With two decades of research behind it, the "invisible economy" of care is a critical area of scientific enquiry and policy action. However, far from being global, much of the public debate has been limited to advanced industrialised countries. Meanwhile, governments in developing countries - where economic restructuring raises perennial concerns about social reproduction, and women's increasing burdens of unpaid care work - are experimenting with new ways of responding to care needs in their societies. In this book, contributors from a wide range of backgrounds discuss and debate the care economy in the developing world at a moment when existing systems are under strain and new ideas are coming into focus. Empirically grounded case studies of countries as diverse as China, Nicaragua, India and South Africa shed new light both on existing care arrangements and changing policies.
Equitable health services
In 2007 Madagascar implemented a sentinel surveillance system for influenza-like illness (ILI) based on data collected from sentinel general practitioners, launching an innovative case reporting system based on the use of cell phones. Encrypted short message service (SMS), which costs less than US$2 per month per health centre, is now being used by sentinel general practitioners for the daily reporting of cases of fever and ILI seen in their practices. To validate the daily data, practitioners also report epidemiological and clinical data (e.g. new febrile patient’s sex, age, visit date, symptoms) weekly to the epidemiologists on the research team using special patient forms. Madagascar’s sentinel ILI surveillance system represents the country’s first nationwide ‘real-time’ surveillance system. The authors of this paper argue that it has proved the feasibility of improving disease surveillance capacity through innovative systems despite resource constraints. They recommend this type of syndromic surveillance for detecting unexpected increases in the incidence of ILI and other syndromic illnesses.
This study was conducted working with community-owned resource persons to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated. the study found that with basic training and supervision, community-owned resource persons successfully provided early diagnosis and treatment and reduced unnecessary consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested before treatment.
This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the intra-uterine device (IUD) and female sterilisation in a high HIV-prevalence setting in Cape Town, South Africa. A quantitative cross-sectional survey was conducted using an interviewer-administered questionnaire amongst 265 HIV-positive and 273 HIV-negative postpartum women. Women's knowledge and attitudes towards long-acting and permanent methods (LAPMs), as well as factors that influence their choice in contraception, were examined. Current use of contraception was found to be high, with no difference by HIV status (89.8% HIV-positive and 89% HIV-negative). Most women were using short-acting methods, primarily the three-monthly injectable. Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using LAPMs (all chose sterilisation). The researchers conclude that poor knowledge regarding LAPMs is likely to be contributing to their poor uptake . They recommend improving contraceptive counselling to include LAPMs and strengthening services for these methods. Given that HIV positive women were found to be more favourable to future use of the IUD, it is possible that there may be more uptake of the IUD amongst these women, they argue.
Pneumonia is a leading cause of morbidity and mortality worldwide. Effective vaccine and non-vaccine interventions to prevent and control pneumonia are urgently needed to reduce the global burden of the disease. In this paper, researchers explore practical strategies and policies for integrating interventions to prevent and treat pneumonia with routine immunisation services, and investigate the challenges involved in such integration. They identify three primary pneumonia prevention and treatment strategies that should be implemented during routine childhood immunisation visits: vaccination of children against the disease, caretaker education and referral of children to medical services when necessary.
The authors of this article argue that a high prevalence of neglected tropical diseases (NTDs) in sub-Saharan Africa promotes susceptibility to the HIV virus and can worsen the clinical course and progression of AIDS. They highlight emerging evidence to provide a scientific rationale for combining treatment programmes for NTDs with programmes for the treatment of HIV andAIDS. They argue that improved NTD control could both decrease susceptibility to HIV infection and improve morbidity levels in seropositive individuals. Improved efficiency and cost- effectiveness of integrating NTD programmes into a wider framework to provide HIV care would require careful co-ordination and collaboration among concerned NGOs, private entities and Ministries of Health. Major stakeholders should be encouraged to establish operational links between HIV and AIDS and NTD activities.
The aim of this paper is to examine the interactions of neglected tropical disease (NTD) control programmes and general health services, focusing particularly on sub-Saharan African countries and reviewing related studies. The authors found that NTDs affect the poorest communities, which are served by the weakest health systems. Further findings suggest that the strategy of integrated control at the community level offers opportunities for enhanced cost-effectiveness and feasibility in low-resource settings, with managers of disease control programmes playing a crucial role in assessing progress. Co-ordinated efforts based on a coherent overall policy, managerial and administrative vision, and a long-term view are required. The article concludes that NTD campaigns have the potential to enhance some elements of the general health services. These may include the health information system, the drug procurement system, the health workforce and the community volunteers. On the other hand, NTD campaigns are at risk of inducing negative effects on health systems. These can be categorised as duplications, distortions and interruptions. As a result, detailed follow-up and documentation of how NTD campaigns and general health services interact is essential, the paper concludes.
This field study investigated the potential stress-reducing effects of exposure to real or artificial nature on patients in a hospital waiting room. Additionally, it was investigated whether perceived attractiveness of the room could explain these effects. In this between-patients experimental design, patients were exposed to one of the following: real plants, posters of plants, or no nature (control). These conditions were alternately applied to two waiting rooms. The subjects consisted of 457 patients (60% female and 40% male) who were scheduled for various health services, such as echocardiogram and x-ray. Patients exposed to real plants, as well as patients exposed to posters of plants, report lower levels of experienced stress compared to the control condition. Further analyses show that these small but significant effects of exposure to nature are partially mediated by the perceived attractiveness of the waiting room. In conclusion, natural elements in hospital environments have the potential to reduce patients' feelings of stress. By increasing the attractiveness of the waiting room by adding either real plants or posters of plants, hospitals can create a pleasant atmosphere that positively influences patients' well-being.
The authors of this study conducted an external quality assessment of laboratories in Africa that routinely investigate epidemic-prone diseases. Since 2002, three surveys comprising specimens and questionnaires associated with bacterial enteric diseases, bacterial meningitis, plague, tuberculosis and malaria have been sent annually to test participants’ diagnostic proficiency. Identical surveys were sent to referee laboratories for quality control. The authors found that between 2002 and 2009, participation increased from 30 to 48 Member States of the World Health Organisation and from 39 to 78 laboratories. Results of performance evaluations were mixed. Laboratories correctly identified bacterial enteric diseases and meningitis components 65% and 69% of the time, respectively, but their serotyping and antibiotic susceptibility testing and reporting were frequently unacceptable. Microscopy was acceptable for 73%, with tuberculosis microscopy excelling, as 87% of responses received acceptable scores. In the malaria component, 82% of responses received acceptable scores for species identification but only 51% of parasite quantitation scores were acceptable.
Eye injuries that occur in the workplace are more common in developing countries like South Africa where appropriate eye protection might be lacking. The purpose of this paper is to assist the occupational health care provider to correctly assess damage to the eye and interpret the findings to make a diagnosis and appropriate decisions for primary care. The authors argue that examination of the eyes by health-care doctors and nurses should be systematic, assessing all the structures in order to determine appropriate treatment and referral. The most urgent condition is a chemical burn in which minutes matter and immediate irrigation can prevent long-term vision loss. Lid lacerations are usually easy to identify but penetrating globe injuries or intraocular foreign bodies may be missed and result in permanent loss of vision and disability. Many injuries can be adequately managed by primary care health workers, either medical doctors or nurses, and do not require referral, the authors conclude.