The Ideal Clinic programme was initiated by the South African National Department of Health (NDoH) in July 2013 in order to systematically improve Primary Health Care (PHC) facilities and the quality of care they provide. Provinces have submitted their three-year scale-up plans that indicate in which year each facility will reach Ideal Clinic status. Typically, the purpose of a health facility is to promote health and prevent illness and further complications through early detection, treatment and appropriate referral. An Ideal Clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies. It uses applicable clinical policies, protocols and guidelines, and it harnesses partner and stakeholder support. It also collaborates with other government departments, the private sector and non-governmental organisations to address the social determinants of health.
Equitable health services
Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. The authors assessed the impact of text message reminders on adherence to ACT regimens. Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. The authors estimated the impact of the messages on treatment completion using logistic regression. The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.
This review indicates that universal health coverage (UHC) interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status. The effect of UHC schemes on access, financial protection, and health status varies across contexts, UHC scheme design, and UHC scheme implementation processes. Regarding UHC design features, there are several common features across countries and regions, such as the coexistence of UHC schemes, heterogeneity in design and organisation, a widespread effort to include the poor in the schemes, and the prevalence of mixed financing sources (contributions plus taxes). Yet, in most cases, evidence is scarce and inconclusive on the impact of specific UHC design features on their intended outcomes. Four lessons are highlighted: affordability is important but may not be enough; target the poor, but keep an eye on the non-poor; benefits should be closely linked to target populations' needs; and highly focused interventions can be a useful initial step toward UHC.
In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions. In this study, researchers used a monitoring framework recommended by World Health Organisation and the United States’ Centres for Disease Control and Prevention to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. Findings showed improvements in the performance of IDSR, including: improved reporting at the district level (49% in 2001; 85% in 2007); an increase and then decrease in timeliness of reporting from districts to central level; and an increase in analysed data at the local level. The case fatality rate for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
This Code of Conduct for Health Systems Strengthening offers guidance on how international non-governmental organisations (NGOs) can work in host countries in a way that respects and supports the primacy of the government’s responsibility for organising health system delivery. The code is intended to be clear, direct, succinct and action-oriented. There are six areas where NGOs can do better: 1) hiring policies; 2) compensation schemes; 3) training and support; 4) minimising the management burden on government due to multiple NGO projects in their countries; 5) helping governments connect communities to the formal health systems; and 6) providing better support to government systems through policy advocacy.
This study determined the effects of health systems’ organisation and performance on the West African Ebola outbreak in Guinea, Liberia and Sierra Leone and lessons learned. The WHO health system building blocks were used to evaluate the performance of the health systems in these countries. A systematic review of articles published from inception until July 2015 was conducted following the PRISMA guidelines. Electronic databases including Medline, Embase, Global Health, and the Cochrane library were searched for relevant literature. Grey literature was also searched through Google Scholar and Scopus. Articles were exported and selected based on a set of inclusion and exclusion criteria. Data was then extracted into a spreadsheet and a descriptive analysis was performed. Each study was critically appraised using the Crowe Critical Appraisal Tool. The review was supplemented with expert interviews where participants were identified from reference lists and using the snowball method. Thirteen articles were included in the study and six experts from different organisations were interviewed. A shortage of health workers had an important effect on the control of Ebola but also suffered the most from the outbreak. This was followed by information and research, medical products and technologies, health financing and leadership and governance. Poor surveillance and lack of proper communication also contributed to the outbreak. Lack of available funds jeopardised payments and purchase of essential resources and medicines. Leadership and governance had least findings but an overarching consensus that they would have helped prompt response, adequate coordination and management of resources. Ensuring an adequate and efficient health workforce is thus judged to be of high importance to ensure a strong health system and a quick response to new outbreaks. Adequate service delivery results from a collective success of the other blocks. Health financing and its management is crucial to ensure availability of medical products, fund payments to staff and purchase necessary equipment. The authors also note that leadership and governance needs to be explored for their role in controlling outbreaks.
In this study, 2010-2011 data are reported from public facilities in Kenya where alarming stock-outs were revealed in 2008. Data were collected between January 2010 and June 2011 as part of 18 monthly cross-sectional surveys undertaken at nationally representative samples of public health facilities. The primary monitoring indicator was total stock-out of all four weight-specific artemether-lumefantrine (AL) packs. The secondary indicators were stock-outs of at least one AL pack and individual stock-outs for each AL pack. The number of surveyed facilities across 18 time points ranged between 162 and 176 facilities. The stock-out means of the proportion of health facilities were 11.6% for total AL stock-out, 40.6% for stock-out of at least one AL pack, and between 20.5% and 27.4% for stock-outs of individual AL packs. Despite lower levels of AL stock-outs compared to the reports in 2008, the stock-outs at Kenyan facilities during 2010-2011 are still substantial and of particular concern. Only a minor decrease was observed in the stock-outs of individual AL packs. Recently launched interventions to eliminate AL stock-outs in Kenya are fully justified, the authors argue.
An integrated mHealth solution was developed to improve quality of newborn care and survival in a district hospital in Malawi. The NeoTree application described in this paper focused on newborn care in low-income facilities, combining data collection by healthcare workers themselves, with interactive decision support and education for improving quality of care. Focus groups explored the acceptability and feasibility of digital health solutions before and after implementation of the NeoTree in the clinical setting. Healthcare workers perceived the NeoTree to be acceptable, feasible and clinically usable. Healthcare workers reported high perceived improvements in quality of newborn care after using the NeoTree on the ward. They described improved confidence in clinical decision-making, clinical skills, critical thinking and standardisation of care. The authors suggest that such an interactive co-development with healthcare workers can create a highly usable interactive admission platform, providing a teaching resource and improving the perceived quality of care delivered by healthcare workers involved in newborn care.
The Code of Conduct for Health Systems Strengthening is a response to the recent growth in the number of international non-governmental organizations (INGOs) associated with increase in aid flows to the health sector. It is intended as a tool for service organizations – and eventually, funders and host governments. The code serves as a guide to encourage NGO practices which contribute to building public health systems and discourage those which are harmful. The working document was drafted by a coalition of activist or service delivery organizations, including Health Alliance International, Partners in Health, Health GAP, and Action Aid International. EQUINET also contributed to the consultations on the code. It will be revised in a series of consultations over 2008.
Based on research in education, health, water and sanitation, the authors of this paper sought to identify how politics and governance can constrain or enable equitable and efficient service delivery in developing countries, including Malawi, Rwanda and Uganda. Some of these constraints reflect the nature of the wider governance system, and may have similar effects across sectors, for example in how financial resources are used or how human resources are allocated. The authors’ focus was on the interactions at regional, district and community level between local government officials, service providers and users – the ‘missing middle’ of the service delivery chain. Their analysis of four aid programmes suggests that aid-funded activities can facilitate government efforts to address governance constraints in public service delivery. However, it also indicates that the way in which programmes are designed and implemented matters to whether they are able to gain domestic traction and support institutional change. The authors advocate for ‘arm’s length’ aid models, which work through organisations that offer advisory services directly to governments and other public bodies in developing countries and have had some success as brokers of collective action and facilitators of change.