The overarching aim of this study was to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. The broader context of the study is the 'urban health crisis'; a term that refers to the disparity between the increasing need for medical care in urban areas against the declining carrying capacity of existing public health systems. The analysis illustrates how more sophisticated GIS-based analytical techniques can be usefully applied in support of strategic spatial planning of urban health services delivery. The study offers two frameworks for analysis. Its evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators, while its intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. When used together, these two planning instruments offer a flexible framework with which health planners can formulate and evaluate alternative intervention scenarios and deal with the most important problems involved in the spatial planning of urban health services.
Equitable health services
The Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994 offers a comprehensive framework for achieving sexual and reproductive health and rights, including the prevention and treatment of HIV and AIDS, and for advancing other development goals. However, combating HIV remains a separate project with malaria and tuberculosis. This paper presents a brief history of key decisions made by major international donors that have led to the separation of HIV and AIDS from its logical programmatic base in sexual and reproductive health and rights. In urging a return to the original ICPD construct as a framework for action, the paper calls for renewed leadership commitment, investment in health systems to deliver comprehensive sexual and reproductive health services, including HIV prevention and treatment, comprehensive youth programmes, streamlined country strategies and donor support. All investments in research, policies and programmes should build systematically on the natural synergies inherent in the ICPD model.
The control of sexually transmitted infections (STIs) is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: targeting and outreach to populations at greatest risk; promoting and providing condoms and other means of prevention; effective clinical interventions; an enabling environment; and reliable data. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations. STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.
Over 4,000 men are diagnosed with prostate cancer every year in South Africa and more than half of them die, according to the Cancer Association of South Africa (CANSA). These numbers could be reduced if more men were screened. Vanitha Naidoo, head of health programmes at CANSA in KwaZulu Natal, explained that screening for prostate cancer was expensive, making it difficult for more men to access it. ‘Unfortunately there is currently no institution that offers free screenings for prostate cancer to our knowledge, which means people have to go to private care to be screened and not everyone can afford that. Most people are dependent on public hospitals and clinics for their health needs,’ she said. According to the National Cancer Registry (NCR) prostate cancer is the first of the five leading male cancers and it affects one in 23 men. ‘If screening was applied to prostate cancer as it is with other cancers such as breast and cervical cancer there would be a greater chance of diagnosing more men and offering them treatment. If a day was set aside for men to get free screening at hospitals we could see a reduction in men who die from the condition,’ said Dr Tjaart Fourie, head of Urology at the University of KwaZulu Natal.
This paper briefly reviews global progress and challenges with respect to public vaccination programmes. The most striking recent achievement has been that of reduction of global measles mortality from an estimated 750,000 deaths in 2000 down to 197,000 in 2007. Global vaccination coverage trends continued to be positive. In 2007 most regions reached more than 80% of their target populations with three doses of DPT containing vaccines. However, the coverage remains well short of the 2010 goal on 90% coverage, particularly in the WHO region of Africa, while had only 74% coverage. Remaining challenges include the need to: develop and implement strategies for reaching the difficult to reach; support evidence-based decisions to prioritise new vaccines for introduction; strengthening immunisation systems to deliver new vaccines; expand vaccination to include older age groups; scale up vaccine preventable disease surveillance; improve quality of immunisation coverage monitoring and use the data to improve programme performance; and explore financing options for reaching the GIVS goals, particularly in lower middle-income countries.
Landmines are the third leading cause of amputations in Mozambique, after diabetes and road accidents, and the threat they still pose – more than 17 years after peace came to the country following four decades of independence and civil wars – still looms large. There are no benefits for the survivors of landmine blasts, nor for those who died or their next of kin, so there is no incentive to report incidents of landmine accidents to the authorities. In one of the world's poorest nations, assistance for the disabled is often far down the list of priorities. There are government-run orthopaedic centres in the ten provincial capitals, except Manica Province, where it is situated in Chimoio, but essential equipment is faulty or lacking entirely. For example, in Inhambane (in central Mozambique, currently the most mined province) the orthopaedic centre is not open. In Beira, Mozambique's second-largest city, the oven to make prosthetics is broken and has not been replaced. The situation at orthopaedic centres in Mozambique does not meet minimum standards.
Human papillovirus (HPV) types 16 and 18 are responsible for about 70% of all cervical cancer cases worldwide. This report provides key information for Kenya on cervical cancer, other anogenital cancers and head and neck cancers, HPV-related statistics, factors contributing to cervical cancer, cervical cancer screening practices, HPV vaccine introduction, and other relevant immunisation indicators. The report is intended to strengthen the guidance for health policy implementation of primary and secondary cervical cancer prevention strategies in the country. Kenya has a population of 10.32 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that, every year, 2,635 women are diagnosed with cervical cancer and 2,111 die from the disease. Cervical cancer ranks as the most frequent cancer among women in Kenya, and the second most frequent cancer among women between 15 and 44 years of age. About 38.8% of women in the general population are estimated to harbour cervical HPV infection at a given time, and 60.9% of invasive cervical cancers are attributed to HPVs 16 or 18.
To detect malaria people might soon be able to chew a stick of gum and swipe it over a magnet or scan a finger with ultra-far infrared light. These are some of the winning proposals for the Bill and Melinda Gates Foundation Grand Challenges awards, which invite researchers to find non-invasive diagnostic alternatives for priority global health conditions such as malaria, tuberculosis and HIV. To date, all commercially available malaria tests require extracting blood, partly because up to now it has been more difficult to detect malaria in other body fluids. Andrew Fung, who is developing the chewing gum test, said: ‘By working in a user's mouth this test will operate at a higher temperature, and millions of microscopic particles will be examined across a small surface area [the gum], increasing the test's sensitivity.’ Winner Lu, from the University of Michigan, is pioneering the infrared option by tapping into body level vibrations rather than testing molecules, making this test highly sensitive too. To date one of the drawbacks of the 60 rapid diagnostic tests currently on the market has been that they are unregulated, so while some are quite sensitive and can provide 95–100% accuracy, others provide far less accurate results.
The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralisation of mental health services to district level, as set out in the new Mental Health Care Act, No. 17 of 2002, and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to de-institutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. The paper recommends that, in a similar vein to other low- to middle-income countries, de-institutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
This paper considers new developments to strengthen sexual and reproductive health and HIV links and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these links. It argues that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision. A lack of common understanding of terminology and clear technical operational guidance, and separate policy, institutional and financing processes continue to represent significant constraints. The paper draws on experience with tuberculosis and HIV integration to highlight some lessons. It concludes that there is little evidence to determine whether funding for health systems is strengthening links, and makes several recommendations to maximise opportunities represented by recent developments.