This analysis identified the gaps and opportunities for cervical cancer prevention, diagnosis, treatment, and care to inform the next cervical cancer strategy in Zimbabwe. A mixed methods approach was used. This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. There was no national data on the proportion of women who ever tested for cervical cancer, or to quantify the level of awareness and advocacy for cervical cancer prevention which existed nationally. Some health facilities were inappropriately screening women above 50 years old using VIAC. Gaps were identified in pathology services, in data on investigations at the national level, in limited funding, personnel, equipment, and commodities as well as lack of leadership at the national level to coordinate the various components of the cervical cancer programme. Numerous opportunities were identified to build upon the successes realized to date, with the findings emphasising the importance of effective and holistic planning and public investment in cervical cancer screening.
Equitable health services
This report from the Global Alliance for Vaccines and Immunisation (GAVI) Alliance looks at how failing or inadequate health systems are one of the main obstacles to scaling up effective distribution of life-saving interventions such as drugs, vaccines and other preventative treatments. The report describes health system strengthening (HSS) as improving governance and leadership, health financing, human resources management, information and knowledge strategies, service delivery and technology and infrastructure. All GAVI-eligible countries (those with a gross national income per capita of less than US$ 1000 in 2003) can apply for health system strengthening funds. Applications for these funds should be coordinated by the national health sector coordination committee (which should involve health sector stakeholders including civil society) and must be approved by ministries of health and finance.
On 14 February 2011, the GAVI Alliance rolled out its plan for a new pneumococcal vaccine for children, which it aims to administer in 19 countries by 2012 and in more than 40 countries by 2015. GAVI’s plan is part of the global drive to reach the Millennium Development Goals for Maternal and Child Health. The Kenya Medical Research Institute in Kilifi has welcomed the vaccine's rollout in the fight against penicillin-resistant and multi-drug resistant pneumococcal strains of the disease that are emerging in Africa. The Institute noted that the disease also causes severe financial difficulties and emotional burdens for families and communities, most of whom never have sufficient funding to treat their affected children. At US$3.50 per dose, the vaccine being issued in developing countries is about 90% cheaper than in the developed world. GAVI and its partner countries will co-finance the rollout, with governments in the poorest income bracket paying US$0.15 per dose. GAVI warned that participating countries would need to step up their health system capacity to achieve this. In addition, the Alliance’s plans to roll out this and other vaccines for major killer diseases are threatened by a funding gap of US$3.7 billion over the next five years.
Mozambique’s health system reconstruction supports the team’s conclusion that the reconstruction of health systems is mainly “gender blind”. In order to review whether the health system is gender equitable, the team assessed the country’s progress against the framework of WHO’s six aspirational building blocks of the health system. From the evidence the authors suggest that policy-makers in Mozambique have not adequately considered the role of gender in contributing to health or addressed women’s and men’s different health needs. Despite government commitment to gender mainstreaming, the health system is far from gender equitable. Donors have shied away from tackling the thorny issue of the social and cultural norms, including gender, which drive ill health.
In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women’s lack of maternal health care access and utilization. This paper reports the key gender dynamics identified, detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women’s workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women’s attitudes and behaviour during pregnancy, men’s attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need to integrate gender into maternal health care interventions if they are to address the root causes of these barriers to maternal health care.
This paper synthesizes findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gender approach can be applied by researchers in a range of low- and middle-income settings to these domains and demonstrates that this can uncover new ways of viewing seemingly intractable problems. The studies used a combination of mixed, quantitative, qualitative and participatory methods, including photovoice and life histories, to prompt deeper and more personal reflections on gender norms. Five core themes that cut across the different studies were the intersection of gender with other social stratifiers, the importance of male involvement, the influence of gendered social norms on health system structures and processes, the reliance on unpaid carers within the health system and the role of gender within policy and practice. These themes indicate the relevance of and need for gender analysis by researchers, policy-makers and health practitioners.
Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many regions with high maternal mortality. In this study, the authors combined a detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana. They estimated journey-time for all women of childbearing age (WoCBA) to their nearest health facility. Findings indicated that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. The authors conclude that their approach, using detailed data assembly combined with geospatial modeling, can provide accurate nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes, they argue, because they fail to take account of the location and accessibility of services relative to the women they serve.
Implementation of known effective interventions could reduce the malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scale-up efforts should be concentrated. They also provide baseline data against which to compare future scale-up of interventions. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes.
Though there is an evidence of increased overall contraceptive prevalence, a substantial effort remains behind in Ethiopia. This study aimed to identify factors associated with modern contraceptive use and to examine its geographical variations among 15–49 married women in Ethiopia. Researchers conducted secondary analysis of 10,204 reproductive age women included in the 2011 Ethiopia Demographic and Health Survey (DHS). Results indicated that being wealthy, more educated, being employed, higher number of living children, being in a monogamous relationship, attending community conversation, being visited by health worker at home strongly predicted use of modern contraception. While living in rural areas, older age, being in polygamous relationship, and witnessing one’s own child’s death were found negatively influence modern contraceptive use. The central and south-western parts of the country had higher prevalence of modern contraceptive use than that of the eastern and western parts. The findings indicate significant socio-economic, urban–rural and regional variation in modern contraceptive use among reproductive age women in Ethiopia. Strengthening community conversation programmes and female education should be given top priority.
This study sought to describe the magnitude and variation of the epilepsy treatment gap worldwide. A systematic review of the peer-reviewed literature published from 1 January 1987 to 1 September 2007 in all languages was conducted, using PubMed and EMBASE. The purpose was to identify population-based studies of epilepsy prevalence that reported the epilepsy treatment gap, defined as the proportion of people with epilepsy who require but do not receive treatment. The study found that the treatment gap was over 75% in low-income countries and over 50% in most lower middle- and upper middle-income countries, while many high-income countries had gaps of less than 10%. However, treatment gaps varied widely both between and within countries. The dramatic global disparity in the care for epilepsy between high- and low- income countries, and between rural and urban settings, calls for immediate attention, according to the study. It urged for a broadening of current understanding of the factors affecting the treatment gap and recommended that future investigations should explore other potential explanations of this gap.