This report uses the examples of the health and education sectors to consider South Africa's compliance with the various standards and best practices laid down in relation to the functioning of the public service -- including the African Union Convention on Preventing and Combating Corruption, and the Charter for the Public Service in Africa. While South Africa has many examples of best practice on paper, it is struggling to ensure that these policies are fulfilled in practice: this report offers analysis and suggestions on critical problems for attention.
Equitable health services
South Africa: Effective Delivery of Public Services
AfriMAP, 29 November 2007
Strategies to Achieve Universal Coverage: Are there Lessons from Middle Income Countries?
Mills A: WHO Health Systems Knowledge Network, 2007
This study assesses the evidence regarding strategies used to attain universal coverage and draws out a list of lessons for policy makers, donors and civil society groups. It focuses mainly on middle-income countries that have recently gained, or are close to gaining, universal coverage. It looks at the extent to which various strategies promote equity in terms of financing, access to and use of services. Key financing priorities are to gradually increase risk pooling arrangements over time, and to focus on protecting the poorest and most socially disadvantaged against the costs of health care.
Contextual factors associated with treatment-seeking and higher-risk sexual behaviour in Botswana among men with symptoms of sexually transmitted infections
Langeni T: African Journal of AIDS Research 6(3): 261–269
This study investigates contextual factors associated with treatment-seeking behaviour and higher-risk sexual conduct of men symptomatic of sexually transmitted infections (STIs) in Botswana. At the heart of Botswana's epidemic lies men's reluctance to seek medical treatment, engaging in unprotected sex, and having sex with multiple partners while symptomatic of an STI. The odds of engaging in unprotected sex while symptomatic of an STI were significantly higher among teenage males, males in urban households, where age differences between partners was higher, in married men and men with more than one sexual partner. Having sought medical treatment from hospitals, clinics and health workers, as opposed to consulting traditional healers, significantly reduced the odds of having had unprotected sex while infected with an STI. The results indicate the need to encourage men to utilise public healthcare services. The public health sector in Botswana needs to provide healthcare services that are user-friendly for men. Special attention needs to be paid to boys' socialisation towards gender norms, and men are to be encouraged to play a responsible role in HIV prevention.
Early child development: strategies to ensure children achieve their potential
Engle PL et al: The Lancet 369 (9557): 229-242
This paper assesses strategies to promote child development and to prevent or limit the loss of development potential. The programmes reviewed have been implemented in developing countries since 1990. Thirty-five such studies were identified of which 20 met the researchers’ criteria. They fell into three groups: centre-based early learning, parenting and parent-child programmes, and comprehensive programmes that include health and nutrition interventions. The researchers identify factors that are consistently associated with effective programmes and identify a need to establish globally accepted monitoring indicators for child development and for more evaluation. They conclude with a discussion of priorities and crucial issues for future programmes.
Sound Choices at the Global Forum for Health Research, Beijing, October 2007
Alliance for Health Policy and Systems Research, December 2007
While health systems constraints are increasingly recognized as primary barriers to the scaling up of health services and achievement of health goals, knowledge regarding how to improve health systems is often weak and frequently not well-utilised in policy-making. This Review addresses a mismatch between what is known about how to respond to particular health problems in poor economies and what is actually done about them. It focuses on one cause of the problems that ensue from the mismatch – capacity constraints.
Transgender bodies, identities, and healthcare: Effects of perceived and actual violence and abuse
Witten TM: Research in the Sociology of Health Care 25: 225-249, 15 December 2007
“Disparity” implies the existence of a “markedly distinct in quality or character,” difference between one group and another. Some groups, due to elevated stigma associated with group membership, are invisible as a disparate minority and therefore, while there may be a great inequity in healthcare between that group and the normative population, the invisible minority is ignored. This chapter addresses the issue of healthcare for the transgender-identified population. It addresses how the normative viewpoint of mental illness and unacceptable religious status, along with lifelong perceived and actual abuse and violence, creates a socially sanctioned inequality in healthcare for this population.
Not enough research to treat TB-HIV properly
Thom A: Health-e, 2 November 2007
Health systems cannot properly diagnose, treat, or contain the co-epidemic of HIV and tuberculosis (TB) because not enough is known about how the two diseases interact. A report by leading global health experts warned that the largely “unnoticed collision” of the global epidemics of HIV and TB has exploded to create a deadly co-epidemic that is rapidly spreading in sub-Saharan Africa. About one-third of the world’s 40 million people with HIV/AIDS are co-infected with TB, and the mortality rate for HIV-TB co-infection is five-fold higher than that for tuberculosis alone.
Cancer care in sub-Saharan Africa – urgent need for population-based cancer registries
Okobia MN: Ethiopian Journal of Health Development, 2007
This article reviews literature on cancer statistics in sub-Saharan Africa, and assesses the need for population-based cancer registries to enhance cancer care and prevention within the region. The article finds that there are few cancer registries in sub-Saharan Africa and most of these are hospital based. This is partly because in many countries cancer is a low priority as more emphasis is placed on the control of communicable diseases and improving environmental sanitation.
Challenges Facing Community Home Based Care Programmes in Botswana
Odek AW, Oloo JA: East African Social Science Research Review 23 (2): 1-18, 2007
This study examines the role of Community Home-Based Care in Botswana for people with HIV/AIDS and those with other terminal illnesses. Kerkhoven and Jackson (1995) attribute the popularity of Community Home-Based Care (CHBC) programmes in the developing countries to high rates of HIV/AIDS. Botswana has adult HIV/AIDS prevalence rate of 37 per cent and over 350,000 people living with HIV/AIDS. Rapid rise in incidences of HIV/AIDS has hence resulted in increasing need for CHBC and thus many CHBC services have been established through disorganized and fragmented manners. This paper is an extended literature review. It identifies and discusses challenges facing CHBC programmes in Botswana. The findings indicate that poverty, high cost of community care, inadequate medical facilities, poor infrastructures and socio-cultural issues have threatened the sustainability of CHBC programmes in Botswana. Recommendations and policy options are discussed.
Controlling cancer in developing countries: prevention and treatment strategies merit further study
Disease Control Priorities Project, 2007
This paper discusses the burden of cancer in developing countries and examines which types of cancers can be prevented and treated affordably in low-resource settings and which interventions can be used to control them. The paper concludes that to guide policymakers on the most effective cancer control strategies in developing countries, more work is needed in: clinical evaluations of cancer control interventions, health services research, and country specific economic evaluations. It recommends that since current knowledge about cancer control is incomplete, developing countries should start in small areas and gain knowledge from well-documented pilot programmes. Starting small might entail focusing on individuals with certain high-risk characteristics or in a limited geographic area, and scaling up should occur only after pilot programmes have been shown to perform well.