Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
Equitable health services
Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme
Hetzel MW, Iteba N, Makemba A, Mshana C, Lengeler C, Obrist B, Schulze A, Nathan R, Dillip D, Alba S, Mayumana I, Khatib RA, Njau JD, Mshinda H: Malaria Journal 6:83, 29 June 2007
Deficient supplies of drugs for life threatening diseases in an African community
Lufesi NN, Andrew M, Aursnes I: BMC Health Services Research 7:86, 15 June 2007
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres.
Donor leverage: Towards more equitable access to essential medicines?
Chan CK, de Wildt C: In Press
In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centers pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity? This paper will appear in Development in Practice 18(1), February 2008 and also shortly as a UN-DESA working paper.
Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya
Ohrt , Obare P, Nanakorn A, Adhiambo C, Awuondo K, Prudhomme O'Meara W, Remich S, Martin K, Cook E, Chretien J-P, Lucas C, Osoga J, McEvoy P, Owaga ML, Sande Odera J, Ogutu B: Malaria Journal 6:79, 12 June 2007
Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.
Exploratory study of factors that affect the performance and use of rapid diagnostic tests for malaria in the Limpopo Province, South Africa
Moonasar D, Ebrahim Goga A, Frean J, Kruger P, Chandramohan D: Malaria Journal 6:74, 2 June 2007
Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa.
Pain relieving drugs in 12 African countries: Mapping providers, identifying challenges and enabling expansion of pain control provision in HIV and AIDS management
Harding R, Powell RA, Kiyange F: African Palliative Care Association, 2007
This report from the African Palliative Care Association (APCA) identifies a number of problems with the delivery of pain-relief drugs to people with HIV and AIDS. The survey found that the key problems were inadequate and unreliable supplies of drugs, restrictive legislation, poor levels of education and training about prescribing such drugs among clinical staff, and practical problems such as high costs and inadequate storage facilities. The key challenges to overcoming these problems were identified as a lack of political will, the need for education and cultural change among medical practitioners and a lack of resources.
State of the Nation, South Africa 2007: The Promise and the Practice of Transformation: the state of South Africas health system
Fonn S, Schneider H, Barron P: Human Sciences Research Council, 2007
This chapter provides an overview of developments in South Africas health system over the past 12 years, using the WHOs assessment framework. While this framework has good health is an obvious goal, broader social objectives such as responsiveness to the needs of citizens and promotion of equity are also measured. Despite the largely successful efforts to shrug off the legacy of a racially divided health system and to generate numerous transformation initiatives, the reality is that the current system is as problematic as it was 12 years ago.
Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis
Chuma J, Gilson L, Molyneux C: Tropical Medicine & International Health 12(5): 673-686, May 2007
This study investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens.
WHO, Stop TB Partnership release two-year response plan
World Health Organisation, 22 June 2007
Hundreds of thousands of cases of drug-resistant tuberculosis (TB) can be prevented and as many as 134 000 lives saved through the implementation of a two-year response plan, published/launched by WHO and Stop TB Partnership. The Global MDR-TB and XDR-TB Response Plan 2007-2008 sets out measures needed now to prevent, treat and control extensively drug-resistant TB (XDR-TB) and multidrug-resistant TB (MDR-TB). The plan also sets in motion actions to reach a 2015 goal of providing access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients, saving the lives of up to 1.2 million patients.
Zimbabwe fighting the spread of Polio - Again
Kwidini T: Inter Press Service, 25 June 2007
The Zimbabwe government and the United Nations Children’s Fund (UNICEF) conducted a countrywide immunisation programme aimed at eliminating polio and other diseases to prevent children from having the same experience as Chirewa and others. It is a continuation of similar efforts over the past few years. The programme has seen many mothers across the country taking their children to centres around the country for immunisation. About two million children were vaccinated during the week-long programme, not only immunised against polio but also against diseases such as tuberculosis, measles, diphtheria, tetanus, whooping cough and hepatitis B. They also received vitamin A supplements.