According to a WHO study published in Global health: science and practice in August last year, about one in four health facilities in 11 countries in sub-Saharan Africa has no access to electricity and most facilities that do have access have an unreliable supply. This paper describes the use of portable solar power kits containing a small photovoltaic (PV) solar panel, battery charger and outlets for energy-efficient LED (light-emitting diode) lights at clinics in African countries, installed 26 units in clinics in Malawi, Uganda and the United Republic of Tanzania, as well as a mini-grid in the Malawian village of Ndaula, where a PV solar system powers the health clinic, school, a water pumping station and a drip irrigation system. It also raises the work to systematically evaluate needs and interventions for “green” health facilities and energy access in health clinics.
Equitable health services
Recent analyses have drawn attention to the weaknesses of health care systems in low- and middle-income countries. In response to such deficiencies in the health care system, a number of countries have been introducing new approaches to financing, organizing, and delivering health care. This article briefly reviews the main weaknesses of health care systems in low- and middle-income countries, lists the most common responses to those weaknesses, and then presents three of the most popular responses for further review. These responses, which have attracted considerable controversy, involve the questions of whether to pay for health care through general taxation or contributory insurance funds to improve financial protection for specific sections of the population, whether to use financial incentives to increase health care utilization and improve health care quality, and whether to make use of private entities to extend the reach of the health care system. This review raises that the specific circumstances of individual countries strongly influence both decisions about which approaches might be relevant and their success, so the author cautions that any generalizations made from health systems research in particular countries must be carefully considered. It is unlikely that there is one single blueprint for an ideal health care system design or a magic bullet that will automatically remedy deficiencies. The strengthening of health care systems in low- and middle-income countries must be seen as a long-term developmental process.
The district strategy is the backbone of nearly every national health system in Africa; countries are covered by health facilities – organized in a tier system – whose activity packages focus on priority services. The Community of Practice “Health Service Delivery” convened a regional conference in Dakar, Senegal, from 21 to 23 October 2013 gathering 20 country delegations and 170 experts who shared their experiences in organizing primary-health-care services at the local level. The meeting identified that market liberalization means that African health authorities need to use new policy instruments enhanced by information and communication technology; implement the district strategy pragmatically; and ensure inclusiveness, openness to dialogue and support of innovation and learning at the organizational level. The meeting also noted that Primary health care remains as relevant today as it was in 1978.
This paper explored whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology applied semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, over-protectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.
Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining. This study evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. It aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy. The wired mothers' mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services, more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred. Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource-limited settings.
Health system weaknesses in Africa are well known, constraining progress in reducing the burden of both communicable and non-communicable disease. This paper used a focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care in Kenya. The discussions found weaknesses in the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, especially in district level targets, resulting in the exclusion of mental health from such district level supervision and a lack of awareness in the district management team about mental health. Generic health system weaknesses in Kenya are reported to impact on efforts for horizontal integration of mental health into routine primary care practice, and to frustrate health worker efforts. The authors report that a major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels.
Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres HCs) to scale up the provision of antiretroviral therapy (ART). This paper compares outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.
The importance of poor-quality anti-tuberculosis drugs cannot be underestimated, as they may disrupt all major complex interventions to ensure treatment efficacy. Not only treatment failure may ensue, but, more importantly, rapid emergence of acquired drug resistances can also be favoured. The authors raise that a relevant proportion of underqualified medicines could be detected through relatively inexpensive and simple assays at destination countries, based on chromatographic techniques. Such tests are able to identify the type and concentrations of the various components. They note that their execution is not compulsory and only rarely pursued. They describe a vicious cycle where local regulatory authorities fail to implement controls of fraudulent manufacturers being encouraged to enter the market.
This study described the healthcare access, beliefs, and practices of middle-aged and older women residing in Soweto, South Africa. The study instrument was administered to 1102 caregivers. Over half the respondents reported having at least one chronic non-communicable disease (NCD), only a third of whom reported accessing a healthcare service in the last six months. Reported availability of private medical practice and government clinics was high (75% and 62% respectively). The low utilisation of healthcare services by women with NCDs is a concern for health care management.
Inequities in both health status and coverage of health services are considered important barriers to achieving Millennium Development Goal 4. Community-based health promotion is a strategy that is believed to reduce inequities in rural low-income settings. This paper examines the contributions of community-based programming to improving the equity of newborn health in three districts in Malawi. This study is a before-and-after evaluation of Malawi's Community-Based Maternal and Newborn Care (CBMNC) program, a package of facility and community-based interventions to improve newborn health. Health Surveillance Assistants (HSAs) within the catchment area of 14 health facilities were trained to make pregnancy and postnatal home visits to promote healthy behaviours and assess women and newborns for danger signs requiring referral to a facility. Core groups of community volunteers were also trained to raise awareness about recommended newborn care practices. Baseline and endline household surveys measured the coverage of the intervention and targeted health behaviours for this before-and-after evaluation. Wealth indices were constructed using household asset data and concentration indices were compared between baseline and endline for each indicator. Despite modest coverage levels for the intervention, health equity improved significantly over the study period for several indicators. Greater improvements in inequities were observed for knowledge indicators than for coverage of routine health services. Although these results indicate promising improvements for newborn health in Malawi, the extent to which the programme contributed to these improvements in coverage and equity are not known. The strategies through which community-based programs are implemented likely play an important role in their ability to improve equity, and further research and monitoring are needed to ensure that the poorest households are reached by community-based health programs.