This WHO review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions needed to cope with challenges facing the health systems in the 21st century. It finds that PHC policy formation had been well articulated in the national health policies by most countries; however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will. Key recommendations include harmonising health sector reforms with PHC to ensure initiatives promote equity and quality in health services, improving the fairness of financing policies and strategies and service coverage for the poor, and supporting countries to address particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies, as well as to identify and put in place mechanisms for attracting and retaining health personnel.
Equitable health services
This paper set out to evaluate birth preparedness and complication readiness among antenatal care clients at Kenyatta National Hospital, Nairobi, Kenya. A total of 394 women attending antenatal care were systematically sampled to select every third interviewee for the study. The paper found that over 60% of the respondents were counselled by health workers on various elements of birth preparedness and many were aware of their expected date of delivery, had set aside funds for transport to hospital or for emergencies and knew at least one danger sign in pregnancy. Level of education positively influenced birth preparedness. However, education and counselling on different aspects of birth preparedness was not provided to all clients, especially about danger signs in pregnancy, birth preparedness and plans for emergencies.
This study’s main objective was to determine the length of delays from onset of symptoms to initiation of treatment of pulmonary tuberculosis (PTB). A total of 230 patients aged between 12 and 80 years were included in the study. A cough was the commonest symptom, reported by 99% of the patients, followed by chest pain (80%). Factors like marital status, being knowledgeable about TB, distance to the clinic and where they sought help first had significant effect on how long it took a patient to seek treatment. TB control programmes in this region must emphasise patient education regarding symptoms of tuberculosis and timely health-seeking behaviour.
This preliminary report from Malawi describes a process of developing standards for maternity care together with a multidisciplinary team of health professionals.Conventionally standards for maternity care are developed by a panel of experts (usually obstetricians) and then implemented by a multidisciplinary team. The present study concerns the feasibility of involving health professionals of all grades in the establishment standards for obstructed labour in Malawi. Standards for obstructed labour were developed by a multidisciplinary team involving all cadres of health professionals working in maternity units, as well as hospital managers and policy makers, using evidence from Malawi national guidelines, World Health Organisation manuals and peer-reviewed journals. The standards addressed different aspects of the management of obstructed labour, namely early recognition of prolonged labour by labouring women and traditional birth attendants, early arrival of women to health facilities during labour, proper use of partograph by healthcare providers, proper management of prolonged labour, proper management of obstructed labour, appropriate management of uterine rupture and early delivery of the baby.
The study aimed to evaluate health facility and health worker readiness to deliver new artemetherlumefantrine (AL) treatment policy for uncomplicated malaria in Kenya, using a cross-sectional survey at health facilities in four sentinel districts in Kenya. All government facilities in study districts and all health workers performing outpatient consultations were involved in the study. The availability of any tablets of AL , sulfadoxine-pyrimethamine and amodiaquine was nearly universal on the survey day. However, only 61% of facilities stocked all four weight-specific packs of AL. In the past six months, 67% of facilities had stock-out of at least one AL tablet pack and 15% were out of stock for all four packs at the same time. Duration of stock-out was substantial for all AL packs (median range: 27-39% of time). During the same period, the stock-outs of sulfadoxine-pyrimethamine and amodiaquine were rare. Only 19% of facilities had all AL wall charts displayed, AL in-service training was provided to 47% of health workers and 59% had access to the new guidelines. Health facility and health worker readiness to implement AL policy is not yet optimal. Continuous supply of all four AL pack sizes and removal of not-recommended antimalarials is needed. Further coordinated efforts through the routine programmatic activities are necessary to improve delivery of AL at the point of care.
This paper identifies priorities for disease control as an input into the Copenhagen Consensus effort for 2008 (CC08). The analysis builds on the results of the Disease Control Priorities Project (DCPP). The DCPP engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide region-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities. Some interventions are clearly low priority. Others are attractive and worth doing but either address only a small proportion of disease burden or are simply not quite as attractive as a few key interventions. This paper identifies seven priority interventions in terms of their cost-effectiveness, the size of the disease burden they address, and other criteria.
TB control is hampered by the dual HIV epidemic, and is one of the main reasons for the rapid increase in TB in South Africa, compounded by escalating rates of multidrug resistance (MDR) and the emergence of extensively drug-resistant TB (XDR-TB) in all nine provinces. Rapid diagnosis of drug-resistant TB has been identified as one of the key efforts to find a solution to the control of MDR-TB. A demonstration study under field conditions involving 20,000 TB patients at risk of MDR-TB was conducted in four provinces in South Africa, evaluating the effectiveness of a new molecular test for rapid diagnosis of MDR-TB. Outcomes of this study showed that the test has the potential to revolutionise the control of MDR-TB and its use in TB control programmes has been endorsed by the World Health Organisation. The study showed that the test is highly effective in diagnosing MDR-TB and can be used in laboratory settings in developing countries. Although specialised laboratory facilities and specially trained personnel are required, the test is easy to perform in the laboratory and results are accurate and reproducible. This is very likely one of few instances that global policy for poverty-related disease is driven by evidence generated by scientists and institutions from high-burden countries, such as South Africa, with full credit for the results. The test will be rolled out to all provinces in South Africa, following the acceptance of a new diagnostic algorithm by the National TB Control Programme.
A lack of laboratory facilities, transport and skilled medical workers is reported to be hampering efforts to tackle an outbreak of visceral leishmaniasis, a parasitic disease also known as kala azar or black fever, in northern Kenya’s Isiolo and Wajir districts, officials said. According to public health officials in the district prevention and management of the disease is limited by the availability of trained personnel.
KwaZulu-Natal seems to be winning the battle against malaria in the province, with only about 1,000 cases reported in the province in the past malarial season. According to Prof. Maureen Coetzee, an entomologist from the University of the Witwatersrand, in a paper presented to the International Congress of Entomology in Durban, the situation in the province and the country is favourable because of reduced rainfall and the changes made to malaria control programmes, with use of two insecticides to control mosquitoes and a change to the drug for treatment of the parasite. Similar control programmes have also been introduced in Mozambique. The use of fungi to kill mosquitoes is being tested and research at Wits University showed that mosquitoes exposed to
fungi died within 12 to 14 days after exposure.
People in low-resource countries who are ill with multidrug-resistant TB (MDR-TB) will get a faster diagnosis and a new treatment regime, thanks to two new initiatives unveiled by the World Health Orgqnisation, the Stop TB Partnership, UNITAID and the Foundation for Innovative New Diagnostics (FIND). On diagnosis, the method gives results in two days rather than the standard two to three months. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. The initiatives should increase the proportion diagnosed and treated at least seven-fold over the next four years, to 15% or more.