This story describes the experience of Professor Stanis Wembonyama as director of the main hospital in Democratic Republic of Congo's second city, Lubumbashi, last year. Gecamines, the state-owned mining monopoly used to be in charge - theoretically - of the Jason Sendwe Hospital, but the institution had been left to rot. Most of the beds had been either stolen or stripped down and sold as scrap metal. Doctors and nurses had not been paid their salaries for five years and so they earned their living by demanding cash before treating their patients. The story outlines the steps to clean up the hospital and instil management discipline.
Equitable health services
Breathing life into DRC's sick hospital
Winter J: BBC News International, 8 August 2006
Bridging the gap between biomedicine and traditional healing
Buisnessinafrica, 17 April 2006: Etkind J
Nearly 18 months ago, South Africa’s Traditional Health Practitioners Bill made a triumphal passage through parliament, raising hopes in the hearts of the 300 000 or so practising traditional healers in South Africa that they might at last begin to ply their trade on an equal footing with their biomedical counterparts. The legislation included allowing traditional healers’ patients to claim through medical aid schemes, giving them access to government hospitals and clinics and demanding the same respect and courtesy accorded to general practitioners, surgeons and other biomedical professionals.
Building consensus on key priorities for rural health care in South Africa using the Delphi technique
Versteeg M, du Toit L, Couper I and Mnqapu M: Global Health Action 6(19522), 24 January 2013
Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. Therefore, the objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. The top five priorities identified by participants were aligned to three of the World Health Organisation’s health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel made the following policy recommendations: a focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.
Call to Action: Health System Strengthening through the Global Fund
The Global Fund
Round 7 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which launches March 1, 2007, offers an important opportunity to fund health system strengthening, including the health workforce. To prepare for Round 7, health workers, ministry of health officials, and other individuals and institutions that have an interest in their countries' health systems are strongly encouraged to consider utilizing this opportunity for strengthening health systems. If interested, you should immediately contact members of your country's Country Coordinating Mechanism to discuss this potential, as well as the national process and timeline for developing these proposals. The proposals are expected to be due to the Global Fund in early July 2007.
Further details: /newsletter/id/32113
Cancer care in sub-Saharan Africa – urgent need for population-based cancer registries
Okobia MN: Ethiopian Journal of Health Development, 2007
This article reviews literature on cancer statistics in sub-Saharan Africa, and assesses the need for population-based cancer registries to enhance cancer care and prevention within the region. The article finds that there are few cancer registries in sub-Saharan Africa and most of these are hospital based. This is partly because in many countries cancer is a low priority as more emphasis is placed on the control of communicable diseases and improving environmental sanitation.
Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa
Carlson S; Duber H; Achan J; Ikilezi G; Mokdad A; Stergachis A; Gollum A; Bushman G; Roth G: Heart, doi: http://dx.doi.org/10.1136/heartjnl-2016-310913, 2017
Heart failure is a major cause of disease burden in sub-Saharan Africa. The authors aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions. They analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya) and report on the availability of cardiac diagnostic technologies and select medications for heart failure. Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities). Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter. Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. The authors’ findings call for increased investment in cardiac care to reduce the growing burden of heart failure.
Capacity of healthcare facilities in the implementation of Direct Observed Treatment strategy for tuberculosis in Arumeru and Karatu districts, Tanzania
Mfinanga GS, Ngadaya E, Kimaro G, Mtandu R, Lema LA, Basra D, Lwila F, Egwaga S, Kitau AY: Tanzania Journal of Health Research 10(2): 95-98, 2008
Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuberculosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS, in Arumeru and Karatu districts, Tanzania. Information sought included the capacity to offer TB service and availability of qualified staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed, 86 (77.5%) in Arumeru and 25 (22.5%) in Karatu. Only 23.4% (26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38%) of them were government owned. Thirty eight (44.7%) facilities were offering TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0%) of health facilities which do not provide any TB services had qualified clinical officers and at least a microscopy. Of the 339 cases notified in Arumeru in 2004, 187 (60.7%) had treatment outcome available, 124 (66.3%) were cured and 55 (29.4%) completed treatment. In Karatu 638 cases were notified in 2004, 305 (47.8%) had treatment outcome available, 68 (22.3%) cured and 165 (54.1%) completed treatment. In conclusion, the overall capacity for implementing DOTS among the facilities surveyed is found only in about 20% and 30% for clinical and laboratory components of DOTS, respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower than Arumeru. It is important that capacity of the facilities is strengthened concurrently with the planned introduction of community- based DOTS in Tanzania.
Cardiovascular disease prevention in Ghana: feasibility of a faith-based organisational approach
Abanilla PKA, Huang K, Shinners D, Levy A, Ayernor K, de-Graft Aikins A and Ogedegbe O: Bulletin of the World Health Organisation 89(9): 648-656, September 2011
The authors of this study examined the feasibility of using community health workers (CHWs) to implement cardiovascular disease (CVD) prevention programmes within faith-based organisations in Accra, Ghana. Faith-based organisation capacity, human resources, health programme sustainability/barriers and community members’ knowledge were evaluated. Data on these aspects were gathered through a mixed method design consisting of in-depth interviews and focus groups with 25 church leaders and health committee members from five churches, and of a survey of 167 adult congregants from two churches. Findings indicated that the delivery of a CVD prevention programme in faith-based organisations by CHWs is feasible. Many faith-based organisations already provide health programmes for congregants and involve non-health professionals in their health-care activities, and most congregants have a basic knowledge of CVD. Yet despite the feasibility of the proposed approach to CVD prevention through faith-based organisations, sociocultural and health-care barriers such as poverty, limited human and economic resources and limited access to health care could hinder programme implementation.
Caring for a child with Cerebral Palsy: The experience of Zimbabwean mothers
Dambi J; Jelsma J; Mlambo T: African Journal of Disability 4(1) 2015 doi: 10.4102/ajod.v4i1.168
The needs of caregivers of children with disability may not be recognized despite evidence to suggest that they experience increased strain because of their care-giving role. This strain may be exacerbated if they live in under-resourced areas. The authors set out to establish the well-being of caregivers of children with Cerebral Palsy (CP) living in high-density areas of Harare, Zimbabwe. In addition, the authors wished to identify factors that might be predictive of caregivers’ well-being. Finally, they examined the psychometric properties of the Caregiver Strain Index (CSI) within the context of the study. Caregivers of 46 children with CP were assessed twice, at baseline, and after three months, for perceived burden of care and health-related quality of life. The psychometric properties of the CSI were assessed post hoc. The caregivers reported considerable caregiver burden with half of the caregivers reporting CSI scores in the ‘clinical distress’ range. Many of the caregivers experienced some form of pain, depression and expressed that they were overwhelmed by the care-giving role. No variable was found to be associated with clinical distress. The authors propose that caregivers be monitored routinely for their level of distress and that there is an urgent need to provide them with support. The CSI is likely to be a valid measure of distress in this population.
Cataract surgery: Ensuring equal access for boys and girls
Bronsard A and Shirima S: Community Eye Health Journal 22(70): 28–29, 2009
Surgical intervention is necessary if children with cataract are to regain their sight. In many low- and middle-income countries, cataract is the leading cause of avoidable blindness among children. This article in considers the gender dimensions of surgery and the background to the situation in Tanzania where many children are not brought for surgery in a timely fashion and follow up is often poor. Girls have a significantly lower rate of surgery with only half as many girls receiving treatment as boys and tended to be bought for surgery much later than boys. In poor or struggling communities, sons are often seen as a source of income and financial security for parents when they get older, whereas girls are seen as a financial burden. Analysis showed that women’s level of education, their socioeconomic status, and the decision-making power they had within their household and their community all played a major role in determining whether and when their children would receive cataract surgery and whether they would be taken for follow-up visits. A number of ways forward are discussed including mass media efforts which may provide the first opportunity for rural villagers to learn about the need for early referral of young children with vision loss.