Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The author discusses in detail how a revitalisation of the agenda is urgently needed.
Equitable health services
Family planning: The unfinished agenda
Cleland J, Bernstein S, Ezeh A, et al: The Lancet 368 (9549), 1810-1827, 18 November 2006
Hospital admissions resulting from unsafe abortion: Estimates from 13 developing countries
Singh S: The Lancet, 369 (9550), 25 November 2006
Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem.
Opportunities for Africa's newborns: Practical data, policy and programmatic support for newborn care in Africa
The Partnership for Maternal, Newborn and Child Health (PMNCH), 2006
This report provides an overview of the continuum of care for maternal, newborn and child health (MNCH) in Africa. The report investigates the prevalence and causes of neonatal deaths and highlights the gaps in coverage of care through the pre-pregnancy, pregnancy, childbirth and postnatal period. It also discusses how to integrate care with key programmes aimed at preventing mother to child transmission of HIV, controlling malaria, and immunisation. The report presents case studies of six African countries which have progressively reduced newborn death rates despite low gross national income. The authors find that two thirds of the 1.6 million newborn deaths in sub-Saharan Africa could be avoided if essential interventions already in policy reached 90 per cent of African mothers and newborns.
Problems in providing universal access to services highlighted at UNCTAD meeting
Tayob R: Third World Network, 21 November 2006
A recent United Nations Conference on Trade and Development (UNCTAD) expert meeting discussed how developing countries face challenges and problems in providing universal access to services to their people. The meeting comprised panels looking at general issues as well as various sectors, including water, health, education and telecommunication services. It also had a session on the WTO's General Agreement on Trade in Services (GATS). Among the problems highlighted were the adverse effects of user fees, with the imposition of charges and fees to citizens in exchange for public services, introduced in many countries as part of World Bank-IMF programmes, the effects of privatisation of services, and the negative effects of patents and bilateral free trade agreements on access to medicines and health services.
Reducing maternal mortality stymied by lack of funds and absence of national laws
Macan-Markar M: Third World Network, 7 December 2006
Among all reproductive health indicators, the least progress has been made in reducing maternal mortality. This means that the fifth Millennium Development Goal to reduce by three quarters the maternal mortality ratio, given that over half a million women die every year during pregnancy or childbirth – will not be reached in many countries. Lack of funds and the slow progress to implement laws that protect maternal healthcare and reproductive health rights are undermining this goal.
Refugees discuss pros and cons of health services in Tanzania
Rutta E, et al: id21 Global Issues, 2006
A participatory assessment has revealed the strengths and gaps of health services in Tanzania – from the perspectives of Burundian and Rwandan refugees. Refugees benefit from employment in hospitals, feeding programmes, drugs, HIV and AIDS education and so on. But lack of food, fear of rape and ‘voluntary repatriation’, and preferential treatment by health staff are a problem.
Research for future health systems
Peters DH, Bloom G, Rahman MH, et al: Global Forum Update on Research for Health 3, 133-137
This document contains several different articles by various authors on adressing the global challenges to more equitable health systems. health systems. This article briefly reviews the types of constraints faced by health systems in developing countries, and points to the types of information and research needed by decisionmakers to address these constraints. Future health systems in developing countries will need to understand the increasingly complex and unpredictable interactions of local, national and international actors and trends.
Shaping the health information supply: Improving media coverage of health issues in Sub-Saharan Africa
Nolen LB, Volmink J: Center for the Advancement of Health, October 2006
The importance of media reporting on health issues in sub-Saharan Africa has gained significant attention over the past several years from media outlets, health development organisations and donors. Although reporting on health issues has increased and improved in recent years, stories with little informational content or based on faulty information still surface far too frequently. Using a combination of interviews, document analysis and Internet research, this report describes some of the challenges in increasing the use of high quality scientific information in health coverage, some of the current efforts to make improvements and where the gaps to success lay.
Zimbabwe's sick economy fuels growth of fake drug market
The Integrated Regional Information Networks (IRIN), 11 December 2006
Zimbabwe's deteriorating health services have made room for a thriving parallel market for drugs, many of them counterfeit, warn concerned health professionals. The sale of genuine as well as fake medicines on the streets was "big, booming business," said Dr Paul Chimedza, the president of the Zimbabwe Medical Association (ZIMA). "The health system has been adversely affected by the poorly performing economy. There is a general shortage of drugs within the country and unscrupulous dealers are capitalising on the situation by selling medical drugs on the streets."
Bed/population ratios in South African public sector mental health services
Crick Lund, Alan J. Flisher, Kim Porteus, Tennyson Lee Social Psychiatry and Psychiatric Epidemiology Volume 37, Number 7 July, 2002
Mental health service planners face critical decisions regarding appropriate and affordable inpatient care. Before a fashion of deinstitutionalisation is followed, effective community services should be in place and sufficient psychiatric beds should remain in hospitals for those who cannot be catered for in the community. In order to maintain the delicate balance between hospital and community-based services, it is essential that useful indicators of inpatient care are established. This study documents current bed/population ratios per 100 000 population in public sector mental health services in South Africa. It found low levels of inpatient service provision in South Africa, and considerable variability between provinces. This study gives further support to the need to develop acute inpatient psychiatric services, reduce levels of chronic care where appropriate, and redirect resources towards the development of community-level residential and day-care services. It is crucial to develop accurate indicators to monitor this process.