This report on public healthcare provision in South Africa revealed deficiencies in the national health care system, including a shortage of ambulances, clinics, medical personnel and medication. More than 400 community-based and nongovernment organisations, human rights and health organisations and almost every district municipality across the country participated in the assessment. Patients complained of verbal abuse, discrimination and violation of patient rights, especially with regard to confidentiality. The environmental causes of illness, including poor water quality and a lack of proper sanitation was commonly noted, putting pressure on the health system. Deep concern was also expressed that those suffering from chronic illnesses needed access to social and financial support as well as medical treatment. The consultations exposed an absence of effective monitoring and evaluation systems. There are no central points where complaints can be lodged, the report notes. The report has been released ahead of the scheduled parliamentary debates on the proposed National Health Insurance (NHI) scheme.
Equitable health services
Recent calls have been made by several international organisations for stronger links between sexual and reproductive health and HIV policies, programmes and services. However, implementers of PMTCT and other HIV programmes have been constrained in translating these goals into practice. The obstacles include: the narrow focus of current PMTCT programmes on treating HIV-positive women who are already pregnant; separate, parallel funding mechanisms for sexual and reproductive health and HIV programmes; political resistance from major HIV funders and policy-makers to include sexual and reproductive health as an important HIV programme component; and gaps in the evidence base regarding effective approaches for integrating sexual and reproductive health and HIV services. However, new opportunities exist to address these essential links. More supportive political views in the United States of America and the emergence of health systems strengthening as a priority global health initiative provide important springboards for advancing the agenda on links between sexual and reproductive health and HIV. There is need to tap into these platforms for advocating and continue to invest in research.
In this community-based cross-sectional survey among rural pregnant women in western Kenya, a medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were measured. In this rural area with a high HIV prevalence, the reported use of condoms before pregnancy was extremely low. Pregnancy health was not optimal with a high prevalence of malaria, geohelminth infections, anaemia and underweight. Chances of losing a child after birth were high. Multiple interventions are needed to improve reproductive health in this area
This document contains several different articles by various authors on adressing the global challenges to more equitable health systems. health systems. This article briefly reviews the types of constraints faced by health systems in developing countries, and points to the types of information and research needed by decisionmakers to address these constraints. Future health systems in developing countries will need to understand the increasingly complex and unpredictable interactions of local, national and international actors and trends.
The CWGH made a number of resolutions after the 15th National Conference in Harare, including a demand that the right to health be included in the National Constitution. It committed itself to strengthening primary health care and district systems by lobbying for incentives and resources for community health workers from government, getting health institutions to remove high charge barriers and lobbying government for policies to retain health workers. It will also lobby the government to provide free access to safe water as a human right, as well as lobby the Parliamentary Portfolio Committee on health for increased health funding and government for the fair allocation of resources at national level. Community participation should also be promoted. That CWGH will develop a proactive agenda on health issues and forge and strengthen strategic partnership locally and regionally to take this forward, capacitate its districts to enable them to advance and monitor the implementation of these resolutions and ensure that the health delivery system is not used for partisan politics.
This book documents the largest-ever independent, laboratory-based evaluation of rapid diagnostic tests (RDTs) for malaria. It shows that some tests on the market perform exceptionally well in tropical temperatures and can detect even low parasite densities in blood samples, while other tests were only able to detect the parasite at high parasite densities. Testing was performed at the US Centres for Disease Control and Prevention (CDC). Forty-one commercially available RDTs went through a blinded laboratory evaluation. The findings will serve as a tool for countries to make informed choices, from among the dozens of tests commercially available, on the purchase and use of rapid diagnostics that are best suited to local conditions. This performance evaluation will also inform procurement and prioritisation for diagnostic test entry into the World Health Organization (WHO) Prequalification Diagnostics Programme and WHO Procurement Schemes. Donor agencies also regularly refer to WHO recommendations on diagnostics when making their own purchases.
While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. The authors of this paper argue that a comprehensive systems perspective should guide health practice, education, research and policy. They propose key ‘systems thinking’ tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organisations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organisation within health systems, from families and communities to national Ministries of Health.
South Africa was asked to review the progress made by Africa on the implementation of the Plan of Action on the African Union (AU) Decade of Traditional Medicine (2001-2010). The challenge was noted of getting as broad a representation and information from all regions, to foster collaboration among countries and regions as well as to promote information sharing on how best to put African Traditional Medicine in its rightful place.
This World Health Organisation review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions required to cope with the new challenges facing the health systems in the 21st century. The review addresses PHC policy formation and implementation, the resources that are available for PHC implementation, monitoring and review. The review finds that PHC policy formation had been well articulated in the national health policies by most countries, however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will.
This WHO review examines the implementation of primary health care (PHC) in Africa and identifies strategic interventions needed to cope with challenges facing the health systems in the 21st century. It finds that PHC policy formation had been well articulated in the national health policies by most countries; however, the extent to which PHC policies encompassed equity, community participation, inter-sectoral collaboration and affordability is still questionable. Factors delaying PHC implementation include weak structures, inadequate attention to PHC principles, inadequate resource allocation and inadequate political will. Key recommendations include harmonising health sector reforms with PHC to ensure initiatives promote equity and quality in health services, improving the fairness of financing policies and strategies and service coverage for the poor, and supporting countries to address particular human resource needs through clear articulation of human resources policies, plans, development and strengthening of national management systems and employment policies, as well as to identify and put in place mechanisms for attracting and retaining health personnel.