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.
Equitable health services
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.
This study aimed to assess the changes in the burden of malaria in Mpumalanga Province during the past eight malaria seasons (2001/02 to 2008/09) and whether indoor residual spraying (IRS) and climate variability had an effect on these changes. This is a descriptive retrospective study based on the analysis of secondary malaria surveillance data (cases and deaths) in Mpumalanga Province. Within the study period, a total of 35,191 cases and 164 deaths due to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09. The incidence and case fatality (CFR) rates for the study period were 134 cases per 100,000 and 0.54%, respectively. Mortality due to malaria was lower in infants and children and higher in those >65 years, with the mean CFR of 2.1% as compared to the national target of 0.5%. Mpumalanga Province has achieved the goal of reducing malaria morbidity and mortality by over 70%, partly as a result of scale-up of IRS intervention in combination with other control strategies. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved. However, the goal to eliminate malaria as a public health problem requires efforts to be directed towards the control of imported malaria cases; development of strategies to interrupt local transmission; and maintaining high quality surveillance and reporting system.
There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aimed to address this gap in knowledge and provide recommendations for regional guideline development. The authors prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. The authors identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, with a median of 58% and 83% respectively. 'Stakeholder involvement' followed with median 39%. The authors recommend that future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development.
While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia. From March 2009 to June 2010, a series of cross-sectional surveys of 7,666 employees in seven sectors of industry were conducted in Namibia. Results indicated that, controlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism, followed by anemia and being HIV positive. In addition, working in the fishing or services sectors was associated with an increased incidence of sick days. The highest prevalence of diabetes was in the services sector, with the highest prevalence of HIV in the fishing sector. The authors conclude that both non-communicable disease risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programmes to manage these conditions could help employers avoid costs associated with absenteeism, they recommend, which could include basic health care insurance including regular wellness screenings.