Inadequate patient tracking at one of South Africa's largest antiretroviral (ARV) distribution sites, has led to many patients disappearing from the clinic before treatment starts, a new report has found. The report by the Reproductive Health & HIV Research Unit (RHRU) of the University of the Witwatersrand, based on a 2006 review of patient files at the Tshepong Wellness Clinic, about 120km southwest of Johannesburg, shows that a standard percentage - about 14 percent - stop taking treatment, but more than 20 percent of patients never get to the treatment stage.
Equitable health services
Poor tracking means patients lose out
Integrated Regional Information Network, 15 February 2008
Botswana confirms first case of XDR-TB
Motseta S, Nullis C: Mail and Guardian Online, 17 January 2008
Health authorities reported the first known cases of virtually untreatable tuberculosis in Botswana, following fears that the highly contagious strain has spread beyond South Africa. For the past few months, health professionals have warned that XDR-TB, although only confirmed in South Africa, had spread to other Southern African nations like Swaziland and Lesotho hard hit by the AIDS pandemic, but hadn't been diagnosed because of lack of laboratory facilities.
Estimated financial and human resources requirements for the treatment of malaria in Malawi
Muula AS, Rudatsikira E, Siziya S and Mataya RH: Malaria Journal 6(168), 19 December 2007
Malaria fever is a common medical presentation and diagnosis in Malawi. The national malaria policy supports self-diagnosis and self-medication for uncomplicated malaria with first line anti-malaria drugs. While a qualitative appreciation of the burden of malaria on the health system is recognised, there is limited quantitative estimation of the burden malaria exacts on the health system, especially with regard to human resources and financial burden on Malawi. The burden of malaria was assessed based on estimated incidence rates for a high endemic country of which Malawi is one. Data on the available human resources and financial resources committed towards malaria from official Malawi government documents and programme reports were obtained. Malaria exacts a heavy toll on the health system in Malawi. The national recommendation of self-medication with first-line drug for uncomplicated malaria is justified as there are not enough clinicians to provide clinical care for all cases. The Malawi Ministry of Healthas promotion of malaria drug prescription including other lower cadre health workers may be justified.
Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania
Hetzel MW, Alba S, Fankhauser M, Mayumana I, Lengeler C, Obrist B, Nathan R, Makemba AM, Mshana C, Schulze A and Mshinda H: Malaria Journal 7(7), 9 January 2008
A longitudinal study followed approximately 100 randomly selected farming households over six months in Kilombero Valley, Tanzania. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded. Fever incidence rates were lower in the shamba compared to the villages and moving to the shamba did not increase the risk of having a fever episode. Children aged 1-4 years, who usually spend a considerable amount of time in the shamba with their caretakers, were more likely to have a fever than adults. Despite the long distances to health services, 55.8% (37.9-72.8) of the fever episodes were treated at a health facility, while home-management was less common (37%, 17.4-50.5). Living in the shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.
Managing the health Millennium Development Goals - the challenge of management strengthening: lessons from three countries
Egger D, Ollier E: World Health Organization , 2007
This World Health Organization study describes various activities aimed towards strengthening the management of health service delivery in three countries: South Africa, Togo and Uganda. The paper considers factors that affect management capacity: the number of managers at all levels; opportunities for building existing managers’ own competences; improving management support systems; and creating a more supportive work environment. It also identifies several ways to help managers do their jobs better. These include clarity about their responsibilities; practical reference handbooks; and a regular forum for managers to identify their needs, discuss problems and share ideas. On-the-job support is perceived by many managers as key to improving their performance – this can include technical assistance, mentoring, coaching and learning networks. In terms of management strengthening activities, the study reveals that a range of approaches have been used in recent years, but countries and external development agencies have concentrated mainly on training and some management systems (planning and monitoring) to the detriment of other key conditions for facilitating good management. Medium- to long-term sector-wide budgets and plans for management strengthening are required if good management is to play its appropriate role in scaling up health services.
National audit of critical care resources in South Africa – open versus closed intensive and high care units
Scribante J, Bhagwanjee S: South African Medical Journal Vol. 97 (12): 1323-1326, 2007
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to evaluate the distribution and functioning of South African intensive care units (ICUs) and high care units (HCUs), in particular the extent to which units were ‘closed units'. In the face of already limited resources (financial and human) and given the emphasis on primary care medicine (with consequent limited capacity for further ICU development), it is crucial that existing facilities are maximally utilised.
National audit of critical care resources in South Africa – transfer of critically ill patients
Scribante J, Bhagwanjee S: South African Medical Journal Vol. 97 (12): 1323-1326, 2007
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to establish the efficacy of the current system of referral of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
National audit of critical care resources in South Africa – unit and bed distribution
Scribante J, Bhagwanjee S: South African Medical Journal Vol. 97 (12): 1311-1314, 2007
A descriptive, non-interventive, observational study design was used to audit of all public and private sector ICU and high care units in South Africa to determine the national distribution of intensive care unit (ICU)/high care (HC) units and beds. The most compelling conclusion from this study is the need for regionalisation of ICU services in SA.
Refugees’ perceptions of their health status and quality of health care services in Durban, South Africa: a community based survey
Apalata T, Kibiribiri ET, Knight S, Lutge E: Health Systems Trust, 2007
There is some evidence from refugees that health care services in South Africa are not responsive to their perceived needs. Using quantitative and qualitative approaches to evaluate the perceptions and opinions of refugees about health care services in South Africa, the authors find that major issues affecting refugees include: discrimination and xenophobic attitudes of health service providers; language barriers leading to inappropriate treatments due to misunderstanding; exclusion from public hospitals due to lack of valid permits or delay in the delivery of such permits. Based on these findings, the authors suggest that refugees should have at least a baseline health related interview and check-up preferably done in a primary health care (PHC) centre dedicated to refugees. Refugee support systems should be established and health care workers should be informed about issues such as refugee permits and policies regarding referral systems. Also, public hospitals should employ qualified translators to help in cases that are referred from PHC centres for refugees.
Rehabilitating Health Systems in Post-Conflict Situations
Waters H, Garrett B, Burnham G: UNU-WIDER Research Paper No. 2007/06, United Nations University World Institute for Development Economics Research, 2007
The researchers analysed the experiences of different countries affected by conflict, including Afghanistan, Cambodia, East Timor, Kosovo, Uganda and Mozambique. They began by looking at the impacts of conflict on public health. They then presented a framework for understanding how programmes for rehabilitating health systems might work in post-conflict countries. The authors suggest three interrelated approaches to health sector rehabilitation: an initial response to immediate health needs (through humanitarian assistance and relief); restoration or establishment of a package of essential health services including immunisation and obstetric care; and restoration of the health system itself. The authors highlight the lack of co-ordination between donor organisations, whose competing needs and projects distract health officials. Non-governmental organisations (NGOs) may also delay progress by continuing to focus on relief when the country has moved on to the next stage.