Equitable health services

Africa malaria day: Action or bombast?
The American Daily: Innis R

Parents and children will continue dying from malaria, until Europe rejects its colonialist past. But every year calls for action turn out to be mere bombast, as healthcare agencies refuse to go beyond bed nets and capacity building, radical greens continue to obstruct proven strategies, and disease and death rates climb. This year, however, things may be different. Archbishop Desmond Tutu, Greenpeace co-founder Patrick Moore, and hundreds of physicians, clergy and human rights advocates have joined in demanding that DDT be put back into the malaria control arsenal.

Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria
Tropical Medicine and International Health 11 (3): 299–313: Njau JD, Goodman C, Kachur SP

In mid-2001 a large rural household survey was conducted in Tanzania to investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. Findings reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. Also, poorest groups benefited least from these new and highly effective antimalarials. The report was presented at the EQUIWRITE Workshop in Durban, South Africa.

Patterns of sexually transmitted infections in adolescents and youths in Dar es Salaam, Tanzania
Muhimbili University Health Exchange Forum: Chalamilla C, Mbwana J, Mhalu F, et al

This study set out to investigate the relationship between the syndromic management of STI, specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic in Dar es Salaam, Tanzania. Findings reflected that the burden of STIs in this youth population is large indicating that youth are at increased risk of STIs and will certainly require youth friendly clinics, and the need to refine the current syndromic management guidelines.

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'
Beran D, Yudkin JS, de Courten M: BioMed Central Health Services Research 2006; 6: 17

In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali.

Community referral in home management of malaria in western Uganda: A case series study
Kallander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S: BioMed Central International Health and Human Rights 2006, 6:2

Home Based Management of fever (HBM) was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed to febrile children under-five years in the community. Persisting fever or 'danger signs' are referred to the health centre. Functioning referral to health centres is a critical assumption in HBM. We assessed overall referral rate, causes of referral, referral completion and reasons for non-completion under the HBM strategy.

Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century
Nutbeam in Health Promotion. International..2000; 15: 259-267

Health literacy is a composite term to describe a range of outcomes to health education and communication activities. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. A ‘health outcome model’ is presented, which highlights health literacy as a key outcome from health education.

HealthCast 2020: Creating a Sustainable Future
PricewaterhouseCoopers, 2006

The health systems of nations around the world may be unsustainable if unchanged over the next 15 years. Globally, healthcare is threatened by a confluence of powerful trends -- increasing demand, rising costs, uneven quality, misaligned incentives. If ignored, these trends will overwhelm health systems, creating massive financial burdens as well as health problems for current and future generations.

Seeking equity in maternal health
The Lancet

Inequity in reproductive health between and within countries is well documented, and even where indicators improve, disparities between rich and poor are as likely to be increasing as decreasing. In addition to improving access, it must also be ensured that services are widely used. Because advantaged groups are known to be more apt at using preventive services, the disparity in outcome measures between rich and poor is likely to increase.

Advocating a public health approach to palliative care

National programmes for palliative care offer the most effective means of improving the quality of life for the greatest number of patients and families, even where resources are severely constrained. Palliative care, however, is low on the list of under-resourced governments' health care priorities. What part can advocacy play in raising its profile and promoting its value? According to the World Health Organisation, a public health approach to palliative care has three foundations: Governmental policy: adoption of a national palliative care strategy; Education: training of health care professionals and creating awareness among the general public; Drug availability: assuring the availability of drugs for pain control and symptom management.

Challenging inequity in health

This volume, Challenging Inequities in Health, was conceived as a response to concerns about widening “health gaps” both between and within countries; A disproportionate research focus on inequalities in health in the “North” to the relative neglect of the “South”; and Inadequate analytic tools and pragmatic policies to redress health inequities. Through a collective effort of researchers and practitioners called the Global Health Equity Initiative (GHEI), a set of in-depth country studies and conceptual analyses on health equity were undertaken. The main findings of this effort are presented in this book with the central claim that issues of equity, or distributive justice, deserve primary consideration in health and social policy deliberations.

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