This report on public healthcare provision in South Africa revealed deficiencies in the national health care system, including a shortage of ambulances, clinics, medical personnel and medication. More than 400 community-based and nongovernment organisations, human rights and health organisations and almost every district municipality across the country participated in the assessment. Patients complained of verbal abuse, discrimination and violation of patient rights, especially with regard to confidentiality. The environmental causes of illness, including poor water quality and a lack of proper sanitation was commonly noted, putting pressure on the health system. Deep concern was also expressed that those suffering from chronic illnesses needed access to social and financial support as well as medical treatment. The consultations exposed an absence of effective monitoring and evaluation systems. There are no central points where complaints can be lodged, the report notes. The report has been released ahead of the scheduled parliamentary debates on the proposed National Health Insurance (NHI) scheme.
Equitable health services
This qualitative study was conducted in two malaria-endemic regions of Kenya - South Coast and Busia. Participant selection was purposive and criterion based. A total of 20 focus group discussions, 22 in-depth interviews, and 18 exit interviews were conducted. While support for local child immunisation programmes exists, limited understanding about vaccines and what they do was evident among younger and older people, particularly men. In general, parents and caregivers weigh several factors - such as personal opportunity costs, resource constraints, and perceived benefits - when deciding whether or not to have their children vaccinated, and the decision often is influenced by a network of people, including community leaders and health workers. The study raises issues that should inform a communications strategy and guide policy decisions within Kenya on eventual malaria vaccine introduction. Unlike the current practice, where health education on child welfare and immunisation focuses on women, the communications strategy should equally target men and women in ways that are appropriate for each gender, the authors argue. It should involve influential community members and provide needed information and reassurances about immunisation. Efforts also should be made to address concerns about the quality of immunisation services, including health workers' interpersonal communication skills.
The authors of this study set out to define the patient population at Cape Town’s district-level hospital offering specialist tuberculosis (TB) services, concerning the noted increase in complex, sick HIV-TB co-infected patients requiring increased levels of care. They surveyed all hospitalised adult patients in Brooklyn Chest Hospital, a district-level hospital offering specialist TB services, from 27-30 October 2008. They found that more than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant co-morbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multi-drug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of co-morbidity. Overall, one-fifth of patients required up-referral to higher levels of care. In conclusion, the authors note that district-level hospitals, such as Brooklyn Chest Hospital, that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required, they argue.
Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, the study conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors. The study found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. The authors argue that current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health, and that prison-based health services should make linkages to community-based health care, and address general prison conditions and failures of the criminal justice system that exacerbate overcrowding.
The aim of this study was to investigate latent classes of users in Mozambique based on their preferences for mosquito-control technology attributes and covariates of these classes, as well as to explore which current technologies meet these preferences. Surveys were administered in five rural villages in Mozambique. The data showed that users' preferences for malaria technologies varied, and people could be categorised into four latent classes based on shared preferences. The largest class, constituting almost half of the respondents, would not avoid a mosquito-control technology because of its cost, heat, odour, potential to make other health issues worse, ease of keeping clean, or inadequate mosquito control. The other three groups are characterised by the attributes which would make them avoid a technology - these groups are labelled as the bites class, by-products class, and multiple-concerns class. Those with multiple concerns, mostly men, were likely to avoid using a malaria product as they would still hear or be bitten by mosquitoes, or found it it expensive or uncomfortable. Participants in the by-products group, more likely to be females, avoid a malaria product based on heat, odour and side effects. Participants in the bites class
avoid a product if they would still be bitten by mosquitoes. To become widely diffused, the authors suggest that end-users should be included in product development to ensure that preferred attributes or traits are considered. This study demonstrates that end-user preferences can be very different and that one malaria control technology will not satisfy everyone.
The Joint Learning Network (JLN) for Universal Health Coverage held its third workshop, “Expanding Coverage to the Informal Sector,” in Mombasa, Kenya on 6-10 June 2011. Over 65 country level policymakers and practitioners from developing countries, including Kenya, Nigeria and Rwanda, participated in four days of discussions and problem-solving on issues related to providing health coverage to poor and informal sector populations. Participants also exchanged ideas about how to improve operations. Topics included partnerships with community organisations for targeting and enrollment, new information communications technologies for premium payment and enrollment verification, and innovative models to ensure access to health services, such as health camps and partnerships with social franchise networks. Participants also discussed how to deal with multiple schemes in moving toward universal coverage, looking at the case study of Kenya’s National Hospital Insurance Fund and the path to universal health coverage.
Controlled medicines are medicines that are listed under the international conventions on narcotic and psychotropic drugs and their precursors. Global morphine consumption – an indicator of access to pain treatment – has increased over the past two decades, but mainly in a small number of developed countries. Developing countries, which represent about 80% of the world’s population, accounted for only about 6% of global morphine consumption.
According to this paper, puerperal sepsis is an infection contracted during childbirth and one of the commonest causes of maternal mortality in developing countries, despite the discovery of antibiotics over eighty years ago. Some developing countries have recently experienced increased use of health facilities for labour and delivery care and there is a possibility that this trend could lead to rising rates of puerperal sepsis. Drug and technological developments need to be combined with effective health system interventions to reduce infections, including puerperal sepsis. The authors review health system infection control measures pertinent to labour and delivery units in developing country health facilities. Organisational improvements, training, surveillance and continuous quality improvement initiatives, used alone or in combination have been shown to decrease infection rates in some clinical settings. There is limited evidence available on effective infection control measures during labour and delivery and from low-resource settings. The authors argue that a health systems approach is necessary to reduce maternal mortality and the occurrence of infections resulting from childbirth. Organisational and behavioural change underpins the success of infection control interventions. A global, targeted initiative could raise awareness of the need for improved infection control measures during childbirth.
Insecticide-treated bed nets are the preeminent malaria control means, although there is no consensus as to a best practice for large-scale insecticide-treated bed net distribution. In order to determine the paramount distribution method, the author of this review assessed literature on recent insecticide treated bed net distribution programmes throughout sub-Saharan Eastern Africa. She included all studies that had taken place in sub-Saharan Eastern Africa, targeted malaria prevention and control, and occurred between 1996 and 2007. Forty-two studies were identified and reviewed. The results indicate that distribution frameworks varied greatly, and so did outcomes of insecticide-treated bed net use. Studies revealed consistent inequities between urban and rural populations, which were most effectively alleviated through a free insecticide-treated bed net delivery and distribution framework. Cost sharing through subsidies was shown to increase programme sustainability, which may lead to more long-term coverage. Thus, distribution should employ a catch up/keep up programme strategy, the author argues. The catch-up programme rapidly scales up coverage, while the keep-up programme maintains coverage levels.
Each year in Sub-Saharan Africa, South Central Asia and Southeast Asia, 49 million women have unintended pregnancies, leading to 21 million unplanned births, 21 million induced abortions (15 million of which are unsafe), 116,000 maternal deaths and the loss of 15 million healthy years of women’s lives. Seven in 10 women with unmet need for modern contraception in the three regions cite reasons for non-use that could be rectified with appropriate methods. In these three regions, the typical woman with reasons for unmet need that could be addressed with appropriate methods is married, is 25 or older, has at least one child and lives in a rural area. In the short term, women and couples need more information about pregnancy risk and contraceptive methods, as well as better access to high-quality contraceptive services and supplies. In the medium term, adaptations of current methods can make these contraceptives more acceptable and easier to use. Investment in longer-term work is needed to discover and develop new modes of contraceptive action that do not cause systemic side effects, that can be used on demand, and that do not require partner participation or knowledge. Overcoming method-related reasons for non-use of modern contraceptives is projected to reduce unintended pregnancy and its consequences by as much as 59% in these regions.