Equitable health services

Benefits of global partnerships to facilitate access to medicines in developing countries: A multi-country analysis of patients and patient outcomes in GIPAP
Kanavos P, Vandoros S and Garcia-Gonzalez P: Globalization and Health 5(19), 31 December 2009

Chronic Myeloid Leukemia (CML), a rare disease, can be treated effectively, but the pharmaceutical treatment available (imatinib) is costly and unaffordable by most patients. 'GIPAP' is a programme set up between a manufacturer and a non-governmental organisation to provide free treatment to eligible CML patients in 80 countries worldwide. This study discusses the socio-economic and demographic characteristics of patients participating in GIPAP. It researches the impact GIPAP is having on health outcomes (survival) of assistance-eligible CML patients and discusses the determinants of such outcomes and whether there are any variations according to socio-economic, demographic, or geographical criteria. Data for 13,568 patients across 15 countries, available quarterly, was analysed over the 2005-2007 period. GIPAP was found to have a significant positive effect on patient access to medicines for CML and on survival rates.

Best practices for an insecticide-treated bed net distribution programme in sub-Saharan eastern Africa
Sexton AR: Malaria Journal 10(157), 8 June 2011

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.

Better access to effective antimalarials
ID21 Health News, June 2008

Malaria is one of the main reasons why people use health services in sub-Saharan Africa, placing a considerable burden on primary health care. The Affordable Medicines Facility-malaria (AMFm) is a supply-side intervention designed to reduce malaria mortality by improving the availability and affordability of effective treatment. It also aims to delay the development of drug resistance through the use of artemisinin, in combination with other medicines, rather than as a monotherapy. Access to artemisinin-based combination therapies by people living in poverty – those without public facilities and unable to afford artemisinin-based combination therapies at subsidised prices – is a concern. The AMFm will support an enhanced public sector and NGO distribution of artemisinin-based combination therapies, often without charge but supplementary initiatives at PHC level, such as home-based management of malaria, will still be needed.

Better breast cancer services urgently needed
Health-e, 31 October 2007

At the close of breast cancer awareness month, cancer organisations say proper testing and treatment services for breat cancer are completely inadequate. Breast cancer organisations are concerned that early detection and treatment services are severely lacking in South Africa where over 3 000 women die from this disease annually. The Breast Cancer Advocacy Coalition have sent a memorandum to the South African health department asking it to improve services. The coalition calls for a comprehensive breast health service that is equitable, available, affordable and accessible to all women in South Africa.

Birth preparedness among antenatal clients
Mutiso SM, Qureshi Z and Kinuthia J: East African Medical Journal 85(6):275–283, 2008

This paper set out to evaluate birth preparedness and complication readiness among antenatal care clients at Kenyatta National Hospital, Nairobi, Kenya. A total of 394 women attending antenatal care were systematically sampled to select every third interviewee for the study. The paper found that over 60% of the respondents were counselled by health workers on various elements of birth preparedness and many were aware of their expected date of delivery, had set aside funds for transport to hospital or for emergencies and knew at least one danger sign in pregnancy. Level of education positively influenced birth preparedness. However, education and counselling on different aspects of birth preparedness was not provided to all clients, especially about danger signs in pregnancy, birth preparedness and plans for emergencies.

Botswana confirms first case of XDR-TB
Motseta S, Nullis C: Mail and Guardian Online, 17 January 2008

Health authorities reported the first known cases of virtually untreatable tuberculosis in Botswana, following fears that the highly contagious strain has spread beyond South Africa. For the past few months, health professionals have warned that XDR-TB, although only confirmed in South Africa, had spread to other Southern African nations like Swaziland and Lesotho hard hit by the AIDS pandemic, but hadn't been diagnosed because of lack of laboratory facilities.

Breaking down the silos of Universal Health Coverage: towards systems for the primary prevention of non-communicable diseases in Africa
Oni T; Mogo E; Ahmed A; Davies J: BMJ Global Health 4(4), doi: http://dx.doi.org/10.1136/bmjgh-2019-001717, 2019

The third sustainable development goal (SDG), ensuring healthy lives and well-being for all at all ages, although comprising multiple components, is often strongly linked with the concept of universal health coverage (UHC) and its underlying principles of equity, quality and financial protection. While addressing the upstream determinants of health is seen as a vital accelerator of progress in achieving the SDGs, in practice, UHC has often been focused on a disease-fighting, healthcare-centric approach. African countries are not on track to achieve global targets for non-communicable disease (NCD) prevention, driven by an insufficient focus on ecological drivers of NCD risk factors, including poor urban development and the unbridled proliferation of the commercial determinants of health. As the risk factors for NCDs are largely shaped outside the healthcare sector, an emphasis on downstream healthcare service provision to the exclusion of upstream population-level prevention limits the goals of UHC and its potential for optimal improvements in (achieving) health and well-being outcomes in Africa. The author argues for a systems for health rather than a solely healthcare-centric approach, that proactively incorporates wider health determinants (sectors)—housing, planning, waste management, education, governance and finance, among others—in strategies to improve health. This includes aligning governance and accountability mechanisms and strategic objectives of all ‘health determinant’ sectors for health creation and long-term cost savings. Researchers are seen to have a vital role to play, collaborating with policy makers to provide evidence to support implementation and to facilitate knowledge sharing between African countries.

Breaking the boundaries of depression
Langa L: Health-e News, 21 April 2010

The Perinatal Mental Health Project in Cape Town, which offers counselling to mothers throughout their pregnancy, is playing a role by tackling depression in the initial stages of the pregnancy. While most programmes only tackle cases of depression among pregnant women after the birth of the baby, the Perinatal Mental Health Project (PMHP) at the University of Cape Town intervenes during the early stages of pregnancy. Simone Honikman, director of the project said severe cases of depression could be treated more successfully if detected early. According to PMHP, South Africa’s postnatal depression (PND) prevalence is three times that in developed countries. For over eight years the PMHP has screened about 8,000 pregnant women for mental health conditions, while up to 1 234 women have been counselled as part of this free service. The PMHP model is one of integration. Mental health care is provided on site together with antenatal care services. This means that the mothers needing help can access this service at the same service point where they receive other health care related to the pregnancy.

Breathing life into DRC's sick hospital
Winter J: BBC News International, 8 August 2006

This story describes the experience of Professor Stanis Wembonyama as director of the main hospital in Democratic Republic of Congo's second city, Lubumbashi, last year. Gecamines, the state-owned mining monopoly used to be in charge - theoretically - of the Jason Sendwe Hospital, but the institution had been left to rot. Most of the beds had been either stolen or stripped down and sold as scrap metal. Doctors and nurses had not been paid their salaries for five years and so they earned their living by demanding cash before treating their patients. The story outlines the steps to clean up the hospital and instil management discipline.

Bridging the gap between biomedicine and traditional healing
Buisnessinafrica, 17 April 2006: Etkind J

Nearly 18 months ago, South Africa’s Traditional Health Practitioners Bill made a triumphal passage through parliament, raising hopes in the hearts of the 300 000 or so practising traditional healers in South Africa that they might at last begin to ply their trade on an equal footing with their biomedical counterparts. The legislation included allowing traditional healers’ patients to claim through medical aid schemes, giving them access to government hospitals and clinics and demanding the same respect and courtesy accorded to general practitioners, surgeons and other biomedical professionals.