In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
Equitable health services
To investigate the effect of case management programmes on TB incidence, this paper carried out a comparative analysis of factors that could be key direct or indirect determinants of national TB incidence trends over 1997–2006. Cases of TB (in all its forms) reported annually to WHO were used to calculate trends in incidence rate, the latter expressed as the number of cases notified annually in a given country per 100 000 population. The striking observation in this study was that, more than a decade after directly observed therapy was first implemented, none of the seven direct measures of TB programme performance was associated with TB trends globally. National TB control programmes play a vital role in curing TB patients and preventing deaths, as the diagnosis and treatment of active TB have significantly reduced disease transmission and incidence in some countries. However, treatment programmes have not had a major, detectable effect on incidence on a large scale. The possible reasons are that: patients are not diagnosed and treated soon enough to significantly reduce transmission; case detection, cure and TB incidence trends cannot be measured accurately; there has been insufficient time to see the effects of reduced transmission; and any effects on transmission are offset by a growing risk of developing TB following infection.
A new laboratory in the College of Health Sciences at Uganda's Makerere University will conduct tuberculosis diagnosis and research to the highest international standards. ‘The lab is built with world-class TB diagnostic capacity,’ Moses Joloba, head of the department of microbiology at Makerere University's medical school, said at the opening ceremony on 28 August. ‘Normally difficult-to-treat TB infection will be diagnosed here.’ The new lab will be sued for clinical trials of a potential TB vaccine. The currently available TB vaccine, Bacille Calmette-Guerin (BCG), was developed nearly 90 years ago and provides some protection against serious forms of TB in children. However, it is not reliable against pulmonary TB, which accounts for much of the global disease burden. Uganda ranks 16th out of the 22 countries in the world with the highest TB burden. Insufficient resources, non-adherence to TB treatment, poor access to healthcare services and a limited number of skilled staff and diagnostic facilities all contribute to the country's TB epidemic.
Some manufacturers announced in July that the H1N1 vaccine is available, but that doesn’t mean it’s ready for use, as it needs regulatory approval. Regulatory authorities are considering the best way to register these vaccines as quickly as possible. The consensus is that the first doses will be available to governments for use in September. The World Health Organization (WHO) has a cross-organisational operation that is in place to secure vaccines for developing countries, spearheaded by the Director-General’s Office and the legal and vaccine departments. WHO is engaged in three types of activities. The first is to negotiate donations with manufacturers. Second, it is working with other manufacturers to reserve a portion of their vaccine production for WHO at a reduced price. Third, it is working with governments to raise funds to purchase vaccines, as well as with 11 vaccine manufacturers based in developing countries, providing them with seed financing and technical expertise to help them produce influenza vaccine domestically.
African first ladies have vowed to raise awareness on cervical cancer, one of the leading causes of death among women on the continent. Taking the lead, Tobeka Madiba-Zuma, one of South Africa’s first ladies appealed to everyone attending the third Stop Cervical Cancer in Africa conference in Cape Town to join her in paying tribute to millions of women who lost their lives to the illness. ‘A healthy nation consist of a healthy working class and women are very important part our economy’, she said. Madiba-Zuma said she hoped to use her position to advocate for more attention to be paid to breast and cervical cancer. The focus of this year’s conference was on improving cervical cancer prevention through vaccination, pre-cancer screening and treatment. Delivering the keynote address at the conference, Molefi Sefularo, Deputy Minister of Health, revealed that the National Department of Health was considering making available two cervical cancer vaccines in the public sector. ‘We still need to do a cost-benefit analysis and decide which of the two vaccines would be more beneficial to the country,’ he added.
Almost US$1 million worth of anti-malaria drugs are missing or have expired in Tanzania's medical warehouses, this audit has found. Artemisinin combination therapy (ACT) drugs worth US$819,000 are missing and stock worth US$130,000 has expired, highlighting problems with internal control mechanisms. In addition, glitches in the procurement process led to an oversupply and the consequent expiry of ACTs - which have a relatively short shelf-life - in warehouses around the country. The Global Fund has asked the Tanzanian office of international audit firm Price-Waterhouse-Coopers to investigate.
This study reviewed 26 randomised controlled trials of preventive, oral iron supplementation in young children (aged 0–59 months) living in developing countries to ascertain the associated health benefits and risks. It found that among iron-deficient or anaemic children, haemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anaemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron deficient children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programmes may need to be targeted through identification of iron-deficient children.
A Chronic Disease Outreach Programme (CDOP), based on the chronic care model was used to follow patients with diabetes and hypertension, support primary health care nurses (PHCNs), and improve health systems for management in Soweto. A group of 257 diabetes patients and 186 PHCN were followed over two years, with the study including the evaluation of ‘functional’ and clinical outcomes, diary recordings outlining program challenges, and a questionnaire assessing PHCNs’ knowledge and education support, and the value of CDOP. CDOP was successful in supporting PHCNs, detecting patients with advanced disease, and ensuring early referral to a specialist centre. It improved early detection and referral of high risk, poorly controlled patients and had an impact on PHCNs’ knowledge. Its weaknesses include poor follow up due to poor existing health systems and the programme’s inability to integrate into existing chronic disease services. The study also revealed an overworked, poorly supported, poorly educated and frustrated primary health care team.
Several African governments have launched a drive to strengthen the continent's laboratories to a standard that will enable them to gain accreditation from the United Nations’ World Health Organization (WHO). Only a few African laboratories have WHO accreditation. Experts at a launch of the initiative in the Rwandan capital, Kigali, said better-quality laboratory services would help lower the death toll from treatable diseases like HIV and AIDS, tuberculosis and malaria, which kill more than five million Africans annually. One of the reasons so few African laboratories have gained accreditation is the time-consuming nature of current procedures. The launch was attended by policy-makers and experts from Botswana, Cameroon, Cote d'Ivoire, Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Ghana, Uganda and Zambia. ‘Stronger laboratories with better systems and practices in place will mean better patient care and treatment and, through the use of high-quality laboratories, can be swifter,’ said a spokesperson.
Using the data from the South African World Health Survey (WHS), this study aimed to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa. Data was used from a population-based survey of 2,352 male and female participants, which was conducted in South Africa in 2003. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care –16.8% versus 3.2%. Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.