Equitable health services

Activists call for integrated HIV/TB services
Plus News: 3 June 2010

A consortium of AIDS organisations has given the South African government three months to deliver on promises to integrate tuberculosis (TB) and HIV services. A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF) and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in Durban, which took place from 1–4 June 2010. MSF spokesperson Lesley Odendal called the three-month deadline 'generous' because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implemention plan. TAC Deputy Secretary General, Lihle Dlamini, noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs.

Adherence to TB treatment in Ethiopia: Why do patients default?
Tesfaye H: PLoS Med 4 (4): e165, 24 April 2007

This paper outlines the main findings on reasons for adherence to TB treatment in Ethiopia, including physical lack of access to the treatment centre as the main cause of failure to adherence to therapy.

Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda
Atuyambe L, Mirembe F, Tumwesigye NM, Johansson A, Kirumira EK and Faxelid E: Reproductive Health, 30 December 2008

This paper reports on a cross-sectional study conducted between May and August,2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult)were interviewed using a structured questionnaire. The study calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. It found that adolescent mothers showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatisation and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. The authors propose that adolescent-friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.

Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews
Wiysonge CS, Ngcobo NJ, Jeena PM, Madhi SA, Schoub BD, Hawkridge A et al: BMC Public Health 12:578, 31 July 2012

In this study, researchers assessed challenges and enablers for the Expanded Programme on Immunisation (EPI) in South Africa, in light of the approaching 2015 deadline for the Millennium Development Goals. Between September 2009 and September 2010 they requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. Systematic reviews on the effectiveness of the proposed solutions were added. Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes. The findings from reliable systematic reviews indicate that interactive educational meetings, audits and feedback, and supportive supervision improve healthcare worker performance. The authors conclude that numerous promising strategies for improving EPI performance in South Africa were found but their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation.

Advancing the application of systems thinking in health: why cure crowds out prevention
Bishai D, Paina L, Li Q, Peters DH, Hyder AA: Health Research Policy and Systems 12(28), 2014

This paper illustrates unintended consequences of apparently rational allocations to curative and preventive services, using computer modelling. The model exhibits a “spend more get less” equilibrium in which higher revenue by the curative sector is used to influence government allocations away from prevention towards cure. Spending more on curing disease leads paradoxically to a higher overall disease burden of unprevented cases of other diseases. The authors suggest that this paradoxical behaviour of the model can be stopped by eliminating lobbying, eliminating fees for curative services and ring-fencing public health funding. The authors have created an artificial system as a laboratory to gain insights about the trade-offs between curative and preventive health allocations, and the effect of indicative policy interventions. The underlying dynamics of this artificial system resemble features of modern health systems where a self-perpetuating industry has grown up around disease-specific curative programs like HIV/AIDS or malaria. The model shows how the growth of curative care services can crowd both fiscal and policy space for the practice of population level prevention work, requiring dramatic interventions to overcome these trends.

Advocating a public health approach to palliative care

National programmes for palliative care offer the most effective means of improving the quality of life for the greatest number of patients and families, even where resources are severely constrained. Palliative care, however, is low on the list of under-resourced governments' health care priorities. What part can advocacy play in raising its profile and promoting its value? According to the World Health Organisation, a public health approach to palliative care has three foundations: Governmental policy: adoption of a national palliative care strategy; Education: training of health care professionals and creating awareness among the general public; Drug availability: assuring the availability of drugs for pain control and symptom management.

Africa faces cancer ‘catastrophy’
Thom A: Health-e, 26 October 2007

Experts warn of impending crisis in health systems geared towards epidemics not chronic diseases such as cancer. Unless urgent attention is paid to decreasing the burden of cancer, there are going to be catastrophic results especially in Africa and parts of Asia, experts warned at a gathering in Cape Town in October 2007. Thirty countries in Africa and Asia had no access whatsoever to radiotherapy.

Africa malaria day: Action or bombast?
The American Daily: Innis R

Parents and children will continue dying from malaria, until Europe rejects its colonialist past. But every year calls for action turn out to be mere bombast, as healthcare agencies refuse to go beyond bed nets and capacity building, radical greens continue to obstruct proven strategies, and disease and death rates climb. This year, however, things may be different. Archbishop Desmond Tutu, Greenpeace co-founder Patrick Moore, and hundreds of physicians, clergy and human rights advocates have joined in demanding that DDT be put back into the malaria control arsenal.

Africa must address cancer or face massive suffering, says Seffrin
Thom A: Health-e, 2 September 2009

This interview was conducted with Dr John Seffrin, CEO of the American Cancer Society (ACS), who spoke about the cancer challenges facing Africa. By next year cancer is set to become the biggest killer in the world, killing more people than HIV/AIDS, TB and malaria combined. In Africa, people are dying of cancers that are curable in the developed world. Cancer is a growing problem in Africa but is given little attention as the continent is overwhelmed by many other problems. There are relatively low cancer prevalence rates in Africa, but a high growth of the cancer burden. This is argued to call for health promotion for people who don’t have cancer and palliative care for people who have late-stage disease.

Africa must face the challenge of urban malaria
id21 Health News, December 2006

As more Africans move from rural areas to the cities the risk of urban malaria increases. City health services need to focus on poor people who are most at risk from the disease. Malaria programmes should operate on a district by district basis as levels of malaria can vary dramatically throughout the city.