In 2000, WHO published its first attempt to assess the performance of the world’s health systems in The World Health Report 2000. This report generated enormous interest but, in many ways, the scientific progress was overshadowed by the political debate related to the estimates of country-level performance and the associated league tables. Since then, the WHO European and Eastern Mediterranean Regional Offices have maintained health system observatories, with detailed descriptions of country systems. The considerable interest in measuring the performance of health systems worldwide is illustrated by the recent European Ministerial Conference on Health Systems, which culminated in the Tallinn Charter entitled Health systems for health and wealth. In developed countries, primary concerns include costs, quality of care, aging and chronic diseases. In developing countries, health system constraints have restricted progress towards the UN Millennium Development Goals.
Equitable health services
The aim of this study was to describe the implementation process of a national anti-tuberculosis drug resistance survey in Tanzania, in relation to the study protocol and standard operating procedures. Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well-organised National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling. Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential.
Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 21 randomly selected districts. National IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 and 38% for second dose in 2005 but 30% in 2007. There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit.
Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to destabilise and challenge established general practice and primary care. The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. This 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, by offering integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.
An intellectual property (IP) model intended to preserve the structure of patent protection while adding balance for developing countries, has been proposed to provide incentives for innovators to contribute toward the alleviation of suffering in developing countries in dire need of patented medicines largely owned by rich countries. This IP model, which would increase the role of the World Health Organization (WHO) in the process, was presented recently by Amir Khoury, an intellectual property law and international trade specialist at the law faculty of Tel Aviv University. The proposal would put greater decision-making authority on the use of compulsory licensing to obtain cheaper versions of patented medicines in the hands of the WHO. Currently, that activity occurs under the World Trade Organization.
The Community Working Group on Health (CWGH) in Zimbabwe, with a membership of about 35 civil society organisations representing a wide range of constituent groups, has called on the World Health Organisation to address the severe decline in heath and in the health system in Zimbabwe. It recognises that the current health crisis does not emanate from the health sector but from wider economic collapse. The CWGH urges WHO and partners to more widely address what needs to be done and what resources and support are needed to rebuild health systems from primary health care level upwards, and to involve communities in deliberations and plans on the way forward. Zimbabweans, they indicate, are not numbers of cholera cases or fatalities but people who have responded to an increasingly difficult situation, who are entitled to health as a right and who should be central in any response and rehabilitation of the health system.
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.
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.