This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies the 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. 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. The key recommendations of the review include to: harmonise health sector reforms with PHC to ensure that initiatives promote equity and quality in health services; improve the fairness of financing policies and strategies and service coverage for the poor; support countries to address their particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies; support countries to identify and put in place mechanisms for attracting and retaining health personnel.
Equitable health services
The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management. Data were collected in a government and an NGO clinic in the North West province of South Africa. Key findings included: (i) there are attitudinal differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture. A respectful and caring approach to patients, and an organisational culture which supports and enables staff, can achieve much of this without any additional resources.
Despite the need for oral health morbidity surveys to aid in reviewing of the oral health services, dental data of Ugandan children is scanty. This paper set out to describe the magnitude and distribution of selected oral health conditions among primary school children in Mbarara, Uganda. The oral hygiene of school children was poor, with high plaque prevalence demonstrating a lack of established oral hygiene practices. A comprehensive community-focused oral health care intervention that includes oral health education in homes and the strengthening of school health programme is needed to improve the oral health status of children in Mbarara.
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.
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