This report outlines key interventions for maternal and newborn health care programmes to improve maternal and newborn health and survival. These should be delivered by the health services, family, and the community to the mother during pregnancy, childbirth and in the postpartum period, and to the newborn soon after birth. They include important preventive, curative and health promotional activities for the
present as well as the future.
Equitable health services
Interventions recommended to improve maternal and newborn health
World Health Organisation, May 2007
Introducing vouchers for malaria prevention in Ghana and Tanzania: Context and adoption of innovation in health systems
De Savigny D, Webster J, Agyepong IA, Mwita A, Bart-Plange C, Baffoe-Wilmot A et al: Health Policy and Planning 27 (suppl): iv32–iv43, 27 September 2012
In this study, the authors compare the health system and other contexts between Tanzania and Ghana that are relevant to the scaling up of continuous delivery of insecticide treated nets (ITNs) for malaria prevention. While both countries have made major efforts and investments to address this intervention through integrating consumer discount vouchers into the health system, the schemes have been more successful in Tanzania. The authors found that contextual factors that provided an enabling environment for the voucher scheme in Tanzania did not do so in Ghana. The voucher scheme was never seen as an appropriate national strategy, other delivery systems were not complementary and the private sector was under-developed. The extensive time devoted to engagement and consensus building among all stakeholders in Tanzania was an important and clearly enabling difference, as was public sector support of the private sector. This contributed to the alignment of partner action behind a single co-ordinated strategy at service delivery level which in turn gave confidence to the business sector and avoided the ‘interference’ of competing delivery systems that occurred in Ghana.
Investigating health system performance: An application of data envelopment analysis to Zambian hospitals
Masiye F: BMC Health Services Research 7:58, 25 April 2007
Zambia has recently articulated an ambitious national health program designed to meeting health-related MDGs. Public expectations are high and Zambia continues to receive significant resources from global and bilateral donors to support its health agenda. Although the lack of adequate resources presents the most important constraint, the efficiency with which available resources are being utilised is another challenge that cannot be overlooked. Inefficiency in producing health care undermines the service coverage potential of the health system. This paper estimates the technical efficiency of a sample of hospitals in Zambia. This study demonstrates that inefficiency of resource use in hospitals is significant. Policy attention is drawn to unsuitable hospital scale of operation and low productivity of some inputs as factors that reinforce each other to make Zambian hospitals technically inefficient at producing and delivering services. It is argued that such evidence of substantial inefficiency would undermine Zambia's prospects of achieving its health goals.
Investigating preferences for mosquito-control technologies in Mozambique with latent class analysis
Smith RA, Barclay VC and Findeis JL: Malaria Journal 10(188), 21 July 2011
The aim of this study was to investigate latent classes of users in Mozambique based on their preferences for mosquito-control technology attributes and covariates of these classes, as well as to explore which current technologies meet these preferences. Surveys were administered in five rural villages in Mozambique. The data showed that users' preferences for malaria technologies varied, and people could be categorised into four latent classes based on shared preferences. The largest class, constituting almost half of the respondents, would not avoid a mosquito-control technology because of its cost, heat, odour, potential to make other health issues worse, ease of keeping clean, or inadequate mosquito control. The other three groups are characterised by the attributes which would make them avoid a technology - these groups are labelled as the bites class, by-products class, and multiple-concerns class. Those with multiple concerns, mostly men, were likely to avoid using a malaria product as they would still hear or be bitten by mosquitoes, or found it it expensive or uncomfortable. Participants in the by-products group, more likely to be females, avoid a malaria product based on heat, odour and side effects. Participants in the bites class
avoid a product if they would still be bitten by mosquitoes. To become widely diffused, the authors suggest that end-users should be included in product development to ensure that preferred attributes or traits are considered. This study demonstrates that end-user preferences can be very different and that one malaria control technology will not satisfy everyone.
Investigation of an anthrax outbreak in Makoni District, Zimbabwe
Makurumidze R; Tafara Gombe N;Magure T; Tshimanga M: BMC Public Health 21(298), 1-10, 2021
The authors investigated an anthrax outbreak in Makoni District, Zimbabwe, and assessed the environment, district preparedness and response, and outbreak prevention and control measures. They found that most of the cases were managed according to the national guidelines. Multivariable analysis demonstrated that meat sourced from other villages, skinning, and belonging to religions that permit eating meat from cattle killed due to unknown causes or butchered after unobserved death were associated with contracting anthrax. The poor availability of resources in the district caused a delayed response to the outbreak. Although the outbreak was eventually controlled through cattle vaccination and health education and awareness campaigns, the authors report that the response of the district office was initially delayed and insufficient. They call for strengthened emergency preparedness and response capacity at district level, for revival of zoonotic committees, awareness campaigns and improved surveillance, especially during outbreak seasons.
Investing in sanitation is investing in human dignity, says UN expert
United Nations: November 2008
Access to improved sanitation is a matter of human rights, says the UN. There is compelling evidence that sanitation brings the single greatest return on investment of any development intervention (roughly $9 for every $1 spent). Yet it remains the most neglected and most off-track of the Millennium Development Goal (MDG) targets. Sanitation has been considered as the most important medical advance since 1840 – beating antibiotics, vaccines and anaesthesia. Access to sanitation is essential for people to live in dignity, yet 40% of the world still does not have basic sanitation. The scale of the crisis is enormous, according to the United Nations, which reports that 2.5 billion people do not have access to proper sanitation.
Investment in HIV/AIDS programmes: Does it help strengthen health systems in developing countries?
Yu D, Souteyrand Y, Banda MA, Kaufman J and Perriens JH: Globalization and Health, 16 September 2008
Is scaled-up investment in HIV/AIDS programmes strengthening or weakening fragile health systems of developing countries? Among the positive impacts are the increased awareness of and priority given to public health by governments, some primary health care services have been inmproved, services to people living with HIV/AIDS have rapidly expanded, and in many countries infrastructure and laboratories have been strengthened. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and task-shifting. However, there are concerns about a temporal association between increased AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programmes - with limited hard evidence. Because service delivery for AIDS has not reached a level close to Universal Access, countries and development partners must maintain the momentum of investment in HIV/AIDS programmes. At the same time, global action for health is even more underfunded than the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.
Iron supplementation in early childhood: Health benefits and risks
Iannotti LL, Tielsch JM and Black MM: American Journal of Clinical Nutrition 84(6): 1261–1276, 2009
This study reviewed 26 randomised controlled trials of preventive, oral iron supplementation in young children (aged 0–59 months) living in developing countries to ascertain the associated health benefits and risks. It found that among iron-deficient or anaemic children, haemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anaemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron deficient children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programmes may need to be targeted through identification of iron-deficient children.
Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians
Dei V; Sebastian M: International Journal for Equity in Health 17(86)1-12, 2018
This paper aimed to assess whether horizontal and vertical equity were being met in the healthcare utilisation among adults aged 50 years and above. The paper was based on a secondary cross-sectional data from the World Health Organization’s Study on global AGEing and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Horizontal and vertical inequities were found in the use of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services. Whilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The paper reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access.
Is malaria eradication possible?
The Lancet Editorial 370 (9597): 1459, 27 October 2007
Malaria remains a leading global health problem that requires the improved use of existing interventions and the accelerated development of new control methods. In this editorial we reflect on the possibility of eradicating malaria in infants in Africa with the introduction of the malaria vaccine RTS,S/AS02D.