The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralisation of mental health services to district level, as set out in the new Mental Health Care Act, No. 17 of 2002, and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to de-institutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. The paper recommends that, in a similar vein to other low- to middle-income countries, de-institutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.
Equitable health services
This report presents results from a total population survey of malaria infection and intervention coverage in a rural area of eastern Uganda, with a specific focus on how risk factors differ between demographic groups in this population. In 2008, a cross-sectional survey was conducted in four contiguous villages in Mulanda, sub-county in Tororo district, eastern Uganda, to investigate the risk factors of Plasmodium species infection. All permanent residents were invited to participate, with blood smears collected from 1,844 individuals aged between six months and 88 years (representing 78% of the population). Overall, 709 individuals were infected with Plasmodium, with prevalence highest among 5-9 year olds (63.5%). In total, 68% of households owned at least one mosquito net, although only 27% of school-aged children reported sleeping under a net the previous night. These findings demonstrate that mosquito net usage remains inadequate and is strongly associated with risk of malaria among school-aged children. Infection risk amongst adults is influenced by proximity to potential mosquito breeding grounds. Taken together, these findings emphasise the importance of increasing net coverage, especially among school-aged children.
This pilot study in Thailand assessed policies about primary health care (PHC), focusing on how equitably resources are distributed, the adequacy of resources, comprehensiveness of services and co-payment. A questionnaire survey was administered to five policymakers, five academicians and 77 primary care practitioners at a PHC workshop. Responses were consistent: financial resources should be allocated based on different health needs and special efforts must be made to assure PHC to underserved populations. The supply of essential drugs should be adequate, as well, with equitable distribution of services and low out-of-pocket payments. The questionnaire was robust across key stakeholders and feasible for use in transitional or less-developed countries, like those in Africa.
Hart describes the background of the creation of NHS and its history. Although NHS was relatively under-funded in the 1960s and 1970s, it was still extremely efficient: The UK was under a long period of time the OECD country with the lowest government allocation for health. Despite this, the outcome was impressive: Equal health care for all, evenly distributed throughout the country. The cost for administration was unbeatable: Initially it was 2%, but increased to 6% when the conservative government introduced the principles of ”New Public Management”. Since NHS became subject to privatisation and the introduction of internal markets, the administration cost has risen to 12%. One of Hart’s points is that public health care is cheap, partly because the administration cost is low.
Weak infrastructure and limited distribution systems in low-income countries complicate access to health services, especially in rural areas. Government health outlets may be relatively few and widely dispersed, and private-sector sources often favor wealthier urban areas, resulting in uneven service availability within a country. In the absence of a solid heath infrastructure, strengthening primary health care and innovative community-based health service delivery systems help provide more equitable access to health services. Some programs are underway in Ethiopia whose successes do not depend on the availability of a strong infrastructure.
Inadequate patient tracking at one of South Africa's largest antiretroviral (ARV) distribution sites, has led to many patients disappearing from the clinic before treatment starts, a new report has found. The report by the Reproductive Health & HIV Research Unit (RHRU) of the University of the Witwatersrand, based on a 2006 review of patient files at the Tshepong Wellness Clinic, about 120km southwest of Johannesburg, shows that a standard percentage - about 14 percent - stop taking treatment, but more than 20 percent of patients never get to the treatment stage.
The importance of poor-quality anti-tuberculosis drugs cannot be underestimated, as they may disrupt all major complex interventions to ensure treatment efficacy. Not only treatment failure may ensue, but, more importantly, rapid emergence of acquired drug resistances can also be favoured. The authors raise that a relevant proportion of underqualified medicines could be detected through relatively inexpensive and simple assays at destination countries, based on chromatographic techniques. Such tests are able to identify the type and concentrations of the various components. They note that their execution is not compulsory and only rarely pursued. They describe a vicious cycle where local regulatory authorities fail to implement controls of fraudulent manufacturers being encouraged to enter the market.
Poor-quality antimalarial drugs lead to drug resistance and inadequate treatment, posing a threat to vulnerable populations and jeopardising progress in combating malaria. In this study, the authors reviewed published and unpublished studies reporting chemical analyses and assessments of packaging of antimalarial drugs. Of 1,437 samples of drugs in five classes from seven countries in southeast Asia, 497 (35%) failed chemical analysis, 423 (46%) of 919 failed packaging analysis, and 450 (36%) of 1,260 were classified as falsified. In 21 surveys of drugs from six classes from 21 countries in sub-Saharan Africa, 796 (35%) of 2,297 failed chemical analysis, 28 (36%) of 77 failed packaging analysis, and 79 (20%) of 389 were classified as falsified. Data were insufficient to identify the frequency of substandard (products resulting from poor manufacturing) antimalarial drugs, and packaging analysis data were scarce. Concurrent interventions and a multifaceted approach are needed to define and eliminate criminal production, distribution, and poor manufacturing of antimalarial drugs. Empowering national medicine regulatory authorities to protect the global drug supply is more important than ever, the authors conclude.
This presentation investigates the barriers to access that couples face when deciding to use family planning. It identifies a number of key barriers in Africa, including limited method choice, prohibitive financial costs, psychosocial factors relating to the status of women, medical and legal restrictions, provider bias and misinformation. The author of the presentation has two recommendations. Firstly, Governments should prioritise family planning and have line items in their budgets for family planning training and services, and for commodities. Secondly, they should make available the fullest possible range of contraceptive choices, including voluntary sterilisation, through the widest range of distribution channels, backed up by access to safe abortion.
Ethiopia has one of the highest maternal mortality ratios (673 per 100,000 live births) in the world, and unsafe abortion was estimated to account for 32% of all maternal deaths in Ethiopia. The objective of this study was to assess post-abortion care quality status in health facilities of Guraghe zone, in Ethiopia. A facility based cross-sectional study design with both quantitative and qualitative methods was conducted, which included six health centres, two hospitals and 422 post-abortion patients. Patient-provider interaction was generally satisfactory from the patient’s perspective as, overall, 83.5% of the patients were satisfied with the services. Those who said waiting time was long were less satisfied and unemployed women were more satisfied than others. However, from a clinical service delivery stand point, important medical information on danger signs, follow-up needs of post abortion clients and care associated pain management were neglected by most of the health professionals. Almost all of the health facilities had basic and appropriate medical equipment and supplies required for providing post-abortion services. This study has also shown that significant proportions of providers were trained on important aspects of pregnancy and ante-natal care.