The objective of this study was to assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg, South Africa. Sixteen PHC clinics were surveyed, using a researcher-developed structured checklist based on national guidelines and protocols. Most facilities were found to be adequately equipped and well stocked with drugs. A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean length of 135 minutes). Many routine examination procedures were poorly performed, with an adequate diagnosis established in 108 of 141 consultations (77%), even though health professionals were experienced and well trained. Triage and attention to danger signs were poor. An antibiotic was prescribed in almost half of the consultations, but antibiotic use was unwarranted in one-third of these cases. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. HIV status was seldom asked about or investigated, for the mother or for the child. Growth monitoring and nutritional counselling at well child visits was generally inadequate, with not one of 11 children who qualified for food supplementation receiving it. In conclusion, the findings indicate that PHC offered to children in Johannesburg is seriously inadequate. The study urges for a deliberate and radical restructuring of PHC for children, with clearly defined and monitored standard clinical practice routines and norms.
Equitable health services
In this report, research findings from a population-based household survey are presented on the general health status of infants, children, and adolescents in South Africa including morbidity, utilisation of health facilities, immunisation coverage, HIV status and associated risk factors. It also investigates the exposure of children and adolescents to HIV communication programmes. Close to 90% of children visited a public or private outpatient clinic the last time they were sick, indicating a high rate of utilisation for health services in South Africa. However, more than 20% of children were hospitalised for an average duration of 6.9 days. This demonstrates both the failure of the primary health care system to prevent and adequately manage diseases and the low quality of care provided in these services. This report is intended to play a vital role in assisting policy makers and stakeholders in targeting and prioritising key issues in planning and programming efforts focusing on the broad health issues of South African children.
Malnutrition in Congo-Brazzaville causes more than a quarter of deaths among children under five, according to United Nations Children's Fund (UNICEF). In response, on 20 October 2010, the Act Now, No Woman Should Die Giving Life campaign was launched across the country. It aims to reduce maternal and child mortality, and involves the government, three United Nations (UN) agencies, civil society and private partners. It aims to reduce the maternal mortality rate of 781 per 100,000 live births, as well as child mortality. UNICEF also pointed out health inequities, as the rich have access to faster essential interventions than the poor and stressed that reducing this inequality is essential to achieve the Millennium Development Goals related to health. The Congolese Minister for Health and Population assured that adoption of the new national roadmap will accelerate reduction in mortality rates. He said that since 2008 pregnant women and children aged 5-15 have been able to access free malaria treatment, and from January 2011 pregnant women will be able to get free Caesarean sections.
The objective of the East Africa Public Health Laboratory Networking Project for Africa is to establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of tuberculosis and other communicable diseases. There are three components to the project, the first component being regional diagnostic and surveillance capacity. This component will provide targeted support to create and render functional the regional laboratory network. Uganda, working in close collaboration with the East, Central and Southern African Health Community (ECSA-HC), will lead the establishment of the network. The second component is joint training and capacity building. The project will support training in a range of institutions in the four countries and across the region. Tanzania will provide leadership in this area and establish a regional training hub. It will provide practical training at its state-of-the-art national health laboratory quality assurance and training centre and in-service training and post-graduate mentorships at the Muhimbili University of Health and Allied Sciences. Finally, the third component includes joint operational research, knowledge sharing and regional co-ordination, and programme management.
The authors of this article challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment in poor countries. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deploying primary and secondary caregivers, using off-patent drugs, and applying regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage, with a focus on people living in poverty. These strategies can reduce costs, increase access to health services and strengthen health systems to meet the challenge of cancer and other diseases, the authors argue. To promote cancer treatment in poor countries, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries was formed in 2009. It is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation and evaluation of strategies to advance this agenda.
Eclampsia is the commonest direct cause of maternal death in South Africa. The latest Saving Mothers Report (2005-2007) indicates that there were 622 maternal deaths due to hypertensive disorders of pregnancy. Of these, 334 (55.3%) were due to eclampsia; of the eclamptic deaths, 50 were over the age of 35 years and 83 were under 20 years old. Avoidable factors involved patient related factors (mainly delay in seeking help), administrative factors (mainly delay in transport) and health personnel issues (mainly due to delay in referring patients). The major causes of death were cerebrovascular accidents and cardiac failure. The majority of deaths due to cardiac failure were due to pulmonary oedema. To reduce deaths from eclampsia, this study argues that more attention must be given to the detection of pre-eclampsia; the provision of information on the advantages of antenatal care to the population at large and training of health professions in the management of obstetric emergencies.
The United Nations Economic Commission for Africa (UNECA) and the World Health Organization (WHO) are joining forces to establish an African-owned and -governed initiative to promote innovation for the research and development of pharmaceuticals and other products to meet the health needs of the continent. The African Network for Drugs and Diagnostics Innovation (ANDI) will be based in Ethiopia and will help build research capacity on the continent and link biomedical innovation to development and public health. Overall, ANDI aims to mobilise Africa health research capability, uncapping African health innovation potential and expanding global partnerships and regional collaborations to accelerate the delivery of quality health care in Africa. Specific goals include increasing research and development collaboration among African institutions and countries, and fostering public-private partnerships within Africa to support the development and manufacture of new drugs and health products. It also aims to generate and manage intellectual property, explore innovative mechanisms to encourage and reward local innovation – including research drawing on traditional medicine – and promote long-term economic sustainability by supporting research and development.
Despite lack of resources, activities undertaken to mitigate the impact of neglected tropical diseases are so far producing unprecedented results, according to this report. It points to a number of successes: treatment with preventive chemotherapy reached 670 million people in 2008, while dracunculiasis, also called guinea worm disease, is on course to becoming first disease eradicated not by a vaccine, but by health education and behaviour change. Reported cases of sleeping sickness have also dropped to their lowest level in 50 years. The report notes opportunities for strengthening delivery systems, such as by targeting primary schools to treat millions of children for schistosomiasis and helminthiasis in Africa. In addition, better co-ordination is argued to be needed, such as with veterinary public health and to respond to changing disease patterns resulting from climate change and environmental factors.
This report provides highlights of the findings of the phase 1 Researching Equity in Access to Health Care (REACH) project, completed in 2009. REACH aims to document levels of and inequities in access, according to socio-economic status, gender, and urban/rural status, within the public health system for three services: maternal health (focusing on emergency and specialised needs at the time of delivery), tuberculosis (TB) care, and antiretroviral therapy. Detailed case studies were undertaken in various parts of South Africa. During 2008 and 2009, the REACH project undertook exit interviews with approximately 4,000 adult (+18 years) users of TB, HIV and maternal health services, carried out quality of care assessments in fifty health facilities, and analysed secondary data from a variety of sources to establish the socio-economic profile of facility catchment populations. The project found that considerably greater access barriers are experienced by rural compared to urban communities, with respect to distance, time, costs and staff attitudes. Rural women experience large health cost burdens during their pregnancy and at the time of delivery, and coverage by a minimum package of antenatal care is still inadequate. TB services were found to be more accessible than anti-retroviral therapy services in all dimensions of availability, affordability and acceptability. The report also notes there was considerable local variation in nature of services (e.g. home visits) and policies (e.g. birth companions).
Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty. Using improved methods to measure urban poverty in 30 countries, this study found substantial inequalities in maternal and newborn health, and in access to health care. The ‘urban advantage’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services. There are two main patterns of urban inequality in developing countries: massive exclusion, in which most of the population do not have access to services, and urban marginalisation, in which only the poor are excluded. At a country level, these two types of inequality can be further subdivided on the basis of rural access levels. Inequity is not mandatory. Patterns of health inequality differ with context, and there are examples of countries with relatively small degrees of urban inequity. Women and their babies need to have access to care, especially around the time of birth. Different strategies to achieve universal coverage in urban areas are needed according to urban inequality typology, but the evidence for what works is restricted to a few case studies.