This paper highlights and promotes the enormous potential that exists between these two initiatives that seek to address closely related issues and targeting the same populations at risk within a fairly well defined geographical setting. It also attempts to argue that malaria control, just like HIV-Aids control be given high priority in the New Partnership for Africa's Development (NEPAD) health agenda, as current statistics indicate that malaria is again on the rise. While much attention and billions of dollars have rightly been given to HIV and Aids research, treatment and prevention, malaria, and not Aids, is the region's leading cause of morbidity and mortality for children under the age of five years. This is the bad news. The good news is that unlike Aids, malaria treatment and prevention are relatively cheap. In addition, there is a payback to fighting malaria; support aimed directly at improving health, rather than poverty reduction, may be a more effective way of helping Africa to thrive. Robust and sustained growth may come to Africa through a mosquito net, Artemisinin-based Combination Therapies (ACTs) or a malaria vaccine, rather that a donor's cheque for economic development initiatives.
Equitable health services
This Code of Conduct for Health Systems Strengthening offers guidance on how international non-governmental organisations (NGOs) can work in host countries in a way that respects and supports the primacy of the government’s responsibility for organising health system delivery. The code is intended to be clear, direct, succinct and action-oriented. There are six areas where NGOs can do better: 1) hiring policies; 2) compensation schemes; 3) training and support; 4) minimising the management burden on government due to multiple NGO projects in their countries; 5) helping governments connect communities to the formal health systems; and 6) providing better support to government systems through policy advocacy.
The study seeks to improve understanding of maternity health seeking behaviours in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
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.
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.
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.
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.
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.
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.
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.