The authors identified gaps in Mozambique in the implementation of existing national policies and laws for domestic violence in the services providing care for domestic violence survivors, through content analysis of guidelines and protocols and interviews with institutional gender focal points. While the guidelines were seen to be relevant, many respondents identified gaps in their implementation, due to weaknesses in penalties for offenders, the scarcity of care providers with appropriate training and socio-cultural factors.
Equitable health services
Domestic violence in Mozambique: from policy to practice
Jethá E; Keygnaert I; Martins E; Sidat M; et al: BMC Public Health 21(772) 1-13, 2021
Donor leverage: Towards more equitable access to essential medicines?
Chan CK, de Wildt C: In Press
In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centers pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity? This paper will appear in Development in Practice 18(1), February 2008 and also shortly as a UN-DESA working paper.
Draft implementation plan for achieving universal access to HIV and AIDS, TB and malaria services, 2007-2010
African Union, 10-13 April 2007
This document presents the AU Implementation Plan on Universal Access to HIV/AIDS, TB and Malaria services in Africa by 2010 from the Abuja, Nigeria Special Summit on HIV/AIDS, Tuberculosis and Malaria, 2-4 May 2006. The theme of the Special Summit was “Universal Access to HIV/AIDS, Tuberculosis and Malaria Services by 2010”. The purpose of the plan is to guide the role of Member States, the African Union Commission (AUC), Regional Economic Communities (RECs), Development Partners (bilateral and multilateral organizations), and Civil Society and the Private Sector in translating the decisions of the Heads of State at the Abuja 2006 Special Summit into action.
Drivers and deterrents of facility delivery in sub-Saharan Africa: A systematic review
Moyer CA and Mustafa A: Reproductive Health 10(40), 20 August 2013
The authors conducted this review to identify articles published in English from 1995-2011 that reported on original research into facility-based delivery (FBD) conducted entirely or in part in sub-Saharan Africa. Sixty-five studies met inclusion criteria, 62 of which were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorised as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied, probably due to overwhelming reliance on household survey data. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.
Drivers of routine immunisation coverage improvement in Africa: findings from district-level case studies
LaFond A; Kanagat N; Steinglass R; Fields R; Sequeira J; Mookherji S: Health Policy and Planning 30(3) 298-308, 2014
There is limited understanding of why routine immunisation (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, the authors conducted in-depth case studies to understand pathways to coverage improvement by comparing immunisation programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques the authors compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunisation services and drivers of coverage improvement. The results informed a model for immunisation coverage improvement that emphasises the dynamics of immunisation systems at district level. In all districts, whether improving or steady, the authors found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. They found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness and identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasise the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunisation system performance.
Drug prescribing habits in private surgeries and public hospitals in South Africa
HSRC Review 4 (4), November 2006
This study looks specifically at prescribing habits in South Africa and examines the following questions: what impact the national drug policy (NDP) has on pharmaceutical use in the public sector; whether the NDP achieved rational prescribing and dispensing of drugs by medical, paramedical and pharmaceutical personnel; whether the essential drugs list is used effectively; and what the level of generic prescribing is.
E-procurement in support of universal health coverage
Humphreys G: Bulletin of the World Health Organization, 93(3) 138-139, 2015
Kenya is gearing up for digital bidding on essential medicines’ contracts, part of a wave of African countries looking at procurement to improve transparency, bring down costs and support universal health coverage. John Kabuchi, procurement manager for the Kenya Medical Supplies Authority, notes: “We are currently gearing up for full e-procurement functionality, including electronic bidding, and I am hopeful that supporting legislation will be passed before next June.” Kenya hopes to make the most of new technologies and approaches, such as e-procurement, to support efforts to make essential health care more widely available.
EAC Executive decries high number of East Africans seeking health services in India
East African Community Secretariat: Arusha, Tanzania, June, 2018
The Executive Secretary of the East African Health Research Commission (EAHRC), Professor Gibson Kibiki, has decried the high number of East Africans going to India to seek medical services which can be accessed in hospitals in the region. Prof. Kibiki attributed the huge exodus of patients to India to the lack of information on health services that were available at referral hospitals in the region. He revealed that East Africans may soon be able to access treatment across national borders in addition to enjoying portable health insurance across the region, adding that the Commission would soon undertake research to gauge the feasibility of a regional health insurance scheme before piloting the scheme. He described as counterproductive the tendency by health researchers and medics in the Partner States to work in silos since the region was one and that diseases did not know national borders.
Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013
Moller A; Petzold M; Chou D; et al: The Lancet Global Health 5(10) e977-e983, 2017
The timing of the first antenatal care visit is paramount for ensuring optimal health outcomes for women and children, and it is recommended that all pregnant women initiate antenatal care in the first trimester of pregnancy (early antenatal care visit). Systematic global analysis of early antenatal care visits has not been done previously. This study reports on regional and global estimates of the coverage of early antenatal care visits from 1990 to 2013. Data were obtained from nationally representative surveys and national health information systems. Estimates of coverage of early antenatal care visits were generated with linear regression analysis and based on 516 logit-transformed observations from 132 countries. The model accounted for differences by data sources in reporting the cutoff for the early antenatal care visit. The estimated worldwide coverage of early antenatal care visits increased from 40.9% in 1990 to 58.6% in 2013, corresponding to a 43.3% increase. Overall coverage in the developing regions was 48.1% in 2013 compared with 84.8% in the developed regions. In 2013, the estimated coverage of early antenatal care visits was 24% in low-income countries compared with 81.9% in high-income countries. Progress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and the authors argue that efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation.
Early child development: strategies to ensure children achieve their potential
Engle PL et al: The Lancet 369 (9557): 229-242
This paper assesses strategies to promote child development and to prevent or limit the loss of development potential. The programmes reviewed have been implemented in developing countries since 1990. Thirty-five such studies were identified of which 20 met the researchers’ criteria. They fell into three groups: centre-based early learning, parenting and parent-child programmes, and comprehensive programmes that include health and nutrition interventions. The researchers identify factors that are consistently associated with effective programmes and identify a need to establish globally accepted monitoring indicators for child development and for more evaluation. They conclude with a discussion of priorities and crucial issues for future programmes.