A Chronic Disease Outreach Programme (CDOP), based on the chronic care model was used to follow patients with diabetes and hypertension, support primary health care nurses (PHCNs), and improve health systems for management in Soweto. A group of 257 diabetes patients and 186 PHCN were followed over two years, with the study including the evaluation of ‘functional’ and clinical outcomes, diary recordings outlining program challenges, and a questionnaire assessing PHCNs’ knowledge and education support, and the value of CDOP. CDOP was successful in supporting PHCNs, detecting patients with advanced disease, and ensuring early referral to a specialist centre. It improved early detection and referral of high risk, poorly controlled patients and had an impact on PHCNs’ knowledge. Its weaknesses include poor follow up due to poor existing health systems and the programme’s inability to integrate into existing chronic disease services. The study also revealed an overworked, poorly supported, poorly educated and frustrated primary health care team.
Equitable health services
Several African governments have launched a drive to strengthen the continent's laboratories to a standard that will enable them to gain accreditation from the United Nations’ World Health Organization (WHO). Only a few African laboratories have WHO accreditation. Experts at a launch of the initiative in the Rwandan capital, Kigali, said better-quality laboratory services would help lower the death toll from treatable diseases like HIV and AIDS, tuberculosis and malaria, which kill more than five million Africans annually. One of the reasons so few African laboratories have gained accreditation is the time-consuming nature of current procedures. The launch was attended by policy-makers and experts from Botswana, Cameroon, Cote d'Ivoire, Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Ghana, Uganda and Zambia. ‘Stronger laboratories with better systems and practices in place will mean better patient care and treatment and, through the use of high-quality laboratories, can be swifter,’ said a spokesperson.
Using the data from the South African World Health Survey (WHS), this study aimed to evaluate the degree of health care service responsiveness (both out-patient and in-patient) and comparing experiences of individuals who used public and private services in South Africa. Data was used from a population-based survey of 2,352 male and female participants, which was conducted in South Africa in 2003. Major components identified for out-patient care responsiveness in this survey were highly correlated with health care access, communication and autonomy, secondarily to dignity, confidentiality and quality of basic amenities, and thirdly to health problem solution. The degree of responsiveness with publicly provided care was in this study significantly lower than in private health care –16.8% versus 3.2%. Health care access, communication, autonomy, and discriminatory experiences were identified as priority areas for actions to improve responsiveness of health care services in South Africa.
Risk communication guidelines widely used in public health are based on the psychometric paradigm of risk, which focuses on risk perception at the level of individuals. However, infectious disease outbreaks and other public health emergencies are more than public health events and occur in a highly charged political, social and economic environment. This study examines other sociological and cultural approaches from scholars such as Ulrich Beck and Mary Douglas for insights on how to communicate in such environments. It recommends developing supplemental tools for outbreak communication to deal with issues such as questions of blame and fairness in risk distribution and audiences who do not accept biomedical explanations of disease.
South Africa witnessed a 20% increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV and AIDS accounting for 43.7% of all deaths. Almost four (38.4%) out of every 10 deaths were ‘clearly avoidable within the health care system’, according to researchers, which means they could have been prevented with proper care. The report recommends that the department of health addresses maternal deaths by: improving health care provider knowledge and skills in providing emergency care and ensuring adequate screening and treatment of the major causes of maternal death; improving the quality and coverage of reproductive health services, namely contraceptive and termination of pregnancy services; better management of staffing and equipment norms, transport and availability of blood for transfusion; and community involvement and empowerment regarding maternal, neonatal and reproductive health in general.
When considering the declining quality of emergency obstetrical surgery in Tanzania, lack of access to facilities, not a shortage of qualified staff, is the issue, argues this paper. Five countries in sub-Saharan Africa use non-physicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers (AMOs) – secondary school graduates with several years of medical training – perform most of this type of surgery outside the cities. The researchers compared obstetrical surgery performed by Tanzanian AMOs with surgery performed by medical officers (MOs) – medical school graduates with at least one year of internship and a licence to practice medicine and surgery. They found no significant differences between AMOs and MOs in outcomes, risk indicators or quality of care indicators. With 1,300 AMOs now trained for this kind of surgery, there are enough surgeons to meet the need in Tanzania. But hospitals are widely spaced and transport is difficult, so that fewer than one-third of Tanzanian women in need of major obstetrical surgery make it to a hospital that can do the job.
Despite widely acknowledged WHO guidelines for the integration of tuberculosis (TB) and HIV services, heavily burdened countries have been slow to implement these and thus significant missed opportunities have arisen. The individual-centred, rights-based paradigm of the national AIDS policy remains dissonant with the compelling public-health approach of TB control. The existence of independent and disconnected TB and HIV services wastes scarce health resources, increases burden on patients' time and finances, and ignores evidence of patients' preference for an integrated service, resulting in ongoing missed opportunities, such as failure to maximise collaborative disease surveillance, voluntary counselling and testing, adherence support, infection control, and positive prevention. The full potential of an integrated TB-HIV service has not been fully harvested. Missed opportunities discount existing efforts in both programmes, will perpetuate the burden of disease, and prevent major gains in future interventions. This paper outlines simple, readily implementable strategies to narrow the gap and reclaim existing missed opportunities.
This document provides advice to clinicians on the use of the currently available antivirals for patients presenting with illness due to influenza virus infection as well the potential use of the medicines for chemoprophylaxis. While the focus is on management of patients with pandemic influenza (H1N1) 2009 virus infection, the document includes guidance on the use of the antivirals for other seasonal influenza virus strains, and for infections due to novel influenza. WHO recommends that country and local public health authorities issue local guidance for clinicians from time to time that places these recommendations in the context of epidemiological and antiviral susceptibility data on the locally circulating influenza strains. It emphasises that healthy people, namely those without chronic or acute diseases, do not need the antivirals.
This paper, covering the period 2002–2008, describes how multisectoral teams at district level in Kenya have provided post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. The paper also found that, between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$27, with numbers increasing each year. Almost half (43%) of these were children younger than 15. The paper outlines how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
At least 6,000 people have been displaced by inter-clan fighting in Kenya's southwestern district of Kuria East, on the Tanzania border, according to humanitarian officials. The Red Cross has provided emergency relief aid for the displaced. The worst affected areas include Wagirabosi/Targai location in Ntimaru Division, inhabited by the Buirege clan; and Girigiri sub-location, and the villages of Nguruna, Getongoroma and Kebaroti in Kegonga Division. The Kenyan Red Cross said there were reports of gunshots along the Nyabasi-Buirege border on 22 June and that attacks and counter-attacks since late May had resulted in the displacement of at least 6,290 people and the burning of 765 homes. According to the Red Cross, health services have taken a knock, as there is no ambulance in Kuria East to support referrals and patients, while water and sanitation facilities remain critical, especially in camps for internally displaced people.