South Africa is increasingly focused on reducing maternal mortality and documenting variation in access to maternal health services across one of is argued to assist in re-direction of resources. Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. Poorest women had near universal antenatal care coverage (ANC), but only 40% attended before 20 weeks gestation; higher in the wealthiest quartile. Women in rural-formal areas had lowest ANC coverage, completion of four ANC visits and share offered HIV testing. Testing levels were highest among the poorest quartile, but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage was lowest in the poorest quartile and rural formal areas. Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Self-reported health status declined considerably with each drop in quartile, education level or age group.
Equity in Health
This study examined the change in equity of insecticide-treated net ownership among 19 malaria-endemic countries in sub-Saharan Africa before and after the launch of the Cover The Bed Net Gap initiative. To assess change in equity in ownership of at least one insecticide-treated net by households from different wealth quintiles, the authors used data from Demographic and Health Surveys and Malaria Indicator Surveys. The authors assigned surveys conducted before the launch (2003–2008) as baseline surveys and surveys conducted between 2009–2014 as endpoint surveys and did country-level and pooled multi-country analyses, dividing geographical zones into either low- and intermediate-risk or high-risk. To assess changes in equity, they calculated the Lorenz concentration curve and concentration index (C-index). Out of the 19 countries assessed, 13 countries showed improved equity between baseline and endpoint surveys and two countries showed no changes. Four countries displayed worsened equity, two favouring the poorer households and two favouring the richer. The multi-country pooled analysis showed an improvement in equity. Similar trends were seen in both low- and intermediate-risk and high-risk zones. They conclude that the mass insecticide-treated net distribution campaigns to increase coverage, linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of insecticide-treated net ownership across sub-Saharan Africa with significant reduction in inequity among wealth quintiles.
Equity has in many instances been framed around the notion of fairness. But the metric used to determine what is fair leaves some people at a disadvantage because the things that they value are not always taken properly into account. The debate about judging equity – about measuring fairness – needs to find the conceptual and methodological space to allow the voices and claims of the other to be heard.
In this paper, the authors argue that addressing inequality should be central to the post-2015 development framework. They say inequality must be approached on multiple levels: within countries, among nations, and between generations. Tracking inequalities – for example, the progress of the poorest quintile of the population – is important, but to actually reduce inequality, we must reduce the structural inequalities that cause poverty, they add. Their paper highlights some of the many examples of severe inequalities that can be found both among and within countries today. Inequalities are caused by structural barriers, and new as well as old deprivations. A post-2015 development framework must find ways to build on the progress that has already been made and identify policies that can break down some of the barriers faced by the disadvantaged. While the world might be ready to set ambitious targets in areas such as sustainable energy, water, sanitation, and access to knowledge and technology, the authors point out that other areas like migration and trade should also be taken into account. They demand an agenda that pays more attention to social cohesion and social justice, and emphasise that getting the metrics right is critical to improving the reach and effectiveness as of public services.
The European Union will grant 32 million euros, or about $31.8 million, to the United Nations Population Fund and the International Planned Parenthood Federation in an effort to "fill the gap" left by the Bush administration's decision to withdraw the United States' $34 million contribution to UNFPA. The funding will go to reproductive health care projects operated by UNFPA and IPPF in 22 developing nations. The money will be used to fund pre- and postnatal care programs, family planning services, sexually transmitted disease prevention, counseling on "avoiding [unintended] pregnancies and unsafe abortion".
The EU has launched an initiative to break the current WTO deadlock on developing countries' access to affordable medicines. WTO members failed to meet the end of a 2002 deadline to find a solution for developing countries without manufacturing capacities, namely given the disagreement over the disease coverage. In a letter addressed to all WTO Trade Ministers, EU Trade Commissioner Pascal Lamy proposes a multilateral solution which is workable, sustainable and legally secure, based both on the Doha mandate and on the chair's compromise text of 16 December 2002.
The health delivery system in Zimbabwe is declining as medical personnel leave the country in search of better working conditions and more money. The exodus of nurses and doctors and other professionals from Zimbabwe for economic reasons is accelerating, with most of those leaving going to Britain, the country's former colonial master.
Experts from southern Africa have gathered in Namibia to discuss critical reproductive health challenges in the sub-region and formulate strategies to address them. About 200 delegates will carve out a comprehensive reproductive health component, to be incorporated into the New Partnership for Africa's Development (NEPAD) framework on related health issues.
Public health experts met in New York recently to discuss expanding access in developing nations to artemisinin-combination therapy (ACT), which offers one of the fastest and most effective cures for malaria, USA Today reports. Malaria parasites have become resistant to older drugs, but funding for the newer ACT remains a problem. ACT costs about $1.50 for a three-day course, compared with 10 cents for older drugs such as chloroquine and Fansidar. Many African governments can devote just $5 per person annually to public health.
The global health situation is facing many critical challenges, and multiple actions must be taken urgently to prevent crises from boiling over. This paper reflects on the 2016 World Health Assembly (WHA) as the world’s prime public health event, attended by 3,500 delegates, including Health Ministers from most of the 194 countries.World Health Organisation director-general Dr Margaret Chan gave an overview of what went right and what is missing in global health. 19,000 fewer children dying every day, a 44% drop in maternal mortality, the 85% cure rate for tuberculosis, and 15 million people living with HIV now receiving therapy, up from just 690,000 in 2000. Chan also described how health has become a globalised problem, with air pollution becoming a transboundary health hazard, and drug-resistant pathogens being spread through travel and food trade. The recent Ebola and Zika outbreaks showed how global health emergencies can quickly develop. The world is not prepared to cope with the dramatic resurgence of emerging and re-emerging infectious diseases. Chan said the global health landscape is being shaped by three slow-motion disasters: climate change, antimicrobial resistance and the rise of chronic non-communicable diseases. The assembly agreed that the WHO set up a new Health Emergencies Programme to enable it to give rapid support to countries and communities to prepare for, face or recover from emergencies caused by health hazards including disease outbreaks, disasters and conflicts. On anti-microbial resistance, many developing countries stressed the importance of funds and technology to help them develop national action plans by 2017. The WHA called on the WHO to develop an implementation plan and urged governments to develop national policies on marketing unhealthy foods to children. Two environment-related health issues were discussed. Air pollution accounts for eight million deaths worldwide annually – 4.3 million due to indoor and 3.7 million to outdoor air pollution. The assembly welcomed a new WHO road map for actions in 2016-19 to tackle the health effects of air pollution. A controversial issue is how the WHO should relate to “non-state actors”. After two years of negotiations, the WHA adopted the Framework of Engagement with Non-State Actors (FENSA), which provides the WHO with policies and procedures on engaging with non-governmental organisations, private sector entities, philanthropic foundations and academic institutions.