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.
Equitable health services
Use of South African Health Care Services Double
KhumaloG: BuaNews, 18 April 2008
A systematic review of delay in the diagnosis and treatment of tuberculosis
Storla DG, Yimer S, Bjune GA: BMC Public Health, 2008
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.
Access to and rational use of medicine
Health Action International and Ecumenical Pharmaceutical Network, 14 November 2007
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.
Reproductive health issues in rural Western Kenya
van Eijk AM, Lindblade KA, Odhiambo F, Peterson E, Sikuku E, Ayisi JG, Ouma P, Rosen DH and Slutsker L: Reproductive Health 5(1), 18 March 2008
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
Social Marketing for Malaria Prevention: Increasing Insecticide Treated Net Coverage
The World Bank
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 NGO Code of Conduct for Health Systems Strengthening
Health Alliance International, 28 November 2007
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.
Africa needs access to affordable medicine
Mbola B: BuaNews, 21 February 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.
Health Care Waste Management in Public Clinics in the Ilembe District: A Situational Analysis and Intervention Strategy
Gabela SD: Health Systems Trust
All waste generated at health care facilities in the past was regarded as hazardous and was incinerated before disposal. Today however, waste generated at health facilities is separated out and disposed of according to the risks it poses. The purpose of this study was to investigate health care waste (HCW) management practices used in public health clinics in the iLembe Health District, with a view to developing a HCW management intervention strategy. The management of health care waste is of great concern. There is need to develop a health care waste management intervention strategy to be implemented consistently and universally in the district.
Implementation of the Mental Health Care Act (2002) at district hospitals in South Africa: Translating principles into practice
Burns JK: South African Medical Journal 98 (1): 46-49
In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles – human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation – are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the ‘rock face', and offers solutions to the problem of translating principles into practice.
Is the Western Cape at risk for an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage
Corrigall J, Coetzee S, Cameron N: South African Medical Journal 98 (1): 41-45
This study in Western Cape South Africa shows that while immunisation coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focussed.