The dominant approach used to promote sexual health relies on centralised public clinic service delivery, unisectoral implementation, and vertically organised support (national/state/local public health structures). But the authors of this study argue that these systems have failed to test, link and retain a large portion of most-at-risk populations. Instead, the authors favour a social entrepreneurship for sexual health (SESH) approach, which focuses on decentralised community delivery, multisectoral networks, and horizontal collaboration (business, technology, and academia). Although SESH approaches have yet to be widely implemented, they show great promise, according to this study. Social marketing and sales of point-of-care, community-based tests for HIV and other sexually transmitted diseases, conditional cash transfers to incentivise safe sex, and microenterprise among most-at-risk-populations are all SESH tools that can optimise the delivery of comprehensive sexual health interventions.
Equitable health services
This study explored possible differences in health care seeking behaviour among a rural and urban African population. Four rural and urban SetTswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to) health care was collected. The results illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. Inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. Rural participants had significantly lower employment and available weekly budget for health care and transport costs. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice.
Maternal mental health is largely neglected in low- and middle-income countries. There is no routine screening or treatment of maternal mental disorders in primary care settings in South Africa. The Perinatal Mental Health Project (PMHP) developed an intervention to deliver mental health care to pregnant women in a collaborative, step-wise manner making use of existing resources in primary care. Over a 3-year period, 90% of all women attending antenatal care in the maternity clinic were offered mental health screening with 95% uptake. Of those screened, 32% qualified for referral to counselling. Through routine screening and referral, the PMHP model demonstrates the feasibility and acceptability of a stepped care approach to provision of mental health care at the primary care level.
Universal coverage by health services is one of the core obligations that any legitimate government should fulfil vis-à-vis its citizens. However, universal coverage may not in itself ensure universal access to health care. Among the many challenges to ensuring universal coverage as well as access to health care are structural inequalities by caste, race, ethnicity and gender. Based on a review of published literature and applying a gender-analysis framework, this paper highlights ways in which the policies aimed at promoting universal coverage may not benefit women to the same extent as men because of gender-based differentials and inequalities in societies. It also explores how ‘gender-blind’ organisation and delivery of health care services may deny universal access to women even when universal coverage has been nominally achieved.
Since 2002, an estimated 4.7 million long-lasting insecticide-treated nets (LLINs) have been distributed in the Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia among a population of approximately 10 million people at risk for contracting malaria. This study sought to determine the status of current net ownership, utilisation and rate of long-lasting insecticide-treated nets (LLIN) loss in the previous three years. A total of 750 household respondents were interviewed in SNNPR. Approximately 67.5% of households currently owned at least one net. An estimated 31% of all nets owned in the previous three years had been discarded by owners, most of whom considered the nets too torn, old or dirty. Households reported that one-third of nets (33.7%) were less than one year old when they were discarded. These results suggest that the life span of nets may be shorter than previously thought, with little maintenance by their owners. With the global move towards malaria elimination it makes sense to aim for sustained high coverage of LLINs, the authors argue. However, in the current economic climate, it also makes sense to use simple tools and messages on the importance of careful net maintenance, which could increase their lifespans.
The purpose of this study was to describe the results of eight human papillovirus (HPV) vaccination programmes conducted in seven lowest-income countries, including Lesotho, through the Gardasil Access Programme (GAP), which provides free HPV vaccines to organisations and institutions working in those countries. The eight programmes initially targeted a total of 87,580 girls, of which 76,983 received the full three-dose vaccine course, with mean programme vaccination coverage of 87.8%, while the mean adherence between the first and third doses of vaccine was 90.9%. Mixed models consisting of school-based and health facility-based vaccinations were found to record better overall performance compared with models using just one of the methods. Increased rates of programme coverage and adherence were positively correlated with the number of vaccination sites. Qualitative key insights from the school models showed a high level of coordination and logistics to facilitate vaccination administration, a lower risk of girls being lost to follow-up and vaccinations conducted within the academic year to limit the number of girls lost to follow-up. This study is intended to provide lessons for development of public health programmes and policies as countries go forward in national decision-making for HPV vaccination.
This report highlights the systemic problems that prevent women, men and young people from accessing reproductive health supplies, and provide recommendations on moving forward. The authors call for increased funding for reproductive health and argue that reproductive health must be incorporated into national health plans and budgeted for accordingly. Additionally, governments should create an enabling environment for sexual and reproductive health and rights. The authors make several recommendations for health service provision. Governments should ensure that a wide range of reproductive health supplies are included in the national essential drug list, while health system-strengthening initiatives and national health plans must include provisions for monitoring the distribution of reproductive health supplies. Capacity for quality of care should be built among all health professionals that deliver supplies, including health care providers, pharmacists and nurses, and there should be more investment in adequate storage facilities at national and municipal levels, and implementation of logistics management systems.
This qualitative study explored in detail the ability of output-based aid (OBA) voucher programmes to increase access to gender-based violence recovery (GBVR) services. It was conducted in 2010 and data was gathered through in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five programme sites in Kenya. The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services, such as lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. The researchers also found that accreditation of only hospitals to offer GBVR services undermined access to the services in rural areas, and low provider knowledge on GBVR services and lack of supplies undermined effective provision and management of GBVR services. They argue that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA programme to promote the GBVR services voucher, and conduct widespread community education programmes aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.
Intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. This study was conducted alongside a cluster-randomised trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast. Six out of the 51 schools receiving the IST intervention were purposively sampled, and 22 focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Results showed that the use of alternative anti-malarial drugs with simpler regimens was generally preferred. General consensus was that health workers were best placed to undertake the screening and provide treatment, and although teachers' involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST. Future research should carefully consider the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens.
Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, posing a threat to vulnerable populations and jeopardising progress in combating malaria. In this study, the authors reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1,437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1,260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2,297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering national medicine regulatory authorities to protect the global drug supply is more important than ever, the authors conclude.