This paper explores the organisation of health care work in primary care clinics in Cape Town by analysing two elements of clinic organisation as rituals: a formal, policy-driven element of care – directly observed therapy for tuberculosis patients – and an informal ritual – morning prayers in the clinic. Seven clinics providing care to people with tuberculosis were sampled. Findings suggest that, rather than seeing the ritualised aspects of clinic activities as merely traditional elements of care that potentially interfere with the application of good practice, it is essential to understand their symbolic value if their contribution to health care organisation is to be recognised. These rituals embody the conflicting values of patients and staff in these clinics and reinforce asymmetrical relations of power between different constituencies, strengthening conventional modes of provider-patient interaction.
Equitable health services
Government has revealed its National Influenza Pandemic Preparedness Plan in the event of an outbreak of swine flu in the country. Dr. Frew Benson, the Chief Director of Communicable Diseases in the Department of Health, explained to the media how the team would respond after being alerted of a suspected case. ‘They would go out to that particular case, investigate, take all the epidemiological data around this case, make certain that the case is isolated and trace all the contacts of this case. They will then make sure, if the case meets the criteria for treatment with anti-virals’, he said. The department has assured the public that it has stockpiled more than enough batches of the anti-viral drug, Tamiflu, which has been found to be effective against swine flu. ‘We’ve got 100,000 doses (of Tamiflu) and more available if need be. We have more than 10 times more than was needed in the Mexican outbreak,’ he added.
Responsibility to take forward a still in-progress framework to cope with global influenza pandemics is now in the hands of the World Health Organization Director General Margaret Chan. The framework is intended to set forth guidelines for the sharing of viruses, vaccines, and other benefits related to pandemic strains of influenza. This includes mechanisms for tracing and reporting outbreaks, as well as for capacity building, technology transfer, and stockpiles of vaccines. It also includes a model binding contract for entities sharing viruses with pandemic potential.
The cholera epidemic in southern Africa continues to abate, but international and local health authorities stress the need to remain vigilant, the United Nations has reported. There were a total of 4,579 new cases between 3 and 17 April in the nine countries – Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe – affected by the often fatal disease since August 2008. During the two weeks preceding 3 April, 6,460 new cases were reported. Authorities warn, however, that cholera could re-appear in the coming one to three weeks, when waters from flooding in the region, which has affected more than 1.2 million people, subside and become stagnant.
There were 1.37 million new TB cases in 2007 among HIV-infected people and 456,000 deaths, says a new global TB report by the World Health Organization. One out of four TB deaths is HIV-related, twice as many as previously recognised. Despite an improvement in the quality of the country data, which are now more representative and available from more countries than in previous years, these shocking findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV. According to Dr Margaret Chan, Director-General of WHO, 'We need to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases,' she said.
Haemorrhage is the leading causes of obstetric mortality. Studies show that active management of third stage of labour (AMTSL) reduces post partum haemorrhage. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Correct practice of AMTSL was observed in only 7% of 251 deliveries. Knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.
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%.
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.