This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions required to cope with the new challenges facing the health systems in the 21st century. The review addresses PHC policy formation and implementation, the resources that are available for PHC implementation, monitoring and review. The review 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.
Equitable health services
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
The US House of Representatives passed HR5501, the US Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2008 on April 2 by a vote of 308-116. Amongst other things, the bill: authorises US$50billion for AIDS, TB, and malaria programs including US$9billion for TB and malaria; links AIDS, TB, and malaria programs to broader health and development programs; formalises activities currently operating under the President’s Malaria Initiative which includes a five-year malaria strategy and a malaria coordinator; calls for enhanced coordination within US government agencies in planning and implementing all three disease areas and with other global health and development programs.
According the South African Health Minister Manto Tshabalala-Msimang the use of health care services has almost doubled over the past eight years with 101 million visits to clinics in the 2006/07 financial year. Addressing the opening of the National Consultative Health Forum (NCHF) recently, the minister said the increase was due to improved access as a result of building more than 1 600 clinics closer to the communities, improved package of care available at clinics and the removal of user fees. Efforts have also been made to decrease the inequalities in the funding amongst health districts and have led to significant improvement in service delivery and health outcomes.
This paper reviews 58 studies that assess the delay in the diagnosis and treatment of tuberculosis (TB). Delay in diagnosis can affect disease prognosis at the individual level and enhance transmission of TB within the community. The paper identifies the main factors associated with diagnostic delay. These include HIV; coexistence of chronic cough and/or other lung diseases; geographical barriers; rural residence; poverty; old age; female sex; alcoholism and substance abuse; low educational level; low awareness of TB; and stigma. The paper concludes that the core problem in delay of diagnosis and treatment appears to be a vicious cycle of repeated visits at the same healthcare level, resulting in non-specific antibiotic treatment, incorrect diagnosis and failure to access specialised TB services. Three groups of healthcare providers were identified as sources of this vicious cycle: primary-level government health posts who have limited diagnostic facilities and poorly trained personnel; private practitioners with low awareness of TB and unqualified vendors and traditional practitioners.
The Pan African meeting on access to essential medicines (AEM) and rational use of medicines (RUM) was convened by Health Action International (HAI) Africa and the Ecumenical Pharmaceutical Network (EPN)2 on 14th and 15th November 2007 in Nairobi, Kenya. The meeting brought together African experts and stakeholders from the pharmaceutical sector, including civil society organizations (CSOs) and faith-based organizations (FBOs), to discuss issues around AEM and RUM.
In this community-based cross-sectional survey among rural pregnant women in western Kenya, a medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were measured. In this rural area with a high HIV prevalence, the reported use of condoms before pregnancy was extremely low. Pregnancy health was not optimal with a high prevalence of malaria, geohelminth infections, anaemia and underweight. Chances of losing a child after birth were high. Multiple interventions are needed to improve reproductive health in this area
The principal challenge to achieving the Abuja Declaration goal was to develop an efficient, equitable and sustainable mechanism to deliver insecticide treated nets to the poor and most vulnerable segments of the population. One method—social marketing, employs the principles and practices of commercial marketing techniques to deliver socially beneficial goods at affordable, and often, at subsidized prices to particular groups. Social marketing of insecticide treated nets, through a public-private partnership and meaningful community participation in Tanzania, has successfully and quickly increased the distribution of mosquito nets among the poorest populations, particularly children and pregnantwomen. This program has resulted in improved health outcomes with respect to morbidity and mortality impact of Malaria on the population of children.
The Code of Conduct for Health Systems Strengthening is a response to the recent growth in the number of international non-governmental organizations (INGOs) associated with increase in aid flows to the health sector. It is intended as a tool for service organizations – and eventually, funders and host governments. The code serves as a guide to encourage NGO practices which contribute to building public health systems and discourage those which are harmful. The working document was drafted by a coalition of activist or service delivery organizations, including Health Alliance International, Partners in Health, Health GAP, and Action Aid International. EQUINET also contributed to the consultations on the code. It will be revised in a series of consultations over 2008.
Health Minister Manto Tshabalala-Msimang has called on the continent's health industry to improve access to affordable medicine. Access to healthcare is a constitutional right for all citizens of this continent.