Reproductive health care for internally displaced persons (IDPs) is a neglected area in humanitarian relief operations. Representatives of twelve relief and development agencies providing reproductive health care to IDPs were interviewed to identify barriers to access and strategies for overcoming these barriers. Although material and human resources were significant constraints, the main challenge ahead is to tackle ideological, managerial and policy barriers, and those related to donor influence. Considerable efforts are needed to close the gap between international commitments and their failure to help provide services in the field. The study strongly recommends developing a legal instrument, like an international convention, to protect the rights of IDPs.
Equitable health services
Amid fears that huge quantities of counterfeit medicines and pesticides are pouring into Africa, the international law enforcement agency INTERPOL is leading the way to invest more effort and money to bring authorities up to speed on the threat faced by those who depend on the imports, from hospital patients to pharmacists to farmers. Among the first of the OASIS anti-counterfeiting moves was Operation Mamba, a police action in Uganda and Tanzania in September and October that led to the seizure of more than 100 kinds of medical products, including anti-malarial pills, multivitamins, skin medicines and heart drugs. Four pharmacies in Tanzania were shut down; in Uganda, police are investigating 38 shops on suspicion that they are working illegally. INTERPOL is investing more effort and attention to Africa as the staggering extent of the counterfeiting problem on the continent becomes clearer. While precise numbers are difficult to come by, the World Health Organization believes that 30 percent of drugs sold in developing countries are counterfeit; in some parts of Africa, that number could be as high as 90%.
The 13th edition of the SAHR focuses on primary health care (PHC) in South Africa, 30 years after the historic Alma Ata Declaration, which famously linked health and health status to broader social determinants of health. It includes a national and international perspective of PHC and focuses on areas such as policy and legislation, determinants of health, lifestyle, infectious diseases, mental health, maternal and child health, nutrition and environmental health. It also reviews issues around human resources, finance, and information and concludes with the ‘Indicators’ chapter, which presents a selection of the best available data on the functioning and performance of the South African health system. It also reflects on lessons and mistakes of the past to improve implementation in the future.
The devastating cholera epidemic continues to spread, with a new outbreak in Chegutu Urban, recording more than 378 suspected cases and 121 deaths. As of 15 December, 9 out of 10 provinces (48 out of 62 districts) in the country are affected with a total count of 978 deaths and a Case Fatality Rate (CFR) of 5.3%. So far most cases have been reported in Harare / Budiriro (8,454 cases, 208 deaths and a CFR of 2.5%), followed by Beitbridge (3,456 cases, 91 deaths and a CFR of 2.6%), Mudzi (1,237 cases, 78 deaths and a CFR of 6.3%) and Chitungwiza (551 cases, 99 deaths and a CFR of 18 %). Higher CFRs have been found in other areas. Cholera continues to affect various parts of the Southern African region, with the Republic of South Africa reporting 859 cumulative cases, 11 deaths and a CFR of 1.2%, the bulk of the cases (731) reported in Limpopo province. Cases have also been reported in Botswana, Mozambique, and Zambia, albeit in much smaller numbers. According to the latest WHO figures, there have been 200 human cases of anthrax and 8 deaths reported since November with the consumption of contaminated meat identified as the most likely cause.
Four days into one-week 'critical' negotiations on pandemic influenza preparedness, World Health Organization members had yet to tackle areas of core disagreement and participants were expressing doubt as to whether consensus can be achieved before the end of the meeting. Details on the definition of 'Pandemic Influenza Preparedness (PIP) Biological Materials', on the content of a standard material transfer agreement for virus sharing and on the interconnection between a mechanism for virus-sharing and a mechanism for sharing of benefits from vaccine development have yet to be discussed or have been pushed until later in the meeting for more substantive discussion and hoped-for consensus. These interrelated topics represent core differences between member states and thus are likely to be most difficult to resolve at the WHO Pandemic Influenza Preparedness Intergovernmental Meeting.
This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. A mixed methods approach using structured Verbal/Social autopsy interviews and case narratives was employed with 26 caretakers living in the Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. The main barriers to care were misdiagnosis by the caregiver, gender and household financial constraints, and dissatisfaction with providers, reflecting inadequate levels of service. Poverty was identified as the underlying theme. Any improvements in basic health care for children suffering from acute febrile illness are likely to substantially reduce mortality.
The use of insecticide-treated bed nets (ITNs) to protect children from malaria has risen six-fold in the past seven years, but 90 million children still do not have access to this simple protective tool, and remain at risk from the life-threatening disease. When African heads of state met in 2000, the Abuja Declaration stated that they would work towards protecting 60% of their vulnerable populations with insecticide treated nets. This study examines what has been achieved since. Data from 40 African countries which shows that at the time of the Abuja meeting in 2000 just over 3% of Africa’s young children were protected by a treated mosquito net. Seven years later this increased to only 18.5%. The authors report that bed net use increases faster in countries that distribute them free of charge by an average of 25% compared to 4% when people have to pay for them.
Zimbabwe's cholera epidemic has crossed into South Africa, with four confirmed diagnoses in a total of 68 suspected cases in the border town of Musina, according to aid workers as of 19 November 2008. The cholera epidemic in Zimbabwe has flared up in several parts of the country, including the capital, Harare, and its satellite town of Chitungwiza, as a result of the collapse of water and sewerage services, worsened by uncollected refuse and the start of the rainy season. Humanitarian officials have reported that a total of 2,893 people were infected by the waterborne disease between the beginning of August and mid-November, with at least 115 deaths. The UN children's agency, UNICEF, and the World Health Organisation (WHO) have also been assisting in the provision of drinking water.
The objective of this study was to evaluate the impact of rapid diagnostic tests (RDTs) on prescribing behaviours, assess prescribers' and patients' perceptions, and identify operational issues during implementation. Baseline data was collected at six Tanzanian public dispensaries. RDTs were implemented for eight weeks and data collected on frequency of RDT use, results, malaria diagnoses and the prescription of antimalarials. The study found that overprescriptions decreased over the study period. There was a high degree of patient/caregiver and provider acceptance and satisfaction with RDTs. Implementation should include community education, sufficient levels of training and supervision and consideration of the need for additional staff.
Health workers of Parirenyatwa and Harare Central Hospital have issued a petition for urgent action to address the prevailing crisis in Zimbabwe’s public health system. Problems within public health institutions include a serious lack of medical supplies, functional equipment and drugs. Since all hospitals and clinics are closed, Zimbabweans that fall ill have no access to health care, given the high cost of private health care. Problems facing health workers include poor salaries (which should be paid in foreign currency, not Zim dollars), rising transport costs and bad working conditions. The continued failure to address the above issues has resulted in lack of services in public health institutions and health workers failing to come to work. The workers call upon the responsible authorities to take urgent steps to remedy the situation above in consultation with the health workers concerned.