Equitable health services

Cervical cancer screening in Zambia saves lives
Plus News: 18 February 2010

Cervical cancer is a leading killer among women living with HIV, but a low-cost screening programme developed in Zambia is proving that simple techniques can go a long way in saving lives. New research presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco has shown that cervical cancer screening among HIV-positive women prevented one death for every 32 women screened. The research originated from a pilot study of about 6,600 HIV-positive women examined as part of the Cervical Cancer Prevention Programme in Zambia (CCPPZ), an ongoing low-cost screening project. More than half the women had abnormal results, and about 20% were diagnosed as having lesions at varying stages from pre-cancerous to advanced cancer. Screening by the programme's service costs about US$1 as compared to pap smears that cost about $15 and remain prohibitively expensive even in richer countries like South Africa. To keep costs this low, the programme enables health workers and nurses to carry out screening and treatment, allowing doctors - already in short supply - to perform other tasks. The screening programme has also drawn interest from other countries, including Botswana, Tanzania and Cameroon, which have sent delegations for training.

Cervical cancer vaccines considered for public sector
Langa L: Health-e, 29 July 2009

African first ladies have vowed to raise awareness on cervical cancer, one of the leading causes of death among women on the continent. Taking the lead, Tobeka Madiba-Zuma, one of South Africa’s first ladies appealed to everyone attending the third Stop Cervical Cancer in Africa conference in Cape Town to join her in paying tribute to millions of women who lost their lives to the illness. ‘A healthy nation consist of a healthy working class and women are very important part our economy’, she said. Madiba-Zuma said she hoped to use her position to advocate for more attention to be paid to breast and cervical cancer. The focus of this year’s conference was on improving cervical cancer prevention through vaccination, pre-cancer screening and treatment. Delivering the keynote address at the conference, Molefi Sefularo, Deputy Minister of Health, revealed that the National Department of Health was considering making available two cervical cancer vaccines in the public sector. ‘We still need to do a cost-benefit analysis and decide which of the two vaccines would be more beneficial to the country,’ he added.

Challenges Facing Community Home Based Care Programmes in Botswana
Odek AW, Oloo JA: East African Social Science Research Review 23 (2): 1-18, 2007

This study examines the role of Community Home-Based Care in Botswana for people with HIV/AIDS and those with other terminal illnesses. Kerkhoven and Jackson (1995) attribute the popularity of Community Home-Based Care (CHBC) programmes in the developing countries to high rates of HIV/AIDS. Botswana has adult HIV/AIDS prevalence rate of 37 per cent and over 350,000 people living with HIV/AIDS. Rapid rise in incidences of HIV/AIDS has hence resulted in increasing need for CHBC and thus many CHBC services have been established through disorganized and fragmented manners. This paper is an extended literature review. It identifies and discusses challenges facing CHBC programmes in Botswana. The findings indicate that poverty, high cost of community care, inadequate medical facilities, poor infrastructures and socio-cultural issues have threatened the sustainability of CHBC programmes in Botswana. Recommendations and policy options are discussed.

Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals
Chang H; Hawley N; Kalyesubula R; Siddharthan T; et al: International Journal for Equity in Health 18(38) 1-14, 2019

This study aimed to understand the challenges in managing hypertension and diabetes care in rural Uganda. The authors conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals, and 12 community health workers in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. The results included patient knowledge gaps regarding the preventable aspects of hypertension and diabetes, mistrust in the Ugandan health care system rather than in individual health care professionals and skepticism from both health care professionals and patients regarding a potential role for village health team members in hypertension and diabetes management. In order to improve hypertension and diabetes management in this setting, the authors recommend taking actions to help patients to understand non communicable diseases as preventable, for health care professionals and patients to advocate together for health system reform regarding medication accessibility, and promotion of education, screening and monitoring activities at community level in collaboration with village health team members.

Challenging inequity in health

This volume, Challenging Inequities in Health, was conceived as a response to concerns about widening “health gaps” both between and within countries; A disproportionate research focus on inequalities in health in the “North” to the relative neglect of the “South”; and Inadequate analytic tools and pragmatic policies to redress health inequities. Through a collective effort of researchers and practitioners called the Global Health Equity Initiative (GHEI), a set of in-depth country studies and conceptual analyses on health equity were undertaken. The main findings of this effort are presented in this book with the central claim that issues of equity, or distributive justice, deserve primary consideration in health and social policy deliberations.

Changes in malaria morbidity and mortality in Mpumalanga Province, South Africa (2001-2009): a retrospective study
Ngomane L and de Jager C: Malaria Journal 11(19), 13 January 2012

This study aimed to assess the changes in the burden of malaria in Mpumalanga Province during the past eight malaria seasons (2001/02 to 2008/09) and whether indoor residual spraying (IRS) and climate variability had an effect on these changes. This is a descriptive retrospective study based on the analysis of secondary malaria surveillance data (cases and deaths) in Mpumalanga Province. Within the study period, a total of 35,191 cases and 164 deaths due to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09. The incidence and case fatality (CFR) rates for the study period were 134 cases per 100,000 and 0.54%, respectively. Mortality due to malaria was lower in infants and children and higher in those >65 years, with the mean CFR of 2.1% as compared to the national target of 0.5%. Mpumalanga Province has achieved the goal of reducing malaria morbidity and mortality by over 70%, partly as a result of scale-up of IRS intervention in combination with other control strategies. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved. However, the goal to eliminate malaria as a public health problem requires efforts to be directed towards the control of imported malaria cases; development of strategies to interrupt local transmission; and maintaining high quality surveillance and reporting system.

Changes in the burden of malaria following scale-up of malaria control interventions in Mutasa District, Zimbabwe
Mharakurwa S, Mutambu SL, Mberikunashe J, Thuma PE, Moss WJ and Mason PR: Malaria Journal 12(223), 1 July 2013

To better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe. Data on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011. Results showed that malaria control interventions were scaled up through the support of several global initiatives, the newer artemisinin-based combination therapy was adopted by all health clinics by 2010, diagnostic capacity improved and vector control was implemented. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%). In conclusions, the burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

Changing global policy to deliver safe, equitable, and affordable care for women’s cancers
Ginsburg O; Badwe R; Boyle P; et al.: The Lancet, 1 November 2016, doi: http://dx.doi.org/10.1016/S0140-6736(16)31393-9

Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women’s health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women’s health and global cancer control, with new approaches to bringing policy to action. .

Child Mental Health Services in the New South Africa
Milne M, Robertson B: Child Psychology and Psychiatry Review 3: 128-134

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.

Childbirth information feeds for first-time Malawian mothers who attended antenatal clinics
Malata A and Chirwa E: Malawi Medical Journal 23(2): 42-46, June 2011

This study identified childbirth information needs of Malawian women as perceived by Malawian mothers and midwives in order to design a childbirth education programme. A total of 150 first-time mothers who attended antenatal clinics at selected central, district and mission hospitals were interviewed. Four focus group discussions were conducted with four different types of midwives, followed by individual interviews with midwives in key positions in government and non-governmental organisations. Results indicated the view that the content of the childbirth education programme for pregnant mothers should include: self-care during pregnancy, nutrition during pregnancy, common discomforts of pregnancy, danger signs of pregnancy, sexually transmitted diseases and preparation for delivery. It was also proposed that programmes address possible complications during labour and birth, caesarean birth and non-pharmaceutical pain relief measures in labour, as well as self-care during postnatal period, exclusive breast feeding, care of the newborn baby, danger signs of puerperium, care of the newborn baby and family planning.