This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
Equitable health services
This report aims to present the evidence that supports the case for expanded access to cancer care and control (CCC) in low and middle income countries (LMICs), and describe innovative models for achieving this goal. The document summarises information from 56 countries. The report emphasises that innovation in delivery systems, increased access to affordable vaccines and medications, innovative financing mechanisms to make care accessible and affordable are of great importance in terms of CCC. The authors call for promoting prevention policies that reduce cancer risk, mobilising all public and private stakeholders in the cancer arena, and expanding training opportunities for researchers in LMICs. They recommend that national cancer control programmes in LMICs must work systematically to adapt global guidelines for national cancer prevention, treatment, and palliation programmes. Also, they must strengthen procurement and distribution systems and ensure regulation of quality and safety. Cancer detection and treatment should be made more accessible and affordable through diagnostic tests and medications that are more easily delivered in remote settings. Governments must expand access across the cancer care control continuum through universal financial protection for health, and efficient use of all levels of care.
For many decades, the cornerstone of malaria management in Africa was to treat all febrile children with chloroquine. With high-level resistance to chloroquine and improved means of malaria diagnosis, recommendations for the management of malaria in Africa have changed in two important ways in the last few years. First, recommended therapy for uncomplicated falciparum malaria has moved to highly effective artemisinin-based combination therapies. Second, it is now recommended that the treatment of malaria be confined to parasitologically confirmed cases. This recommendation requires the availability of reliable diagnostic tests. The gold standard test for the diagnosis of malaria is microscopy. Evaluation of Giemsa-stained thick smears, when performed by expert microscopists, provides accurate diagnosis of malaria, although assuring expert slide preparation and reading can be difficult. Indeed, microscopy is often unavailable, especially in rural settings. In this regard, the advent of rapid diagnostic tests (RDTs) for malaria is an important advance. Multiple immunochromatographic tests, incorporating a number of different parasite antigens and produced by many different manufacturers, are now available. At best, these tests offer a simple, fairly inexpensive, and reliable means of diagnosis that can be performed by healthcare workers with limited training. However, concerns with RDTs include potential unreliability because of inconsistent manufacture or poor storage, uncertain supply, and potential misreading of results by unskilled health workers. An additional, generally unappreciated concern when considering RDTs is differences between available tests.
Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers’ compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and inadequate assessment of disability. These and other systemic deficiencies in administration of the Compensation for Occupational Injuries and Diseases Act of 1993 (COIDA) reduce access by workers with occupational disease to private medical care, and shift costs to workers and to public sector medical care. Another unintended effect is to promote underreporting of occupational disease by employers and medical practitioners. Reforms have been tried or proposed over the years, including decentralisation of medical assessment to specialised units, which showed promise but were closed. Improved annual performance reporting by the Compensation Commissioner on the processing of occupational disease claims would promote greater public accountability. Given the perennial failings of the system, a debate on outsourcing or partial privatisation of COIDA’s functions is due, the author concludes.
Medicins Sans Frontieres will be the first global medical humanitarian organisation to adopt South Africa's Triage Score (Sats) emergency response system in several countries where their teams provide emergency medical care. Triage systems were introduced worldwide to reduce the waiting time for patients who need critical care when they arrive at emergency rooms. Without the system, patients who seek medical attention in understaffed and overcrowded emergency rooms often can't get the help they need in time. With Sats, patients are categorised according to need, decreasing the waiting time for critically ill patients. The triage scoring system has been found to improve patient flow in accident and emergency units, as well as lower mortality rates and improved the delivery of time-critical treatment for patients with life-threatening conditions. The South African system is designed to deal with the unique challenges of emergency rooms in developing countries, where more patients suffer trauma than in developed countries. MSF has already piloted Sats in some district hospitals in Botswana, Malawi and Ghana.
The purpose of this paper is to present a global update of drug-resistant tuberculosis (TB) and explore trends in 1994–2010. Data on drug resistance among new and previously treated TB patients, as reported by countries to the World Health Organization, were analysed. In 2007–2010, 80 countries and eight territories reported surveillance data. In South Africa, more than 10% of the cases of multi-drug resistant (MDR) TB were extensively drug-resistant. Globally, in 1994 to 2010 multidrug resistance was observed in 3.4% of all new TB cases and in 19.8% of previously treated TB cases. No overall associations between MDR-TB and HIV infection or sex were found. Between 1994 and 2010, MDR-TB rates in the general population increased in various countries, including Botswana. In conclusion, the highest global rates of MDR-TB ever reported were documented in 2009 and 2010. Trends in MDR-TB are still unclear in most settings. Better surveillance or survey data are required, especially from Africa and India.
In this study, 2010-2011 data are reported from public facilities in Kenya where alarming stock-outs were revealed in 2008. Data were collected between January 2010 and June 2011 as part of 18 monthly cross-sectional surveys undertaken at nationally representative samples of public health facilities. The primary monitoring indicator was total stock-out of all four weight-specific artemether-lumefantrine (AL) packs. The secondary indicators were stock-outs of at least one AL pack and individual stock-outs for each AL pack. The number of surveyed facilities across 18 time points ranged between 162 and 176 facilities. The stock-out means of the proportion of health facilities were 11.6% for total AL stock-out, 40.6% for stock-out of at least one AL pack, and between 20.5% and 27.4% for stock-outs of individual AL packs. Despite lower levels of AL stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular concern. Only a minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified, the authors argue.
This study was conducted in Chitungwiza, a high density dormitory town outside Harare, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. Results indicated that of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to “retreatment other” TB patients. In conclusion, no differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes “retreatment other” TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The clinics provide basic HIV, TB STI and pre-natal services. The researchers found that in the project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. The mobile clinics provide services for people who otherwise may not have attended a health centre. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programmes.
The main objective of the study was to conduct an audit of home and community-based care (HCBC) organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. Of the 2,001 HCBC organisations that participated in the audit, most were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. Most of the organisations were faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa.