This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB), and treatment seeking behaviour, among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. Fifty-nine (84.1%) patients had good knowledge on the transmission of TB. The majority (75%) of the respondents were of the opinion that the incidence of TB was on the increase mainly due to the AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60%) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68%) visited public health facilities for treatment as their first action. Overall, 83.8% respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Most of the respondents said they were well attended by service providers. Half and 59.3% of the males and females, respectively, mentioned good patient-service provider relationship as an important reason for satisfaction of the service. Twenty-nine respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. There is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care.
Equitable health services
This report presents finding of a nationwide Expenditure Tracking and Service Delivery Survey in Mozambique from August to Ocotober 2002. The study focuses on the primary health care system, which is often the only source of health care for most Mozambicans. The data offers a unique perspective on interactions between different levels of the health system, particularly related to financing, allocation, distribution and use of resources. The report covers a broad set of issues including institutional context, budget managemet, cost recovery, drug allocation and distribution, human resources, infrastructure and equipment, and service outputs.
Inadequate levels of immunisation against childhood diseases remain a significant public health problem in resource-poor areas of the globe. Nonetheless, the reasons for incomplete vaccination and non-uptake of immunisation services are poorly understood. This study aimed at finding out the reasons for non-vaccination and the magnitude of missed opportunities for vaccination in children less than two years of age in a rural area in southern Mozambique. Mothers of children under two years of age (N = 668) were interviewed in a cross-sectional study. The Road-to-Health card was utilised to check for completeness and correctness of vaccination schedule as well as for identifying the appropriate use of all available opportunities for vaccination. The chi-square test and the logistic regression were used for statistical analysis. The researchers found that 28.2% of the children had not completed the vaccination program by two years of age, 25.7% had experienced a missed opportunity for vaccination and 14.9% were incorrectly vaccinated. Reasons for incomplete vaccination were associated with accessibility to the vaccination sites, no schooling of mothers and children born at home or outside Mozambique. Efforts to increase vaccination coverage should take into account factors that contribute to the incomplete vaccination status of children. Missed opportunities for vaccination and incorrect vaccination need to be avoided in order to increase the vaccine coverage for those clients that reach the health facility, specially in those countries where health services do not have 100% of coverage.
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.
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.