The World Health Organization (WHO) announced Thursday that Zambia had achieved a major reduction in malaria mortality through accelerated malaria control activities. Malaria deaths reported from health facilities have declined by 66% in Zambia and this result, along with other data, indicates that Zambia has reached the 2010 Roll Back Malaria target of more than 50% reduction in malaria mortality compared to 2000. WHO said Zambia’s efforts would be promoted as a model for other countries to follow. The decline in Zambia was especially steep after 3.6 million long-lasting insecticide nets were distributed between 2006 and 2008. During this period, malaria deaths declined by 47% and nationwide surveys showed that parasite prevalence declined by 53% from 21.8 to 10.2% and the percentage of children with severe anaemia declined by 68% from 13.3 to 4.3%.
Equitable health services
This pilot study in Thailand assessed policies about primary health care (PHC), focusing on how equitably resources are distributed, the adequacy of resources, comprehensiveness of services and co-payment. A questionnaire survey was administered to five policymakers, five academicians and 77 primary care practitioners at a PHC workshop. Responses were consistent: financial resources should be allocated based on different health needs and special efforts must be made to assure PHC to underserved populations. The supply of essential drugs should be adequate, as well, with equitable distribution of services and low out-of-pocket payments. The questionnaire was robust across key stakeholders and feasible for use in transitional or less-developed countries, like those in Africa.
Normally, women have to wait a long time for the results of a pap smear. But, in Uganda, a fast, cheap diagnostic test based on vinegar is invigorating the battle against cervical cancer. Health activists are raising money to put it in a mobile clinic and health officials are eyeing a national rollout. A pilot project in Kampala has begun to demonstrate that cervical cancer screening is possible in small health centres. As part of that project, two clinics began screening women with a fast, innovative test that used acetic acid--or vinegar--as the primary active ingredient. The test, called visual inspection with acetic acid (VIA) is reported to not require a pathologist, refrigeration of samples or a microscope. A nurse, midwife, or gynecologist swabs a patient's cervix with acetic acid and then inspects the tissue visually. The author reports that if the cervix has lesions, the tissue turns white.
This research report analyses the integrated management of childhood illness (IMCI) policy in Tanzania. Two districts in North-Western Tanzania, Bunda and Tarime, in Mara region, were picked to examine the issues around introduction, planning and implementation by district health managers and at facility levels. The paper found that the percentage in health workers that are trained in IMCI case management varies between districts – Bunda at 44% and Tarime at only 5%. The relatively high levels of training in Bunda might be due to early sensitisation of key actors, a higher health budget per capita, local facilitators and strong external support. However, funding is low and IMCI suffers from poor visibility and challenges of monitoring impact compared to vertical programmes, reducing the potential for attracting donor investment.
This policy brief looks at the challenges of implementing the Integrated Management of Childhood Illness (IMCI) strategy in Kenya. It shows that Kenya has made some progress in rolling out the IMCI strategy; however, implementation remains highly inadequate. The three main challenges to implementation are low training coverage, health workers not following guidelines and barriers to accessing services. These challenges reflect a range of IMCI-specific and broader health system constraints. The authors outline recommendations for increasing IMCI coverage and implementation. They argue that urgent action is needed to review pre-service training, scale up in-service training, address facility-level implementation challenges, improve IMCI supervision and build support for the strategy.
Public health facilities in Africa currently stock only about half of a core set of essential medicines, such as those used to treat malaria, pneumonia, diarrhoea, HIV, TB, diabetes and hypertension, which are among the highest causes of death in Africa. The Stop the Stock-outs Campaign is calling on governments and health departments to end stock-outs by providing financial and operational autonomy to the national medicines procurement and supply agency, giving representation of civil society on the board of the agency, ending corruption in the medicine supply chain to stop theft and diversion of essential medicines, providing a dedicated budget line for essential medicines, living up to commitments to spend 15% of national budgets on health care and providing free essential medicines at all public health institutions.
The objective of this paper was to document the inclusion of key medicines for children in national essential medicines lists (EMLs) and standard treatment guidelines, and to assess the availability and cost of these medicines in 14 countries in central Africa. Surveys were conducted in 12 public and private sector medicine outlets in each country’s capital city. Data was collected on medicine availability on the survey day and on the cost to the patient of the lowest-priced medicine in stock. It found that there was considerable variation in prices, which tended to be higher in retail pharmacies, and the availability of key essential medicines for children was poor. Better understanding of the supply systems in the countries studied and of the pattern of demand for medicines is needed before improvements can be made.
In the run-up to International Women's Day, 8 March, the International Committee of the Red Cross (ICRC) warned that the specific health-care needs of women are often ignored or insufficiently taken into account in war situations. ‘People wounded in fighting are given priority for medical treatment, but women, even pregnant mothers, are often given scant attention despite their special needs,’ said the ICRC's adviser on issues relating to women and war. In the world’s least developed countries, many of which are at war, women are 300 times more likely to die in childbirth or from pregnancy-related complications than in developed countries, according to UNICEF. In war time, women are particularly at risk of rape and other forms of sexual violence and they have no means of transportation to reach a health-care facility so as to give birth safely.
This research report analyses the Integrated Management of Childhood Illness (IMCI) policy in Tanzania. Two districts in North-Western Tanzania, Bunda and Tarime, in Mara region, were picked to examine the issues around introduction, planning and implementation by district health managers and at facility levels. The authors found that the percentage in health workers trained in IMCI case management varies between districts, probably due to differing levels of early sensitisation of key actors, a higher health budget per capita, local facilitators and strong external support. However, the cost of case management training is high and it is difficult for districts to finance more than one training session per year. IMCI suffers from poor visibility and challenges of monitoring impact compared to vertical programmes, reducing the potential for attracting donor investment. Therefore, the status of IMCI vs other health programmes at district and national levels needs to be enhanced and key managers need to be equipped with better resources to monitor overall implementation. Strengthening health systems remains a pillar for success of IMCI. Without required drugs, effective supervision, sufficient numbers of health workers with appropriate skill-mix and geographical distribution, it will be difficult to effectively deliver IMCI. Communities need to participate to enable them to know what to expect from facilities and their role in completing IMCI.
Growing awareness of the need for health systems and GHIs to operate in ways that are mutually supportive has prompted those who are responsible for health systems to actively adopt measures that can help integrate and maximise the impact of global health initiatives (GHIs). This report looks at a number of country-specific interventions. In sub-Saharan Africa, political commitment and creativity have helped Malawi to negotiate a successful collaboration with GHIs to strengthen and expand human resources for health – a key element of the health system. Faced with a severe HIV epidemic and crippling health workforce shortages, Malawi has collaborated with GHIs and other donors to overcome fiscal constraints and to implement an Emergency Human Resource Plan. Through task shifting, training and salary top-ups Malawi has been able to expand the health workforce to deliver HIV services and has also been able to meet new demand for a range of health services at the community level. There are widespread concerns around the effects of the proliferation of actors in global public health and the complexity of the channels and systems through which funds and commodities are now provided. The need for coordination, harmonisation and alignment is strongly felt. In particular, countries face the challenges of excessive reporting requirements, conflicting time frames in planning and funding cycles and parallel bureaucracies.