Medicins Sans Frontieres will be the first global medical humanitarian organisation to adopt South Africa's Triage Score (Sats) emergency response system in several countries where their teams provide emergency medical care. Triage systems were introduced worldwide to reduce the waiting time for patients who need critical care when they arrive at emergency rooms. Without the system, patients who seek medical attention in understaffed and overcrowded emergency rooms often can't get the help they need in time. With Sats, patients are categorised according to need, decreasing the waiting time for critically ill patients. The triage scoring system has been found to improve patient flow in accident and emergency units, as well as lower mortality rates and improved the delivery of time-critical treatment for patients with life-threatening conditions. The South African system is designed to deal with the unique challenges of emergency rooms in developing countries, where more patients suffer trauma than in developed countries. MSF has already piloted Sats in some district hospitals in Botswana, Malawi and Ghana.
Equitable health services
Every year, nearly 200,000 women die during childbirth in sub-Saharan Africa in part due to poor access to basic reproductive and maternal health services. The author argues that Over 80 percent of these deaths could have been prevented with the assistance of a midwife. This campaign, Stand Up for African Mothers. aims to ensure that more African women can count on the assistance of a trained midwife during pregnancy and childbirth, and promotes reproductive rights and education to help women and their partners make informed choices about family planning. Through campaign, Amref is training 15,000 midwives to reduce the high rate of maternal mortality in sub-Saharan Africa through both traditional classroom-based teaching, and innovative methods such as distance learning and mLearning, which allows midwives to study using basic mobile phone technology. With a skilled midwife providing care to 500 mothers annually, over seven million African women each year could benefit from this campaign in 13 African countries. By 2016, almost 7,000 midwives had been trained since the campaign began in 2010.
The authors of this study set out to identify the progress made by the Tanzanian Ministry of Health and Social Welfare (MOHSW) in achieving the objective it had set in its National Adolescent Health and Development Strategy: 2002–2006, namely to systematise and extend the reach of Adolescent Friendly Health Services (AFHS) in the country. They reviewed plans and reports from the MOHSW and journal articles on AFHS. Results showed that the MOHSW identified four key problems with what was being done to make health services adolescent friendly in the country – firstly, it was not fully aware of the various efforts under way; secondly, there was no standardised definition of AFHS; thirdly, it had received reports that the quality of the AFHS being provided by some organisations was poor; and fourthly, only small numbers of adolescents were being reached by the efforts that were under way. The MOHSW responded to these problems by mapping existing services, developing a standardised definition of AFHS, charting out what needed to be done to improve their quality and expand their coverage, and integrating AFHS within wider policy and strategy documents and programmatic measurement instruments. It has also taken important preparatory steps to stimulate and support implementation. The authors argue that the focus of the effort must now shift from the national to the regional, council and local levels, with substantial and ongoing support from the Ministry.
This chapter provides an overview of developments in South Africas health system over the past 12 years, using the WHOs assessment framework. While this framework has good health is an obvious goal, broader social objectives such as responsiveness to the needs of citizens and promotion of equity are also measured. Despite the largely successful efforts to shrug off the legacy of a racially divided health system and to generate numerous transformation initiatives, the reality is that the current system is as problematic as it was 12 years ago.
Maternal mental health is largely neglected in low- and middle-income countries. There is no routine screening or treatment of maternal mental disorders in primary care settings in South Africa. The Perinatal Mental Health Project (PMHP) developed an intervention to deliver mental health care to pregnant women in a collaborative, step-wise manner making use of existing resources in primary care. Over a 3-year period, 90% of all women attending antenatal care in the maternity clinic were offered mental health screening with 95% uptake. Of those screened, 32% qualified for referral to counselling. Through routine screening and referral, the PMHP model demonstrates the feasibility and acceptability of a stepped care approach to provision of mental health care at the primary care level.
Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilising interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an inter-agency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobiliser. There are three policy components to the problem of antimicrobials – ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework.
This study assesses the evidence regarding strategies used to attain universal coverage and draws out a list of lessons for policy makers, donors and civil society groups. It focuses mainly on middle-income countries that have recently gained, or are close to gaining, universal coverage. It looks at the extent to which various strategies promote equity in terms of financing, access to and use of services. Key financing priorities are to gradually increase risk pooling arrangements over time, and to focus on protecting the poorest and most socially disadvantaged against the costs of health care.
This book discusses a range of case studies in trauma care, including pre-hospital, hospital-based, rehabilitation and system-wide settings, from all regions of the world and at all socioeconomic levels. It aims to share some of the valuable lessons learned and focuses on practical, affordable and sustainable efforts to improve trauma care, identifying useful methods and strategies that could be adapted for use in other places. It also seeks to dispel the view that little can be done to improve trauma care in low- and middle-income countries. Improvements in care may be measured using outcomes data on decreased mortality or other tangible patient benefits, such as decreased morbidity, improved functional outcome or decreased costs. Performance may also be measured in terms of how much time is devoted to emergency procedures, appropriate use of particular life-saving procedures and greater availability of the human and physical resources needed to provide quality care. The book calls for improvements in training, supervision and monitoring of staff, increased political commitment and timely and accurate data to better inform policy decisions.
This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Provider and patient interviews at both of the sites in the study indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. The paper noted that integrating vertical anti-retroviral therapy and outpatient services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalisability.
This paper presents the results of a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Provider and patient interviews at both of the sites in the study indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. The paper argues that integrating vertical anti-retroviral therapy and outpatient services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalisability.