Former Director General of WHO (1973-1988), Halfdan Mahler, said Primary Health Care is essential health care based on scientifically and socially sound methods and technologies that is made available to everyone. It was inspirational to an earlier generation but lost its primary place in public health when it was replaced by vertical programmes, like smallpox eradication, with their single goal, funding and response structure. He cautioned a room packed with hundreds of delegates that to make real progress we should stop seeing the world through medically-tinted glasses. Citing the 'transcended beauty of the Constitution of the WHO', he said that PHC aims to address inequity and social injustices that still plague countries.
Equitable health services
61st World Health Assembly: Primary Health Care is essential
Mahler H: World Health Organisation, 21 May 2008
61st World Health Assembly: Progress on immunisation reported by many countries
World Health Organization, 22 May 2008
More than 40 delegations at the WHA described the status of immunization in their countries, their efforts, future plans and successes. The 68% reduction in measles deaths globally in just six years of accelerated activities points to the potential for such achievements in other areas of immunisation. Constraints raised by governments included financial support especially for new, more expensive life-saving vaccines and for low middle-income countries who are not eligible for support from the GAVI Alliance. The importance of high data quality and injection safety were also of concern to Member States.
Asthma still a big killer
Thom A: Health-e, 6 May 2008
Under-treatment, inappropriate treatment and lack of education for asthma patients in South Africa are contributing to still unacceptably high morbidity rates. The most recent figures reveal that at least 10 percent of South Africans have asthma with many still dying unnecessarily, especially people in poorer households. Asthma deaths are almost all preventable and a 2004 report by the Global Initiative for Asthma found that South Africa has the world's fourth highest asthma death rate among five- to 35-year-olds. Out of every 100 000 South Africans with asthma, 18,5 die of the illness. Asthma therapy is freely available in the government health service. The most effective means of controlling asthma is to use a preventer pump containing an anti-inflammatory. The most cost-effective way of relieving an attack is a pump with a bronchodilator. A study by the University of Pretoria to understand the impact (including the impact on health-related quality of life) of asthma on South African asthmatics found that patients were not accessing treatment or were being inappropriately treated.
It’s evidence time for primary health care
Real Health News, 14 May 2008
WHO Assistant Director General for health systems, Carissa Etienne, stressed the need for evidence, information and research to make cost-effective health policies in developing countries. Specifically, she called for a systematic review of all research on primary health care since Alma Ata to provide real evidence on what works and fails, as well as for research on Community health workers – all against a measure of health outcomes.
Knowledge and healthcare seeking behaviour of pulmonary tuberculosis patients attending Ilala District Hospital, Tanzania
Irani L, Kabalim TK, Kasesela S: Tanzania Journal of Health Research 9(3):169 - 173
A cross-sectional study was conducted, based on systematic sampling of consecutive patients with pulmonary tuberculosis (TB) symptoms and who attended the TB clinic for their medication at Ilala District Hospital, Tanzania. Over half the patients (54.3%) admitted that they openly speak about their illness to others but that only one-third (33.3%) of their friends and family responded in a considerate and sympathetic manner. One-third (36.6%) of the friends and relatives became less friendly and the remaining one-third openly portrayed fear and tried to discriminate the patient even after the commencement of medications. The patients' compliance rate was 100%. The counselling received from the health personnel along with the patients' own motivations to improve their health, was the main driving force in seeking treatment and taking daily medication. Discrimination against TB patients by relatives and friends is likely to hinder positive health seeking behaviour and thus impede control of this disease. This paper discusses identified areas where effort is needed to improve the early management of TB patient.
National audit of critical care resources in South Africa – transfer of critically ill patients
Scribante J, Bhagwanjee S: South African Medical Journal 97(12): 1323-1326
This research sought to establish the efficacy of the current referral system of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. A 100% sample was obtained; 77% of public and 16% of private hospitals have no IC/HC units. Spread of hospitals was disproportionate across provinces. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. In the private hospitals, the mean time to collect was less than an hour. In public hospitals without an ICU, the distance to an ICU was 100 km or less for about 50% of hospitals, and less than 10% of these hospitals were more than 300 km away. For hospitals with units (public and private), the distance to an appropriate hospital was 100 km or less for about 60% of units while for 10% of hospitals the distance was greater than 300 km. For public hospitals without units most patients were transferred by non-ICU transport. In some instances both public and private hospitals transferred ICU patients from one ICU to another ICU in non-ICU transport. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
Nurses to accompany patients to Gauteng hospitals
Khumalo G: BuaNews, 29 May 2008
The Klerksdorp/ Tshepong Hospital Complex have introduced an Escorting Project, which will allow nursing assistants to accompany referral patients to Johannesburg hospitals. The project aims to ensure that patients receive quality care and reduce waiting times. The hospital is the largest provincial hospital operating as the referral hospital for Dr K Kaunda District, Ruth Mopati District as well as tertiary services for the entire province. Hospital Chief Executive Officer, Kathy Randeree said that the hospital recently undertook a mini-survey to determine how best to assist patients who are accessing health services in Gauteng Hospitals. She said that the survey recommended the launch of the project with management resolving to have a pool of escorts for Klerksdorp/ Tshepong hospital so that referred patients are able to have the assistance of an allocated escort for the various hospitals and clinics in Gauteng.
Further details: /newsletter/id/33161
One in three malaria drugs failing in Africa
Health-e, 6 May 2008
Some 35% of antimalarial drugs sold in six major African cities failed basic quality tests. The cities were in Ghana, Kenya, Nigeria Rwanda, Tanzania and Uganda. Artemisinin monotherapies, which the World Health Organisation explicitly rejects as substandard, remain common in Africa. Substandard antimalarial drugs cause an estimated 200,000 avoidable deaths each year.
Referral pattern of patients received at the national referral hospital: Challenges in low-income countries
Mbembati NAA, Museru LM, Lema LEK: East African Journal of Public Health 5(1), May 2008
The study aimed to examine the medical referral pattern of patients received at the Muhimbili National Hospital (MNH) in Tanzania to inform the process of strengthening the referral system. This prospective study was conducted at MNH during a 10-week study period from January to March 2004. The study sample consisted of patients referred to MNH. Of the 11,412 patients seen, 72.5% were self-referrals. More than 70% of the patients seen required admission, though not necessarily at tertiary level. Only 0.8% came from outside the Dar es Salaam region. More than 70% of the patients seen required admission. Surgical services were required by 66.8% of patients, with obstetric conditions being most prominent (24.6% of all patients). For those who were formally referred from other health services, lack of expertise and equipment were the most common reasons given for referral (96.3%). Efforts to improve referral systems in low-income countries require that the primary and secondary level hospitals services be strengthened and increased to limit inappropriate use of national referral hospitals.
Vaccine fund spending US$500m on ‘innovative’ health systems
Real Health News, 14 May 2008
The US$ multi-billion a year GAVI Alliance is spending a fraction of its budget to help its vaccines get to the end of the track, by strengthening health systems in a group of countries in central America, Africa and Asia. GAVI provides support directly to country governments, not through other agencies. Also its large budget and global nature encourages vaccine manufacturers to take a positive view of developing country markets – and thus add relevant, affordable products to their portfolios.