The objective of the Health Systems Strengthening Project, which is funded by the world Bank, is to deliver the Uganda National Minimum Health Care Package (UNMHCP) to Ugandans, with a focus on maternal health, newborn care and family planning. This will be achieved through improving human resources for health; physical health infrastructure; and management, leadership and accountability for health service delivery. There are four components to the project, the first component being improved health workforce development and management. The objective of this component is to improve development and management of the health workforce. The second component is the improved infrastructure of existing health facilities. The objective of this component is to improve infrastructure of existing health facilities. Emphasis will be placed on providing minimum quality standards of health care services, especially in the areas of maternal and child health, through: renovation of selected health facilities; provision of medical equipment; improved capacity for operations and maintenance; and strengthening the referral system. The third component is the improved leadership, management, and accountability for health service delivery. The objective of this component is to strengthen management, leadership, and accountability for health service delivery. Finally, the fourth component is the improved maternal, newborn and family planning services. The objective of this component is to improve access to, and quality of, maternal health, newborn care, and family planning services.
Equitable health services
UNICEF and the World Health Organisation (WHO) have appealed for the participation of all sectors of the Angolan society to ensure the vaccination of about 5.6 million children under five years against polio from 10–12 September 2010. The two United Nations agencies said the exercise was aimed at protecting children in the country against the crippling disease, and a forerunner to Angola's plans to carry out a national vaccination campaign in 2011. It is also part of the Emergency Plan of the Angolan government to eradicate poliomyelitis. According to Angola's Ministry of Health, the country has recorded 17 cases of poliomyelitis in 2010 in the provinces of Luanda, Bengo, Huambo, Bié, Lunda Norte and Lunda Sul. The Ministry warned that the disease is spreading and affecting children who live in the border regions of the Democratic Republic of Congo. The Angolan government has so far committed to releasing US$9.3 million to support vaccination in the 32 main districts in order to increase the coverage to at least 90%.
A Cape Town-based health programme, mothers2mothers (m2m), has received the 2010 Award for Best Practices in Global Health for initiatives to reduce mother-to-child transmission (MTCT) of HIV. The Award is given annually to highlight the efforts of individuals dedicated to improving the health of disadvantaged and disenfranchised populations, and it recognises programmes that demonstrate the links between health, poverty and development. The m2m programme began in 2001 and has grown from one site in South Africa to more than 645 sites in South Africa, Kenya, Lesotho, Malawi, Rwanda, Swaziland and Zambia. It employs over 1,600 HIV-positive women who conduct more than 200,000 client interactions per month. In the programme, HIV-positive mothers are trained as mentors for HIV-positive pregnant mothers seeking health care. By effectively professionalising their role alongside overburdened doctors and nurses, these ‘mentor mothers’ fill health care delivery gaps in the prevention of MTCT of HIV and help breakdown stigma and other treatment barriers, as they are perceived as role models in clinics and their communities.
This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey of 708 households; 24 focus group discussions; semi-structured interviews with 34 health workers; and 359 patient exit interviews. The paper found that multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40% of individuals who self-treated using shop-bought drugs and 42% who visited a formal health facility reported not having enough money to pay for treatment and other factors influencing affordability included seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organisation of health care services, drug and staff shortages.
In July and September 2006, 3.4 million long-lasting insecticide-treated bed nets (LLINs) were distributed free in a campaign targeting children 0-59 months old (CU5s) in the 46 districts with malaria in Kenya. A survey was conducted one month after the distribution to evaluate who received campaign LLINs, who owned insecticide-treated bed nets and other bed nets received through other channels, and how these nets were being used. In targeted areas, 67.5% of all households with CU5s received campaign LLINs. Including previously owned nets, 74.4 % of all households with CU5s had an ITN. Over half of CU5s (51.7%) slept under an ITN during the previous evening. Nearly 40% of all households received a campaign net, elevating overall household ownership of ITNs to 50.7%. The campaign was successful in reaching the target population, families with CU5s, the risk group most vulnerable to malaria. Targeted distribution strategies will help Kenya approach indicator targets, but will need to be combined with other strategies to achieve desired population coverage levels.
To date, no study has yet looked at the effect of incentives on the use of insecticide-treated nets (ITNs). This study aims to fill the research gap. It took the form of a cluster randomised controlled trial testing household-level incentives for ITN use following a free ITN distribution campaign in Madagascar. The study took place from July 2007 until February 2008. Twenty-one villages were randomised to either intervention or control clusters. At baseline, 8.5% of households owned an ITN and 6% were observed to have a net mounted over a bed in the household. At one month, there were no differences in ownership between the intervention and control groups, but net use was substantially higher in the intervention group (99% vs. 78%). After six months, net ownership had decreased in the intervention compared to the control group (96.7% vs. 99.7%). There was no difference between the groups in terms of ITN use at six months; however, intervention households were more likely to use a net that they owned (96% vs. 90%). The study concludes that providing incentives for behaviour change is a promising tool that can complement traditional ITN distribution programmes and improve the effectiveness of ITN programmes in protecting vulnerable populations, especially in the short-term.
The objective of this paper was to compare three methods for evaluating treatment adherence in a seven-day controlled treatment period for malaria in children in Rwanda. Fifty-six children younger than five years old with malaria were recruited at the University Hospital of Butare, Rwanda. Three methods to evaluate medication adherence among patients were compared: manual pill count of returned tablets, patient self-report and electronic pill-box monitoring. Medication adherence data were available for 54 of the 56 patients. Manual pill count and patient self-report yielded a medication adherence of 100% for the in- and out-patient treatment periods. Based on electronic pill-box monitoring, medication adherence during the seven-day treatment period was 90.5%. Based on electronic pill-box monitoring inpatient medication adherence (99.3%) was markedly higher than out-patient adherence (82.7%), showing a clear difference between health workers' and consumers' medication adherence. In conclusion, health workers' medication adherence was good. However, a significant lower medication adherence was observed for consumers' adherence in the outpatient setting. This was only detected by electronic pill-box monitoring. Therefore, this latter method is more accurate than the two other methods used in this study.
This is a cross-sectional survey (June 2007 through July 2008) of 13,814 people aged 15–30 years who had attended trial schools on sexual education during the first phase of the MEMA kwa Vijana sexual health intervention trial (1999–2002). Prevalences of the primary outcomes HIV and herpes simplex 2 (HSV-2) were 1.8% and 25.9% in males and 4% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV or HSV-2 but was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime and an increase in reported condom use at last sex with a non-regular partner among females. There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies, or other reported sexual behaviours. The study concluded that knowledge of sexual and reproductive health can be improved and retained long-term, but this intervention had only a limited effect on sexual behaviour. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated.
The aim of this paper is to reconsider established practices and policies for HIV and tuberculosis epidemic control, aiming at delivering better results and value for money. This may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. The current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens), drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens), research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy development and scaling up interventions, and identify ways of joint planning and joint funding of integrated delivery as part of strengthened health systems.
This research, set in public primary care services in Cape Town, South Africa, set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006. While the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility.