Governments at the recent World Health Assembly have committed to a higher level of action to combat antibiotic resistance that is an increasing public health threat across the world. On 24 May, a resolution was approved by health ministers on “Combating antimicrobial resistance, including antibiotic resistance” after an important exchange of country positions and one amendment put forward by Mexico with regard to conflict of interests. India supported the antimicrobial resistance (AMR) resolution subject to the understanding that its concerns would be included in the proposed global plan of action. These included financial access of developing countries patients to new antibiotics, news ways of funding research and development based on the delinkage principle in the context of developing countries, and the special needs of developing countries and their capacity building to take on relevant activities. India’s proposal was in lieu of making changes in the resolution text itself which was its first preference. The United Kingdom in its statement also acknowledged the legitimate concern of developing countries on access to antibiotics, and the importance of support for technical capacities and affordable drugs. All Member States agreed on the importance and magnitude of antimicrobial resistance and broad support was heard in the statements made by all delegations on the paramount need to take action. Both developing and developed countries agreed that this is of global magnitude and urged the WHO to develop the action plan and for Member States to build up their own national plans. Developing countries stressed on the urgency of the problem but also on the importance of ensuring access to new antibiotics for developing countries and the mobilization of resources so that they can implement action plans and surveillance.
Equitable health services
In January, PIH launched its newest project, located in Neno, Malawi – an impoverished rural area in one of Africa’s poorest and most densely populated countries, with an HIV infection rate among adults of more than 14 percent. By mid-February, PIH doctors were working with Malawian nurses who had staffed the hospital prior to our arrival to provide care for more than 100 patients a day and treat 129 HIV patients with antiretroviral therapy.
Reproductive health problems among teenagers are the focus of a new European Union-funded project, which will investigate the effectiveness of existing programmes and identifying the structural drivers that restrict access to adolescent reproductive health (ARH) services in Niger and Tanzania. The INTHEC ('Health, education and community integration: evidence based strategies to increase equity, integration and effectiveness of reproductive health services for poor communities in sub-Saharan Africa') project has received EUR 2.75 million in funding under the European Union's Seventh Framework Programme. The project, launched in March 2010 and scheduled to end in February 2014, will also address the cultural barriers that currently limit access to or curb the effectiveness of ARH services in the two countries. Led by the Liverpool School of Tropical Medicine in the United Kingdom, the INTHEC consortium consists of experts from the fields of reproductive health research and interventional implementation, as well as leaders in governance and policymaking in Belgium, Niger and Tanzania. The government ministries responsible for ARH in Tanzania and Niger are partners in the programme, meaning that the outcome of the research will be genuinely owned by the key policymakers, helping ensure the impact of this research beyond the life of the project.
Several African governments have launched a drive to strengthen the continent's laboratories to a standard that will enable them to gain accreditation from the United Nations’ World Health Organization (WHO). Only a few African laboratories have WHO accreditation. Experts at a launch of the initiative in the Rwandan capital, Kigali, said better-quality laboratory services would help lower the death toll from treatable diseases like HIV and AIDS, tuberculosis and malaria, which kill more than five million Africans annually. One of the reasons so few African laboratories have gained accreditation is the time-consuming nature of current procedures. The launch was attended by policy-makers and experts from Botswana, Cameroon, Cote d'Ivoire, Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Senegal, Tanzania, Ghana, Uganda and Zambia. ‘Stronger laboratories with better systems and practices in place will mean better patient care and treatment and, through the use of high-quality laboratories, can be swifter,’ said a spokesperson.
People in low-resource countries who are ill with multidrug-resistant TB (MDR-TB) will get a faster diagnosis and a new treatment regime, thanks to two new initiatives unveiled by the World Health Orgqnisation, the Stop TB Partnership, UNITAID and the Foundation for Innovative New Diagnostics (FIND). On diagnosis, the method gives results in two days rather than the standard two to three months. At present it is estimated that only 2% of MDR-TB cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. The initiatives should increase the proportion diagnosed and treated at least seven-fold over the next four years, to 15% or more.
New Health Minister, Dr Aaron Motsoaledi has announced five key priorities for action, one of which is to strengthen the quality of care in the health service. To succeed in boosting service delivery, the new Health Minister identified four key areas he will be giving his immediate attention in the next few weeks: the official launch the prevention of mother-to-child HIV transmission acceleration plan, a new team that will deal with norms and standards between national, provincial and district health systems, a future meeting of provincial health MECs to come up with cost-containment measures or austerity measures to curb over-spending, and a consultation with his counterparts within the Inter-Ministerial Committee to speedily resolve the issues around the occupational-specific dispensation. But Motsoaledi was thin on detail about how he plans to address the issues.
South African health authorities say the visitor diagnosed with the mosquito-spread Zika virus has recovered and there is minimal likelihood of a local outbreak. The visiting Colombian businessperson who was diagnosed with the Zika virus in South Africa last week is “completely well” and “poses no risk to anybody”, says Lucille Blumberg, the deputy director of the National Institute for Communicable Diseases. Blumberg says the man presented with a mild illness four days after his arrival in the country. After he underwent a number of tests, “Zika was confirmed as the cause of his illness”. Blumberg further confirmed, “We’re not going to have local transmissions because of one incoming traveller with Zika. You’ll need multiple people with the virus in their blood and many mosquitoes around with the competent vectors to set off a local outbreak.”
The Ebola outbreak shocked the world of global health. Even while Ebola lingers in West Africa the future of health security and the organisation of health systems are being debated. There have been many conferences held and reports published to provide “lessons learned from the Ebola crisis. A thread running through all of these events has been an agreement on the need to build resilient health systems. Yet building such a system requires planning, investment and serious long term commitment. Short term investment does not produce the necessary workforce needed for a functioning health system. Dhillon and Yates identified 5 key areas that require immediate attention in order to rebuild health systems: community based systems; access to generic medicines; restoring preventive measures; integrating surveillance into health systems and strengthening management. The author identifies 6 critical foundations for resilient health systems: An adequate number of trained health workers, including non-clinical staff and Community Health Workers (CHWs), available medical supplies, including medicines, diagnostics and vaccines, robust health information systems, including surveillance, an adequate number of well-equipped health facilities including access to clean water and sanitation, adequate financing and a strong public sector to deliver equitable, quality services. The author argues that building resilient systems that protect people’s health and deal with outbreaks has to address all the six elements of the system simultaneously and systematically and that a long term global commitment for building health systems must start now.
The district strategy is the backbone of nearly every national health system in Africa; countries are covered by health facilities – organized in a tier system – whose activity packages focus on priority services. The Community of Practice “Health Service Delivery” convened a regional conference in Dakar, Senegal, from 21 to 23 October 2013 gathering 20 country delegations and 170 experts who shared their experiences in organizing primary-health-care services at the local level. The meeting identified that market liberalization means that African health authorities need to use new policy instruments enhanced by information and communication technology; implement the district strategy pragmatically; and ensure inclusiveness, openness to dialogue and support of innovation and learning at the organizational level. The meeting also noted that Primary health care remains as relevant today as it was in 1978.
Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. The authors described the models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. conclusions Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. The authors argue that operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients.