This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector. The paper presents global evidence that suggests significant differences between rural and urban populations in health coverage
and access at global, regional and national levels. Based on the evidence provided, place of residence largely determines coverage and access to health care in all regions and within all countries. . Efficient and effective multisectoral policies to address the root causes of rural inequities should consider the specific living and working characteristics of rural populations. The authors argue that if not addressed, the rural/urban disparities identified in access to health care carry the potential to considerably hamper overall socio-economic development in many developing countries.
Equitable health services
Almost US$1 million worth of anti-malaria drugs are missing or have expired in Tanzania's medical warehouses, this audit has found. Artemisinin combination therapy (ACT) drugs worth US$819,000 are missing and stock worth US$130,000 has expired, highlighting problems with internal control mechanisms. In addition, glitches in the procurement process led to an oversupply and the consequent expiry of ACTs - which have a relatively short shelf-life - in warehouses around the country. The Global Fund has asked the Tanzanian office of international audit firm Price-Waterhouse-Coopers to investigate.
The researchers in this paper identify a gap between what most international health organisations say they are doing to strengthen health systems, and the reality on the ground. Although global health actors claim to be strengthening health systems, the authors argue that they engage almost exclusively with activities that match their own specific aims; tend to concentrate on single diseases, and focus on strengthening elements of health systems essential to their own programmes. Part of the problem, say the researchers, is that the term 'health system strengthening' is being used for any capacity building. They call for a definition that is both shared and consistently applied.
This paper discusses some of the approaches to technical support for health systems strengthening taken to date, and looks at problems and possible solutions. It finds that the growing resources available for health system strengthening are not accompanied by resources and commitment to providing technical support. Furthermore, the global market for technical support is complex: multiple agencies use different approaches for providing support, and a number of issues, including institutional roles, affect the supply and demand for high quality technical assistance. The paper concludes that the provision of technical support for health systems strengthening needs to be scaled up considerably, but in ways that best fit country realities on the ground. Technical support approaches need to take into account the complexity of a country’s national health system and the context within which it operates.
The next leader of a global organisation that fights major infectious diseases, including AIDS, may come from a group that includes the former health minister of Mexico, France's AIDS ambassador, the former leader of UNICEF, and several leaders of the World Health Organization, according to a list of names obtained by the Globe. The board overseeing the organization, Global Fund to Fight AIDS, Tuberculosis and Malaria, failed to select a new executive director last November and now hopes to name one at a meeting in Geneva early next month.
This paper describes and analyses the GAVI Alliance's early experience with health systems strengthening (HSS) to improve immunisation coverage and other maternal-child health outcomes. The challenges have been forging a common vision and approach, governance, balancing pressure to move money with incremental learning, managing partner roles and relationships, managing the ‘value for money’ risk, and capacity building. This mid-point stock-taking makes recommendations for moving GAVI forward in a thoughtful manner. The findings should be of interest to other global health partnerships because of their larger significance. This is a story about how a successful alliance that decided to broaden its mandate has responded to the technical, organisational, and political complexities that challenge its traditional business model.
This paper briefly reviews global progress and challenges with respect to public vaccination programmes. The most striking recent achievement has been that of reduction of global measles mortality from an estimated 750,000 deaths in 2000 down to 197,000 in 2007. Global vaccination coverage trends continued to be positive. In 2007 most regions reached more than 80% of their target populations with three doses of DPT containing vaccines. However, the coverage remains well short of the 2010 goal on 90% coverage, particularly in the WHO region of Africa, while had only 74% coverage. Remaining challenges include the need to: develop and implement strategies for reaching the difficult to reach; support evidence-based decisions to prioritise new vaccines for introduction; strengthening immunisation systems to deliver new vaccines; expand vaccination to include older age groups; scale up vaccine preventable disease surveillance; improve quality of immunisation coverage monitoring and use the data to improve programme performance; and explore financing options for reaching the GIVS goals, particularly in lower middle-income countries.
The Ebola virus disease outbreak in west Africa and the rapid spread of other emerging viruses, such as the severe acute respiratory syndrome or the Middle East respiratory syndrome coronaviruses, showed how limited or non-existent infection prevention and control (IPC) programmes, combined with an inadequate water supply, poor sanitation, and a weak hygiene infrastructure in health facilities, can threaten global health security. In such outbreaks, instead of serving as points where disease was controlled, health-care facilities became dangerous places for outbreak amplification among staff and patients and transmission back to communities. The authors argue that it is now urgent to consider IPC capacity building and actual implementation as global health priorities. Among its efforts in this field, WHO coordinates the Global IPC (GIPC) Network. There are strong economic and ethical reasons to enhance IPC within the national and global health security agendas and efforts should capitalise upon evidence-based recommendations, proven and feasible implementation strategies, and awareness raised by AMR and epidemic-prone disease threats.
Government, business and civil society leaders gathered at the United Nations to launch a global campaign to reduce malaria deaths, currently at more than 1 million each year, to near zero by 2015, with an initial commitment of nearly a $3 billion. The Global Malaria Action Plan (GMAP) aims to cuts deaths and illness by 2010 to half their 2000 levels by scaling up access to insecticide-treated bed nets, indoor spraying and treatment, and achieve the near-zero goal through sustained universal coverage. Ultimately it seeks to eradicate the disease completely with new tools and strategies.
The world risks losing its most potent treatment for malaria unless steps are quickly taken to prevent the development and spread of drug-resistant parasites, according to this action plan by the World Health Organization (WHO) and Roll Back Malaria partnership (RBM). The plan outlines the necessary actions to contain and prevent resistance to artemisinins, which are the critical component of artemisinin-based combination therapies (ACTs), the most potent weapon in treating falciparum malaria, the deadliest form of the disease. Resistance to artemisinins has already emerged in areas on the Cambodia-Thailand border. Although ACTs are currently more than 90% efficacious around the world, quick action is essential, WHO and RBM argue. If these treatments fail, many countries will have nothing to fall back on. The global plan aims to contain and prevent artemisinin resistance through a five-step action plan. 1. Stop the spread of resistant parasites through a fully funded and implemented malaria control agenda. 2. Increase monitoring and surveillance for artemisinin resistance. 3. Improve access to malaria diagnostic testing and rational treatment with ACTs and reduce unnecessary use of ACTs – WHO recommends diagnostic testing of all suspected malaria cases prior to treatment. 4. Invest in artemisinin resistance-related research, especially with regard to developing more rapid techniques for detecting resistant parasites, and to developing new classes of antimalarial medicines to eventually replace the ACTs. 5. Motivate action and mobilise resources.