Sub-Saharan Africa (SSA) communities suffer a disease burden that is aggravated by shortage of medical personnel and medical supplies such as medical devices. This paper outlines how for a long time, observation and practical experiences meant that people learned to use different plant species that led to the emergence of traditional medicine (TM) systems. The ancient Pharaonic Egyptian TM system is for example, said to be one of the oldest documented forms of TM practice in Africa and a pioneer of world’s medical science. These medical practices diffused to other continents and were accelerated by advancement of technologies while leaving Africa lagging behind in the integration of the practice in formal health-care system. The author raises issues that drag back integration, such as the lack of development of education curricula for training TM experts as the way of disseminating the traditional medical knowledge and practices. A few African countries such as Ghana have managed to integrate TM products in the National Essential Medicine List while South Africa, Sierra Leone, and Tanzania have TM products being sold over the counters due to the availability of education training programs. This paper analyses the contribution of TM practice and products in modern medicine and gives recommendations that Africa should take in the integration process to safeguard the SSA population from disease burdens.
Equitable health services
Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). In this study, the authors explored the distributions in the utilisation MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH as key for health equity, using Demographic and Health Surveys data of 12 countries in SSA. Some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilisation in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from ‘adequate antenatal care’ to ‘adequate delivery care’ (0.32) and to ‘adequate child’s immunisation’ (0.36); from ‘adequate delivery care’ to ‘adequate postnatal care’ (0.78) and to ‘adequate child’s immunisation’ (0.15) were positively associated and statistically significant. Only the path relationship from ‘adequate postnatal care’ to ‘adequate child’s immunisation’ (−0.02) was negatively associated and significant. In conclusion, utilisation of each level of MNCH care is related to the next level of care, that is – antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child’s immunisation. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child’s immunisation program could serve towards improving maternal and infant health outcomes and equity.
The needs of caregivers of children with disability may not be recognized despite evidence to suggest that they experience increased strain because of their care-giving role. This strain may be exacerbated if they live in under-resourced areas. The authors set out to establish the well-being of caregivers of children with Cerebral Palsy (CP) living in high-density areas of Harare, Zimbabwe. In addition, the authors wished to identify factors that might be predictive of caregivers’ well-being. Finally, they examined the psychometric properties of the Caregiver Strain Index (CSI) within the context of the study. Caregivers of 46 children with CP were assessed twice, at baseline, and after three months, for perceived burden of care and health-related quality of life. The psychometric properties of the CSI were assessed post hoc. The caregivers reported considerable caregiver burden with half of the caregivers reporting CSI scores in the ‘clinical distress’ range. Many of the caregivers experienced some form of pain, depression and expressed that they were overwhelmed by the care-giving role. No variable was found to be associated with clinical distress. The authors propose that caregivers be monitored routinely for their level of distress and that there is an urgent need to provide them with support. The CSI is likely to be a valid measure of distress in this population.
Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV) and to acquired immunodeficiency syndrome (AIDS) than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. This study explored and described the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs, as were providers. The authors argue that inputs from people at grass roots level be integrated during policy development to ensure that informal settlement residents are provided with accessible reproductive health services. It was further found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.
This study assesses universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. The authors obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. The weighted proportion of participants with access to basic chronic care ranged from 21% in Mexico to 48% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 15% in China to 55% in Ghana. Financial hardship was more common among poor people in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. No country provided access to basic chronic care for more than half of the participants with chronic illness. Poor people were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. The authors argue that future health reforms should aim to improve service quality and increase democratic oversight of health care.
The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection. First, it must consider the part it played in relation to an important public health question: why did this epidemic take hold and spread in this unprecedented manner? Second, it must use the lessons learnt to answer the subsequent question: what can be done now to prevent further such outbreaks in the future? The authors contribute to the current self-reflection by presenting an analysis using a Primary Health Care (PHC) approach. This approach is appropriate as African countries in the region affected by EVD have recommitted themselves to PHC as a framework for organising health systems and the delivery of health services. The approach suggests that, in an epidemic made complex by weak pre-existing health systems, lack of trust in authorities and mobile populations, a broader approach is required to engage affected communities. In the medium-term health system development with attention to primary level services and community-based programmes to address the major disease burden of malaria, diarrhoeal disease, meningitis, tuberculosis and malnutrition is needed. This requires the development of local management and an investment in human resources for health. Crucially this has to be developed ahead of, and not in parallel with, future outbreaks. In the longer-term a commitment is required to address the underlying social determinants which make these countries so vulnerable, and limit their capacity to respond effectively to, epidemics such as EVD.
MamaYe is a campaign initiated by Evidence for Action, a multi-year programme which aims to improve maternal and newborn survival in sub-Saharan Africa. It is led by African experts in the six countries, Nigeria, Ghana, Sierra Leone, Ethiopia, Malawi and Tanzania and supported by experts in academic and other institutions specialising in maternal and newborn health. MamaYe has produced a factsheet to summarise the evidence on Malawi’s blood services, including how much blood is collected and how much is needed. Just over one third of blood needed in Malawi is being collected. The factsheet covers the importance of blood for preventing maternal deaths, the 4 key components of World Health Organization’s strategy for safe and effective use of blood and achievements in Malawi in blood donation and availability. The factsheet also reviews continued challenges for availability of blood in Malawi and an overview of Malawi’s blood transfusion services, including: the organisation of the blood transfusion services; blood supply; donor population; blood use towards maternal, newborn and child health; and blood safety and screening.
Three global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) for 2016-2021 were adopted by the 2016 World Health Assembly, outlining key actions to be undertaken by countries and WHO, along five strategic directions, over the course of the next six years. The HIV strategy aims to achieve "fast-track" targets by 2020 towards ending AIDS by 2030. The hepatitis strategy – the first of its kind - introduces the first-ever global targets, including the target to eliminate viral hepatitis as a public health threat by 2030. For the HIV strategy, a central element for success will be country efforts to implement "Treat All" recommendations.
The Ebola outbreak shocked the world of global health. Even while Ebola lingers in West Africa the future of health security and the organisation of health systems are being debated. There have been many conferences held and reports published to provide “lessons learned from the Ebola crisis. A thread running through all of these events has been an agreement on the need to build resilient health systems. Yet building such a system requires planning, investment and serious long term commitment. Short term investment does not produce the necessary workforce needed for a functioning health system. Dhillon and Yates identified 5 key areas that require immediate attention in order to rebuild health systems: community based systems; access to generic medicines; restoring preventive measures; integrating surveillance into health systems and strengthening management. The author identifies 6 critical foundations for resilient health systems: An adequate number of trained health workers, including non-clinical staff and Community Health Workers (CHWs), available medical supplies, including medicines, diagnostics and vaccines, robust health information systems, including surveillance, an adequate number of well-equipped health facilities including access to clean water and sanitation, adequate financing and a strong public sector to deliver equitable, quality services. The author argues that building resilient systems that protect people’s health and deal with outbreaks has to address all the six elements of the system simultaneously and systematically and that a long term global commitment for building health systems must start now.
In this blog, the author reports that in Tanzania, less than one in 10 (9%) of sexually active youth who want to avoid pregnancy use modern contraceptives and that 22.8% of young women between the ages of 15 and 19 are mothers, according to the Tanzania Demographic and Health Survey 2010. Tanzanian women, the survey shows, have an average of 5.4 children each. Early childbearing and high rates of fertility put stress on the health and education systems, on the availability of food and clean water, and on natural resources, according to the country's National Family Planning Costed Implementation Plan. Tanzania has committed to Family Planning 2020 (FP2020), to ensure that, in line with the United Nations secretary general's global strategy for women, children, and adolescent health, all women have access to contraceptives by 2020. The aut5hor indicates that its needed: 47% of Tanzania's population is 15 years or younger. In Tanzania, family planning has been synonymous with child spacing for married men and women, as typified by posters and brochures featuring monogamous couples with their three distinctly spaced children. But the term "family planning" doesn't resonate with young people because they are not yet ready to start families. He notes therefore that as a result, the global health workers' advocacy and support group, IntraHealth International, has started referring to it as "future planning."