The authors of this paper drew upon local-level research to examine the roll out of treatment for two neglected tropical diseases (NTDs) – schistosomiasis and soil-transmitted helminthes – in Uganda. Ethnographic research was undertaken over a period of four years between 2005-2009 in north-west and south-east Uganda to determine the effectiveness of mass drug administration (MDA) for the two NTDs. In addition to participant observation, survey data recording self-reported take-up of drugs was collected from a random sample of at least 10% of households at study locations. The comparative analysis of take-up among adults revealed that, although most long-term residents have been offered treatment at least once since 2004, the actual take-up of drugs varies considerably from one district to another and often also within districts. The authors argue that this is due to local dynamics and highlight the need to adapt MDA to local circumstances. They call for improvements in health education, drug distribution and more effective use of existing public health legislation. Current standard practices of monitoring, evaluation and delivery of MDA for NTDs were found to be inconsistent and inadequate.
Equitable health services
The aim of this study was to synthesise recent evidence on how to scale up the delivery of malaria interventions in endemic regions through a systematic review of the available literature. The researchers included 39 papers, including 19 African countries, related to scaling up the delivery of intermittent preventive treatment in pregnancy (IPTp), artemisinin combination therapy (ACT) or insecticide-treated nets (ITNs). They found that relatively few strategies for scaling up have been reported in published literature and acute knowledge gaps exist for scale up of diagnostics and treatment. In terms of coverage and equity, the evidence to link changes in coverage to any specific strategy was found to be weak. IPTp coverage was low, while a 15% increase in ACT among children was reported with delivery through accredited drug dispensing outlets and health facilities in Tanzania. For ITN programmes, reaching programme targets was associated with free delivery through campaigns. There was a shortage of information on facilitators and barriers to scale up and what little was available was setting-specific. The researchers conclude that, to prioritise strengthening of health system elements for scale up, additional research methods and new studies are needed to fill the knowledge gap.
The aim of this study was to synthesise knowledge concerning various models for the integrated delivery of TB/HIV services at health facility level in low- and middle-income countries. The authors conducted a systematic review of literature, selecting 63 papers and 70 abstracts for inclusion, which described 136 examples of models of integration. Strengths and weaknesses of different models of integration are identified. Models based on referral only are easiest to implement, requiring as little as additional staff training and supervision, if a functional referral system exists, but optimal communication is necessary. Models with closer integration are more efficient but require more staff training and may also require additional infrastructure, e.g. private space for HIV counselling. The authors conclude that their comparison of different models of integration of tuberculosis and HIV services was undermined by a lack of rigorous studies. More research is needed to investigate potential efficiencies of integrated care from the perspective of both provider and service user.
Médecins Sans Frontières welcomes the World Health Organization’s (WHO) proposed Global Immunization Vision and Strategy, which encourages a rebalancing of the global vaccine strategy so that support for the introduction of the newer vaccines does not mean momentum is lost as regards the need to ensure basic immunisation. New vaccines such as pneumococcal vaccines have the potential to avert millions of deaths worldwide, but MSF argues that the need for their medical teams to intervene in several measles outbreak responses illustrates the weak coverage of traditional vaccines, and is a clear indication of the failure of routine basic immunisation, despite the global decrease in measles morbidity and mortality. National immunisation programmes should be supported to leverage every interaction with young children to provide ‘catch-up’ vaccinations. The report lacks strategies and concrete actions to bring vaccine prices down, according to MSF, despite the fact that the WHO admits that vaccine prices continue to be a major obstacle. MSF notes that the current funding crisis at the GAVI Alliance is partly due to overpriced vaccines. Too much emphasis has been put on incentivising multinational pharmaceutical companies, at the expense of investing in support to emerging producers that can produce quality vaccines at dramatically reduced prices.
Those who are against privatisation of public services are often confronted with the objection that there is no alternative. This book takes up that challenge by establishing theoretical models for what does (and does not) constitute an alternative to privatisation, and what might make them ‘successful’, backed up by a comprehensive set of empirical data on public services initiatives in over 40 countries. This is the first such global survey of its kind, providing a rigorous and robust platform for evaluating different alternatives and allowing for comparisons across regions and sectors. The book helps to conceptualise and evaluate what has become an important and widespread movement for better public services in the global South. The contributors explore historical, existing and proposed non-commercialised alternatives for primary health, water/sanitation and electricity. The objectives of the research have been to develop conceptual and methodological frameworks for identifying and analysing alternatives to privatisation, and testing these models against actually existing alternatives on the ground in Asia, Africa and Latin America. Information of this type is urgently required for practitioners and analysts, both of whom are seeking reliable knowledge on what kind of public models work, how transferable they are from one place to another and what their main strengths and weaknesses are.
This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Researchers randomly selected six hospitals in Addis Ababa, three private and three public. Data was recorded by using an appropriately designed questionnaire. Results revealed that the management of health care waste at hospitals in Addis Ababa city was poor. The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, consisting of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased, and it was positively correlated with the number of patients. Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The waste separation and treatment practices were very poor. The authors recommend that other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented.
The main objective of this study was to decompose wealth-related inequalities in skilled birth attendance (SBA) and measles immunisation into their contributing factors. Researchers used data from the Kenyan Demographic and Health Survey 2008/09 to investigate the effects of socio-economic determinants on coverage and wealth-related inequalities of the two health services. Results indicated that SBA utilisation and measles immunisation coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilisation further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunisation was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality. The authors conclude that both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.
Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease. In this study, researchers conducted focus group discussions with men, women and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Participants had very low awareness of cervical cancer. The perceived benefits of modern treatment were also very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behaviour and alternated between traditional remedies and modern treatment methods. Prior to the introduction or scale up of cervical cancer prevention programmes, socio-cultural barriers and health service related factors that influence health seeking behaviour must be addressed through appropriate community level behaviour change communications.
In this study, researchers analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009, disaggregating data according to age, sex, medical specialty, date of admission and discharge, and socio-economic status (SES). There were 42,582 first admissions. Patient demographics shifted towards a lower SES. Median age decreased from 52 years in 2002 to 49 years in 2009, while patients aged 20-39 years increased in proportion from 26% to 31%. The unadjusted proportion of admissions which resulted in in-hospital deaths increased from 12% in 2002 to 17% in 2009. Corresponding mortality rates per 1,000 patient days were 17 and 23.4, respectively. Annual increases in mortality rates were highest during the first two days following admission (increasing from 30.1 to 50.3 deaths per 1,000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward.
This paper reports on the strategies, achievements and challenges of the past and contemporary malaria vector control efforts in Zambia. Researchers reviewed all available information and accessible archived documentary records on malaria vector control in Zambia. They also conducted a retrospective analysis of routine surveillance data from the Health Management Information System (HMIS), data from population-based household surveys and various operations research reports on implementing policies and strategies. Results suggested that Zambia has made great progress in implementing the World Health Organisation’s integrated vector management (IVM) strategy within the context of the IVM Global Strategic framework with strong adherence to its five key attributes. In conclusion, the country has solid, consistent and coordinated policies, strategies and guidelines for malaria vector control. The authors highlight the Zambian experience as a successful example of a coordinated multi-pronged IVM approach effectively operationalised within the context of a national health system.