Three African countries have been chosen to test the world’s first malaria vaccine, the World Health Organisation announced in April 2017. Ghana, Kenya, and Malawi will begin piloting the injectable vaccine next year with hundreds of thousands of young children, who have been at highest risk of death. The vaccine, which has partial effectiveness, has the potential to save tens of thousands of lives if used with existing measures, the WHO regional director for Africa, Dr. Matshidiso Moeti, said in a statement. The challenge is whether impoverished countries can deliver the required four doses of the vaccine for each child. Malaria remains one of the world’s most stubborn health challenges, infecting more than 200 million people every year and killing about half a million, most of them children in Africa. Bed netting and insecticides are the chief protection. A global effort to counter malaria has led to a 62 percent cut in deaths between 2000 and 2015, WHO said. But the U.N. agency has said in the past that such estimates are based mostly on modelling and that data is so bad for 31 countries in Africa — including those believed to have the worst outbreaks — that it couldn’t tell if cases have been rising or falling in the last 15 years. The vaccine will be tested on children five to 17 months old to see whether its protective effects shown so far in clinical trials can hold up under real-life conditions. At least 120,000 children in each of the three countries will receive the vaccine, which has taken decades of work and hundreds of millions of dollars to develop. Kenya, Ghana and Malawi were chosen for the vaccine pilot because all have strong prevention and vaccination programs but continue to have high numbers of malaria cases, WHO said. The countries will deliver the vaccine through their existing vaccination programs. WHO is hoping to wipe out malaria by 2040 despite increasing resistance problems to both drugs and insecticides used to kill mosquitoes. The malaria vaccine has been developed by pharmaceutical company GlaxoSmithKline, and the $49 million for the first phase of the pilot is being funded by the global vaccine alliance GAVI, UNITAID and Global Fund to Fight AIDS, Tuberculosis and Malaria.
Equitable health services
Globally, inadequate sexual and reproductive health services have resulted in maternal deaths and rising numbers of sexually transmitted infections (STIs), particularly in developing countries. Leaders of the World Health Organization (WHO) and UNFPA, the United Nations Population Fund, are coordinating action to reverse the global trend of deteriorating levels of sexual and reproductive health and reduce the adverse impact on mothers, babies and young people.
Modern medicine is often accused by diverse critics of being ‘too materialistic’ and therefore insufficiently holistic and effective. Yet, this critique can be misleading, the authors of this paper argue, as it is dependent upon the ambiguous meanings of ‘materialism’. The term can refer to the prevalence of financial concerns in driving medical practice or it can refer to ‘mechanistic materialism,’ the patient viewed as a body-machine. In each case, this article shows that this represents not authentic ‘materialism’ at play, but a focus upon high-level abstractions. ‘Bottom-line’ financial or diagnostic numbers can distract practitioners from the embodied needs of sick patients. In this sense, medical practice is not materialist enough. Through a series of clinical examples, the authors explore how an authentic materialism would look in current and future practice. They examine the use of prayer/comfort shawls at the bedside, the redesign of hospitals and nursing homes as enriched healing environments, and a paradigmatic medical device - the implantable cardioverter defibrillator - as it might be presented to patients, in contrast to current practice.
Using case studies, the authors of this study collated and analysed practical examples of operational research projects on health in sub-Saharan Africa that demonstrate how the links between research, policy and action can be strengthened to build effective and pro-poor health systems. Three operational research projects met the case study criteria: HIV counselling and testing services in Kenya; provision of TB services in grocery stores in Malawi; and community diagnostics for anaemia, TB and malaria in Nigeria. The authors found that building equitable health systems means considering equity at different stages of the research cycle. Partnerships for capacity building promotes demand, delivery and uptake of research. Links with those who use and benefit from research, such as communities, service providers and policy makers, contribute to the timeliness and relevance of the research agenda and a receptive research-policy-practice interface. The study highlights the need to advocate for a global research culture that values and funds these multiple levels of engagement.
The overarching aim of this study was to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. The broader context of the study is the 'urban health crisis'; a term that refers to the disparity between the increasing need for medical care in urban areas against the declining carrying capacity of existing public health systems. The analysis illustrates how more sophisticated GIS-based analytical techniques can be usefully applied in support of strategic spatial planning of urban health services delivery. The study offers two frameworks for analysis. Its evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators, while its intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. When used together, these two planning instruments offer a flexible framework with which health planners can formulate and evaluate alternative intervention scenarios and deal with the most important problems involved in the spatial planning of urban health services.
The move towards universal health coverage is premised on having well-functioning health systems. The authors present an approach to provide countries with information on the functionality of their systems in a manner that will facilitate movement towards universal health coverage. They propose four capacities: access to, quality of, demand for essential services and its resilience to external shocks and provide results for the 47 countries of the WHO African Region based on this. The functionality of health systems in these countries ranged from 34.4 to 75.8 on a 0–100 scale. Access to essential services represents the lowest capacity. Funding levels from public and out-of-pocket sources represented the strongest predictors of system functionality. The authors propose that such assessment on the capacities that define system functionality can help countries to identify where to focus to improve the functioning of the health system.
Traditional health practitioners (THPs) and their role in traditional medicine health care system are worldwide acknowledged. Trend in the use of Traditional medicine (TRM) and Alternative or Complementary medicine (CAM) is increasing due to epidemics like HIV/AIDS, malaria, tuberculosis and other diseases like cancer. Despite the wide use of TRM, genuine concern from the public and scientists/biomedical heath practitioners (BHP) on efficacy, safety and quality of TRM has been raised. While appreciating and promoting the use of TRM, the World Health Organization (WHO), and WHO/Afro, in response to the registered challenges has worked modalities to be adopted by Member States as a way to addressing these concerns. Gradually, through the WHO strategy, TRM policy and legal framework has been adopted in most of the Member States in order to accommodate sustainable collaboration between THPs and the scientist/BHP. Research protocols on how to evaluate traditional medicines for safety and efficacy for priority diseases in Africa have been formulated. Creation of close working relationship between practitioners of both health care systems is strongly recommended so as to revamp trust among each other and help to access information and knowledge from both sides through appropriate modalities. In Tanzania, gaps that exist between THPs and scientists/BHP in health research have been addressed through recognition of THPs among stakeholders in the country's health sector as stipulated in the National Health Policy, the Policy and Act of TRM and CAM. Parallel to that, several research institutions in TRM collaborating with THPs are operating. Various programmed research projects in TRM that has involved THPs and other stakeholders are ongoing, aiming at complementing the two health care systems. This paper discusses global, regional and national perspectives of TRM development and efforts that have so far been directed towards bridging the gap between THPs and scientist/BHP in contemporary health research in Tanzania.
“Disparity” implies the existence of a “markedly distinct in quality or character,” difference between one group and another. Some groups, due to elevated stigma associated with group membership, are invisible as a disparate minority and therefore, while there may be a great inequity in healthcare between that group and the normative population, the invisible minority is ignored. This chapter addresses the issue of healthcare for the transgender-identified population. It addresses how the normative viewpoint of mental illness and unacceptable religious status, along with lifelong perceived and actual abuse and violence, creates a socially sanctioned inequality in healthcare for this population.
During 2004-2008, several FIDELIS projects (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) in Tanzania were conducted by the National Tuberculosis and Leprosy Programme to strengthen tuberculosis (TB) diagnostic and treatment services. The authors of this study assessed the duration and determinants of treatment delay among new smear-positive pulmonary TB patients in FIDELIS projects, and compared delay according to provider visited prior to diagnosis. They included 1,161 cases, 10% of all patients recruited in the FIDELIS projects in Tanzania. Median delay was 12 weeks. Compared to Hai district, Handeni had patients with longer delays and Mbozi had patients with shorter delays. Urban and rural patients reported similar delays. In conclusion, half of the new smear positive pulmonary tuberculosis patients had a treatment delay longer than 12 weeks. Delay was similar in men and women and among urban and rural patients, but longer in the young and older age groups. Patients using traditional healers had a 25% longer median delay.
Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). The authors aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription? Data were identified from 37 published studies, 46 WHO/Health Action International national surveys, and eight service provision assessments. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs.