In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles – human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation – are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the ‘rock face', and offers solutions to the problem of translating principles into practice.
Equitable health services
The strengths and weaknesses of the sector wide approach (SWAP) have been extensively analysed, but much less has been written on country experience to inform good practice elsewhere. This technical paper draws some lessons from SWAP in health in Mozambique. SWAP is not a panacea for donor coordination, and cannot address deep-rooted constraints typical of a young national health system. This paper explores how the key elements of the SWAP have been developed, how processes and mechanisms are working now, and studies some of its successes and challenges.
This policy brief looks at the challenges of implementing the Integrated Management of Childhood Illness (IMCI) strategy in Kenya. It shows that Kenya has made some progress in rolling out the IMCI strategy; however, implementation remains highly inadequate. The three main challenges to implementation are low training coverage, health workers not following guidelines and barriers to accessing services. These challenges reflect a range of IMCI-specific and broader health system constraints. The authors outline recommendations for increasing IMCI coverage and implementation. They argue that urgent action is needed to review pre-service training, scale up in-service training, address facility-level implementation challenges, improve IMCI supervision and build support for the strategy.
This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies the strategic interventions required to cope with the new challenges facing the health systems in the 21st century. The review addresses PHC policy formation and implementation, the resources that are available for PHC implementation, monitoring and review. PHC policy formation had been well articulated in the national health policies by most countries, however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will. The key recommendations of the review include to: harmonise health sector reforms with PHC to ensure that initiatives promote equity and quality in health services; improve the fairness of financing policies and strategies and service coverage for the poor; support countries to address their particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies; support countries to identify and put in place mechanisms for attracting and retaining health personnel.
Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, the study conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors. The study found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. The authors argue that current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health, and that prison-based health services should make linkages to community-based health care, and address general prison conditions and failures of the criminal justice system that exacerbate overcrowding.
This framework paper is aimed at policy makers who are involved in the development or management of programmes in the health sector in developing countries. It provides a ‘snapshot’ of the type of information and communication technology (ICT) interventions that are being used in the health sector, and the policy debates around ICTs and health. It draws from the experience of use in both the North and South, but with a focus on applicability in the South to identify the most effective and relevant uses of ICTs.
Improving maternal health remains the most elusive of the Millennium Development Goals. Every minute, at least one woman dies from pregnancy-related causes: 99 percent of these are in developing countries. The majority of these deaths occur in sub-Saharan Africa and south Asia, and are avoidable through using standard interventions and health care which all pregnant women and their newborns need.
In this blog, the author reports that in Tanzania, less than one in 10 (9%) of sexually active youth who want to avoid pregnancy use modern contraceptives and that 22.8% of young women between the ages of 15 and 19 are mothers, according to the Tanzania Demographic and Health Survey 2010. Tanzanian women, the survey shows, have an average of 5.4 children each. Early childbearing and high rates of fertility put stress on the health and education systems, on the availability of food and clean water, and on natural resources, according to the country's National Family Planning Costed Implementation Plan. Tanzania has committed to Family Planning 2020 (FP2020), to ensure that, in line with the United Nations secretary general's global strategy for women, children, and adolescent health, all women have access to contraceptives by 2020. The aut5hor indicates that its needed: 47% of Tanzania's population is 15 years or younger. In Tanzania, family planning has been synonymous with child spacing for married men and women, as typified by posters and brochures featuring monogamous couples with their three distinctly spaced children. But the term "family planning" doesn't resonate with young people because they are not yet ready to start families. He notes therefore that as a result, the global health workers' advocacy and support group, IntraHealth International, has started referring to it as "future planning."
To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, the university has developed a demand and supply side strategy by working with local communities and national stakeholders. This quasi-experimental trial was conducted in two districts in Eastern Uganda. The supply side component included health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involved vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery and postnatal care. Analysis from routine health information systems showed that motorcyclists in the community organised themselves to accept vouchers in exchange for transport for maternal care and have become actively involved in ensuring that women obtain care. Maternal care improved, with the number of safe deliveries in the intervention area immediately jumping from less than 200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues were used to obtain needed supplies and to pay health workers, ensuring their availability at a time when workloads are increasing. The researchers conclude that transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care.
Fever in malaria endemic areas, has been shown to strongly predict malaria infection and is a key symptom influencing malaria treatment. WHO recommended confirmation testing for Plasmodium spp. before initiation of antimalarials due to increased evidence of the decrease of morbidity and mortality from malaria, decreased malaria associated fever, and increased evidence of high prevalence of non-malaria fever. To immediately diagnose and promptly offer appropriate management, caretakers of children with fever should seek care where these services can be offered; in health facilities. This study was conducted to describe healthcare seeking behaviours among caretakers of febrile under five years, in Tanzania, and to determine children’s, household and community-level factors associated with parents’ healthcare seeking behaviour in health facilities. Of the 8573 children under the age of five years surveyed, 19.5% had a history of fever two weeks preceding the survey. Of these, 56.8% sought appropriate healthcare. Febrile children aged less than a year have 2.7 times higher odds of being taken to the health facilities compared to children with two or more years of age. Febrile children from households headed by female caretakers have almost three times higher odds of being taken to the health facilities compared to households headed by men. Febrile children with caretakers exposed to mass media (radio, television and newspaper) have more than two times higher odds of being taken to health facilities compared to those not exposed to mass media. Febrile children from regions with malaria prevalence above national level have 41% less odds of being taken to health facilities compared to those febrile children coming from areas with malaria prevalence below the national level. Furthermore, febrile children coming from areas with higher community education levels have 57% higher odds of being taken to health facilities compared to their counterparts coming from areas with low levels of community education. To effectively and appropriately manage and control febrile illnesses, the authors propose that the low proportion of febrile children taken to health facilities by their caretakers should be addressed through frequent advocacy of the importance of appropriate healthcare seeking behaviour, using mass media particularly in areas with high malaria prevalence. They recommend that a multifaceted approach be used in malaria control and eradication as multiple factors are associated with appropriate healthcare seeking behaviour.