are not yet ready to start families. He notes therefore that as a result, the global health workers' advocacy and support group, IntraHealth International, has started referring to it as "future planning."
Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study
Kanyuka M; Ndawala J; Mleme T; Chisesa L; et al.: The Lancet Global Health 4(3) e201-e214, 2016
This in-depth country case study aimed to explain Malawi's success in improving child survival. The authors estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. They documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths per 1000 livebirths in 1990 to 71 deaths in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly, representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280 000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The funding allocated to the health sector increased substantially, particularly to child health and HIV and from external sources, albeit below internationally agreed targets. This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. The authors’ findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth.
Stand Up for African Mothers Campaign
AMREF: Amref Health Africa in the USA, 2016
Every year, nearly 200,000 women die during childbirth in sub-Saharan Africa in part due to poor access to basic reproductive and maternal health services. The author argues that Over 80 percent of these deaths could have been prevented with the assistance of a midwife. This campaign, Stand Up for African Mothers. aims to ensure that more African women can count on the assistance of a trained midwife during pregnancy and childbirth, and promotes reproductive rights and education to help women and their partners make informed choices about family planning. Through campaign, Amref is training 15,000 midwives to reduce the high rate of maternal mortality in sub-Saharan Africa through both traditional classroom-based teaching, and innovative methods such as distance learning and mLearning, which allows midwives to study using basic mobile phone technology. With a skilled midwife providing care to 500 mothers annually, over seven million African women each year could benefit from this campaign in 13 African countries. By 2016, almost 7,000 midwives had been trained since the campaign began in 2010.
Rural Health Care Access and Policy in Developing Countries
Strasser R; Kam S; Regalado S: Annual Review of Public Health 37, 395-412, 2016
Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status, and a shortage of health professionals. This article explores rural areas of Sub-Saharan Africa (SSA). Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from under-serviced areas to deliver quality health care in rural community settings.
Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa
Parpia A; Ndeffo-Mbah M; Wenzel N; Galvani A: Emerging infectious diseases 22(3) 433-41, 2016
Response to the 2014–2015 Ebola outbreak in West Africa overwhelmed the healthcare systems of Guinea, Liberia, and Sierra Leone, reducing access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS, and tuberculosis. To estimate the repercussions of the Ebola outbreak on the populations at risk for these diseases, the authors developed computational models for disease transmission and infection progression. They estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 (2,564–12,407) in Guinea; 1,535 (522–2,8780) in Liberia; and 2,819 (844–4,844) in Sierra Leone. The authors report that the 2014–2015 Ebola outbreak was catastrophic in these countries, and its indirect impact of increasing the mortality rates of other diseases was also substantial.
Equity and achievement in access to contraceptives in East Africa between 2000 and 2010
Shah C; Griffith A; Ciera J; Zulu E; Palermo T: International Journal of Gynaecology and Obstetrics 133(1), 53-58, 2016
This paper presents trends in equity in contraceptive use and contraceptive-prevalence rates in six East African countries. In this repeated cross-sectional study, Demographic and Health Survey data from women aged 15–49 years in Ethiopia, Kenya, Malawi, Rwanda, Tanzania, and Uganda between 2000 and 2010 were analysed. Individuals were ranked according to wealth quintile, urban/rural populations stratified, and a concentration index calculated. Equity and contraceptive-prevalence rates increased in most country regions over the study period. In rural Rwanda, contraceptive-prevalence rates increased from 3.9 to 44.0. Urban Kenya showed highest equity with a concentration index of 0.02. The Pearson correlation coefficient between improvements in concentration index and contraceptive-prevalence rates was significant. The results indicate that countries seeking to increase contraceptive use should also prioritize equity in access.
Yellow fever vaccine supply: a possible solution
Monath T; Woodall J; Gubler D; Yuill T; Mackenzie J;Martins R; Reiter P; Heymann D: The Lancet 387;10028; 1599–1600, 2016
The authors note the emerging epidemic of yellow fever in Angola and spread of similar Aedes aegypti mosquito-borne viruses including dengue, chikungunya, and now Zika, albeit with differences noted. Yellow fever was first identified as a viral infection in 1900, has been reported from more than 57 countries and yellow fever outbreaks have case fatality rates as high as 75% in hospitalised cases. There has been an effective yellow fever vaccine since the late 1930s, but with outbreaks in unvaccinated populations in 1987 in urban Nigeria, despite a mass vaccination campaign. According to WHO, the current yellow fever outbreak is in more than six of Angola's 18 provinces, and there has been movement of unvaccinated travellers from Angola to neighbouring Democratic Republic of the Congo, but also to further states, including Mauritania, and China. Southeast Asian countries are now considered at risk because the Aedes vector is present and the population is unvaccinated. However should yellow fever outbreaks occur elsewhere in Africa, in Latin America, or in Asia, the authors note that the current global supplies of yellow fever vaccine may be inadequate.
Assessing Coverage, Equity and Quality Gaps in Maternal and Neonatal Care in Sub-Saharan Africa: An Integrated Approach
Wilunda C; Putoto G; Dalla Riva D; Manenti F; Atzori A; Calia F; Assefa T; Turri B; Emmanuel O; Straneo M; Kisika F; Tamburlini G; Tarmbulini G: PloS one 10(6), May 2015
The authors present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries. Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs) utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC) indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level. The authors findings confirm the existence of serious issues regarding coverage, equity and quality of health care for mothers and newborns in all study districts. Gaps in one dimension hinder the potential gains in health outcomes deriving from good performances in other dimensions, thus confirm the need for a three-dimensional profiling of health care provision as a basis for data-driven planning.