Equitable health services

Angola to boost polio eradication programme
IRIN News: 25 January 2011

The Angolan government is preparing to renew efforts to eradicate polio with support from global partners, including the Bill and Melinda Gates Foundation, which has made polio eradication its top priority. Angola succeeded in stamping out polio for three consecutive years at the beginning of the century, but a strain of the virus prevalent in India reappeared in 2005 and has since spread to the neighbouring countries of Namibia, the Democratic Republic of Congo and the Republic of Congo. In 2010, 32 people in Angola contracted the highly infectious and incurable disease. Angola's health system, still recovering from years of war, only managed to fully vaccinate 35% of infants in 2009. According to UNICEF, supplementary immunisation campaigns have been beset by a lack of manpower, technical capacity and planning, particularly in Luanda where most of the polio cases in recent years have been concentrated. Since the war, Luanda's population has boomed, and many of the rural migrants live in cramped conditions with little access to safe water and sanitation. Such conditions are ideal for spreading polio, which is transmitted through faecal-oral contact. During a meeting on 24 January 2011 with Anthony Lake, UNICEF Executive Director, and Tachi Yamada, president of The Gates Foundation's global health programme, José Eduardo dos Santos, Angola’s president, reaffirmed the government's commitment to eradicating polio. The government's strategy consists of better surveillance of new polio cases, accelerated routine immunisation of children, better-quality vaccination campaigns and a campaign to promote household water treatment and hygiene.

Anti-fakes bill threatens access to generics
Kimani D: The East African, 8 September 2008

Kenyan health activists last week slammed the country’s proposed anti-counterfeiting law, saying that provisions had been slipped into it to prevent the importation of cheap generic medicines. They say the Kenya Anti-Counterfeit Bill 2008 does not distinguish between medicines and ordinary items such items as pens, DVDs and batteries, and also contravenes the provisions of the 2001 Industrial Property Act (IPA), which paved the way for the widespread use of generic ARVs to manage HIV/AIDS. The Bill contains various ambiguities, which, if misinterpreted or abused, would be detrimental to the government’s ongoing efforts to ensure access to essential medicines for all Kenyans. These ambiguities should be addressed in order to ensure that interested parties, including the multinational pharmaceutical industry, do not misuse the Bill as a front to discriminate against more affordable generic competition.

Antimicrobial resistance among children in sub-Saharan Africa
Williams P; Isaacs D; Berkley J: The Lancet Infectious Diseases, doi: http://dx.doi.org/10.1016/S1473-3099(17)30467-X, 2017

Antimicrobial resistance is an important threat to international health. Therapeutic guidelines for empirical treatment of common life-threatening infections depend on available information regarding microbial aetiology and antimicrobial susceptibility, but sub-Saharan Africa lacks diagnostic capacity and antimicrobial resistance surveillance. The authors systematically reviewed studies of antimicrobial resistance among children in sub-Saharan Africa since 2005. Among neonates, gram-positive bacteria were responsible for a high proportion of infections among children beyond the neonatal period, with high reported prevalence of non-susceptibility to treatment advocated by the WHO therapeutic guidelines. There are few up-to-date or representative studies given the magnitude of the problem of antimicrobial resistance, especially regarding community-acquired infections. Research should focus on differentiating resistance in community-acquired versus hospital-acquired infections, implementation of standardised reporting systems, and pragmatic clinical trials to assess the efficacy of alternative treatment regimens.

Antimicrobial resistance: translating political commitment into national action
Inoue H; Minghui R: Bulletin of the World Health Organisation 95(4) 241-312, 2017

Antimicrobial resistance is one of the most complex global health challenges today. Worsening antimicrobial resistance could have serious public health, economic and social implications around the world and could cause as much damage to the global economy as the 2008 financial crisis. Since May 2015, progress has also been made in the implementation of global commitments in this area. Over one hundred countries have completed, or are about to complete, their national multi-sectoral action plans. WHO has established a global antimicrobial resistance surveillance system to track which drug-resistant pathogens are posing the biggest challenge. Based on a review and analysis of national guidelines and prescribing practices for 20 common syndromes, WHO is revising the antibiotics included in the WHO model list of essential medicines. The organisation has also rolled out a global awareness-raising campaign targeting policy-makers, health and agriculture workers and communities. To scale up activities, the authors suggest that governments can build on existing regulatory frameworks, surveillance systems, laboratory and infection control infrastructure and human resources that are already in place to manage drug resistance in tuberculosis, HIV and malaria. Both at global and country level, much more still needs to be done. An ad hoc interagency coordination group is being established by the United Nations (UN) Secretary-General, in consultation with WHO, the Food and Agriculture Organisation of the UN and the World Organisation for Animal Health. WHO is preparing proposals for a global development and stewardship framework to support the development, control, distribution and appropriate use of new antimicrobial medicines, diagnostic tools, vaccines and other interventions. By May 2017, all countries should have their national action plans ready, as called for by World Health Assembly resolution 68.7. To see tangible progress, the authors argue that these global commitments must be translated into coherent regional and national action across the entire spectrum of diseases and pathogens.

Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital
Bebell L; Ngonzi J; Bazira J et al.: PLoS ONE 12(4) 2017, doi: https://doi.org/10.1371/journal.pone.0175456

Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. The authors performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care. The study found for women in rural Uganda with postpartum fever, a high rate of antibiotic resistance among cultured urinary and bloodstream infections, including cephalosporin-resistant Acinetobacter species. They recommend that increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities.

Apocalypse or redemption? Responding to extensively drug-resistant tuberculosis
Upshur R, Singh J and Ford N: World Health Organization Bulletin, June 2009

The World Health Organization (WHO) has launched an eight-point plan to respond to extensively drug-resistant tuberculosis (XDR-TB): strengthen the quality of basic TB and HIV/AIDS control; scale up programmatic management of multi-drug-resistant TB (MDR-TB) and XDR-TB; strengthen laboratory services; expand MDR-TB and XDR-TB surveillance; develop and implement infection control measures; strengthen advocacy, communication and social mobilization; pursue resource mobilisation at all levels; and promote research and development of new tools. Additional considerations included: conducting adherence research; building the evidence-base for infection control practices; supporting communities affected by TB; enhancing public health response, while addressing the social determinants of health; embracing palliative care; and advocacy for research.

Appeal to the World Health Organisation on the health situation in Zimbabwe
Community Working on Health: December 2008

The Community Working Group on Health (CWGH) in Zimbabwe, with a membership of about 35 civil society organisations representing a wide range of constituent groups, has called on the World Health Organisation to address the severe decline in heath and in the health system in Zimbabwe. It recognises that the current health crisis does not emanate from the health sector but from wider economic collapse. The CWGH urges WHO and partners to more widely address what needs to be done and what resources and support are needed to rebuild health systems from primary health care level upwards, and to involve communities in deliberations and plans on the way forward. Zimbabweans, they indicate, are not numbers of cholera cases or fatalities but people who have responded to an increasingly difficult situation, who are entitled to health as a right and who should be central in any response and rehabilitation of the health system.

Further details: /newsletter/id/33701
Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programmes
Hirschhorn LR, Baynes C, Sherr K, Chintu N, Awoonor-Williams J, Finnegan K et al: BMC Health Services Research 13(Suppl 2):S8, 31 May 2013

In this study, researchers describe the approaches to defining and improving quality of health services across the five country programmes funded through the Doris Duke Charitable Foundation African Health Initiative. They describe the differences and similarities across the programmes in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programmes measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality. Learning the value and challenges of these approaches to measuring and improving quality across the key components of health system strengthening as the projects continue their work, the authors conclude.

Are foreigners stealing your jobs and healthcare? Find out
Heleta S: NGO pulse, Sangonet, April 2019

Clinic and hospitals in the public sector in South Africa are stretched, but the author argues that this is not because of immigrants as is being proposed in some quarters, but because of understaffing, poor planning and other problems. A 2018 World Bank study showed that between 1996 and 2011, every immigrant worker generated two jobs for South Africans, mostly because their diverse skill sets led to productivity gains and multiplier effects. Immigrants also contribute to the national fiscus through payment of VAT and purchase goods and services, such as rent, from South Africans. The author calls for xenophobic blaming of foreigners to be resisted and for South Africans to see this for what it is: scapegoating of immigrants to hide domestic failures

Are vaccination programmes delivered by lay health workers cost-effective? A systematic review
Corluka A, Walker DG, Lewin S, Glenton C and Scheel IB: Human Resources for Health 2009, 7(81), 3 November 2009

This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving lay or community health workers (LHWs). Articles were retrieved if the title, keywords or abstract included terms related to 'lay health workers', 'vaccination' and 'economics'. Reference lists of studies assessed for inclusion were also searched and attempts were made to contact authors of all studies included in the Cochrane review. Of the 2,616 records identified, only three studies fully met the inclusion criteria, while an additional 11 were retained as they included some cost data. There was insufficient data to allow any conclusions to be drawn regarding the cost-effectiveness of LHW interventions to promote vaccination uptake. Studies focused largely on health outcomes and did illustrate to some extent how the institutional characteristics of communities, such as governance and sources of financial support, influence sustainability. Further studies on the costs and cost-effectiveness of vaccination programmes involving LHWs should be conducted, and these studies should adopt a broader and more holistic approach.