A widespread cholera outbreak, under-resourced and under-staffed health system, and inadequate access to safe drinking water and hygiene are threatening the wellbeing of thousands of Zimbabweans. As of 9 December, 16,141 suspected cases of cholera and 775 resultant deaths (case fatality rate of 4.8%) had been recorded since August in two-thirds of the country's 62 districts. WHO is establishing a cholera control and command centre, in conjunction with the Ministry of Health and Child Welfare (MoHCW) and other health partners, to respond in a coordinated manner to Zimbabwe's health challenges. WHO is seeking donor support for a US$6 million proposal for its cholera response plan. Approximately half of cholera cases have been recorded in Budiriro, a heavily populated suburb on the western outskirts of the capital, Harare. Other major concentrations of reported cases include Beitbridge, on the South African border, and Mudzi, on the border with Mozambique.
Equitable health services
Integrating mental health services into primary care is the most viable way of ensuring that people get the mental health care they need and primary care workers need adequate training and support for this. Integration is most successful when mental health is incorporated into health policy and legislative frameworks and supported by senior leadership, adequate resources and ongoing governance. To be fully effective and efficient, primary care for mental health must be coordinated with a network of services at different levels of care and complemented by broader health system development. Numerous low- and middle-income countries have successfully made the transition to integrated primary care for mental health. Mental health is central to the values and principles of the Alma Ata Declaration; holistic care will never be achieved until mental health is integrated into primary care.
The EQUINET Steering Committee made a representation through the SADC Secretariat to the Health and Water Ministers meeting held in South Africa on 11 December 2008 on the cholera situation in the region, and particularly in Zimbabwe. The EQUINET Steering Committee called on SADC Ministers to strengthen the public health leadership of the response, supported by publicly reported and accurate information and effective communication on the epidemic from community to national level; and where necessary invoking public health laws to prioritise resources to prevent and manage the epidemic. The SC recognised the need for urgent measures to control and manage the epidemic, but also called for attention to longer term measures to address determinants of the epidemic.
In spring 2009, the EU’s executive branch will present the findings of an investigation into the pharmaceutical sector. This is a preliminary report of this probe, launched in January this year, which found that leading pharmaceutical companies are using the patent system to delay the entry of generic medicines onto the market. Patent holders tend to embark on a long, legal battle to delay the release of a generic. Examining a sample worth about 10% of the Union’s €150 billion-a-year prescription drugs market, the Commission estimated that €3 billion could have been saved to public health budgets if generic entry had taken place immediately once patents expired. This is based on data indicating that the price of a drug falls by about 20% after a year once it moves from being branded to generic.
Reproductive health care for internally displaced persons (IDPs) is a neglected area in humanitarian relief operations. Representatives of twelve relief and development agencies providing reproductive health care to IDPs were interviewed to identify barriers to access and strategies for overcoming these barriers. Although material and human resources were significant constraints, the main challenge ahead is to tackle ideological, managerial and policy barriers, and those related to donor influence. Considerable efforts are needed to close the gap between international commitments and their failure to help provide services in the field. The study strongly recommends developing a legal instrument, like an international convention, to protect the rights of IDPs.
Amid fears that huge quantities of counterfeit medicines and pesticides are pouring into Africa, the international law enforcement agency INTERPOL is leading the way to invest more effort and money to bring authorities up to speed on the threat faced by those who depend on the imports, from hospital patients to pharmacists to farmers. Among the first of the OASIS anti-counterfeiting moves was Operation Mamba, a police action in Uganda and Tanzania in September and October that led to the seizure of more than 100 kinds of medical products, including anti-malarial pills, multivitamins, skin medicines and heart drugs. Four pharmacies in Tanzania were shut down; in Uganda, police are investigating 38 shops on suspicion that they are working illegally. INTERPOL is investing more effort and attention to Africa as the staggering extent of the counterfeiting problem on the continent becomes clearer. While precise numbers are difficult to come by, the World Health Organization believes that 30 percent of drugs sold in developing countries are counterfeit; in some parts of Africa, that number could be as high as 90%.
The 13th edition of the SAHR focuses on primary health care (PHC) in South Africa, 30 years after the historic Alma Ata Declaration, which famously linked health and health status to broader social determinants of health. It includes a national and international perspective of PHC and focuses on areas such as policy and legislation, determinants of health, lifestyle, infectious diseases, mental health, maternal and child health, nutrition and environmental health. It also reviews issues around human resources, finance, and information and concludes with the ‘Indicators’ chapter, which presents a selection of the best available data on the functioning and performance of the South African health system. It also reflects on lessons and mistakes of the past to improve implementation in the future.
The devastating cholera epidemic continues to spread, with a new outbreak in Chegutu Urban, recording more than 378 suspected cases and 121 deaths. As of 15 December, 9 out of 10 provinces (48 out of 62 districts) in the country are affected with a total count of 978 deaths and a Case Fatality Rate (CFR) of 5.3%. So far most cases have been reported in Harare / Budiriro (8,454 cases, 208 deaths and a CFR of 2.5%), followed by Beitbridge (3,456 cases, 91 deaths and a CFR of 2.6%), Mudzi (1,237 cases, 78 deaths and a CFR of 6.3%) and Chitungwiza (551 cases, 99 deaths and a CFR of 18 %). Higher CFRs have been found in other areas. Cholera continues to affect various parts of the Southern African region, with the Republic of South Africa reporting 859 cumulative cases, 11 deaths and a CFR of 1.2%, the bulk of the cases (731) reported in Limpopo province. Cases have also been reported in Botswana, Mozambique, and Zambia, albeit in much smaller numbers. According to the latest WHO figures, there have been 200 human cases of anthrax and 8 deaths reported since November with the consumption of contaminated meat identified as the most likely cause.
Four days into one-week 'critical' negotiations on pandemic influenza preparedness, World Health Organization members had yet to tackle areas of core disagreement and participants were expressing doubt as to whether consensus can be achieved before the end of the meeting. Details on the definition of 'Pandemic Influenza Preparedness (PIP) Biological Materials', on the content of a standard material transfer agreement for virus sharing and on the interconnection between a mechanism for virus-sharing and a mechanism for sharing of benefits from vaccine development have yet to be discussed or have been pushed until later in the meeting for more substantive discussion and hoped-for consensus. These interrelated topics represent core differences between member states and thus are likely to be most difficult to resolve at the WHO Pandemic Influenza Preparedness Intergovernmental Meeting.
This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. A mixed methods approach using structured Verbal/Social autopsy interviews and case narratives was employed with 26 caretakers living in the Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. The main barriers to care were misdiagnosis by the caregiver, gender and household financial constraints, and dissatisfaction with providers, reflecting inadequate levels of service. Poverty was identified as the underlying theme. Any improvements in basic health care for children suffering from acute febrile illness are likely to substantially reduce mortality.