This paper identifies priorities for disease control as an input into the Copenhagen Consensus effort for 2008 (CC08). The analysis builds on the results of the Disease Control Priorities Project (DCPP). The DCPP engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide region-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities. Some interventions are clearly low priority. Others are attractive and worth doing but either address only a small proportion of disease burden or are simply not quite as attractive as a few key interventions. This paper identifies seven priority interventions in terms of their cost-effectiveness, the size of the disease burden they address, and other criteria.
Equitable health services
This paper considers new developments to strengthen sexual and reproductive health and HIV links and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these links. It argues that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision. A lack of common understanding of terminology and clear technical operational guidance, and separate policy, institutional and financing processes continue to represent significant constraints. The paper draws on experience with tuberculosis and HIV integration to highlight some lessons. It concludes that there is little evidence to determine whether funding for health systems is strengthening links, and makes several recommendations to maximise opportunities represented by recent developments.
This paper, published in BMC Public Health, highlights the effects of urban population growth and access to health and social services on progress in achieving Millennium Development Goal (MDG) 4 – to reduce child mortality by two thirds by 2015. The paper examines trends in childhood mortality in sub-Saharan Africa (SSA) in relation to urban population growth, vaccination coverage and access to safe drinking water.
The level and longevity of protective antibodies elicited by a measles vaccine is significantly shortened by HIV infection in Zambian children. Measles still remains a significant cause of childhood mortality in sub-Saharan Africa despite the availability of a vaccine. Barriers to successful measles control by vaccination include poor logistics and insufficient resources, lack of political will, and HIV/AIDS. Successful measles control in southern Africa with a high HIV prevalence suggests that the HIV epidemic is not a bottleneck to control. The determinants of this success must be identified so that it is replicated in other regions. Specifically, how can a high population immunity be achieved in regions with high HIV prevalence so that measles can be eliminated?
The BHOMA project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia’s Lusaka Province. It has deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. The programme engages community health workers to actively refer and follow up patients. Project implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. The patient-provider interaction is an important interface where the community and the health system meet. This project aims to reduce population mortality by substantially improving this interaction. Success hinges upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognise their value and begin to utilise them.
Reproductive health care for internally displaced persons (IDPs) is a neglected area in humanitarian relief operations. Representatives of twelve relief and development agencies providing reproductive health care to IDPs were interviewed to identify barriers to access and strategies for overcoming these barriers. Although material and human resources were significant constraints, the main challenge ahead is to tackle ideological, managerial and policy barriers, and those related to donor influence. Considerable efforts are needed to close the gap between international commitments and their failure to help provide services in the field. The study strongly recommends developing a legal instrument, like an international convention, to protect the rights of IDPs.
The objective of this study was to determine whether community-based health workers in a rural region of Ethiopia can provide injectable contraceptives to women with similar levels of safety, effectiveness and acceptability as health extension workers. The researchers examined the provision of injectable contraceptives by community-based reproductive health agents (CBRHAs). A total of 1,062 women participated in the study. Compared with health post clients, the clients of CBRHAs were, on average, slightly older, less likely to be married and less educated, and they had significantly more living children. Women seeking services from CBRHAs were also significantly more likely to be using injectable contraceptives for the first time; health post clients were more likely to have used them in the past. In addition, clients of CBRHAs were less likely to discontinue using injectable contraceptives over three injection cycles than health post clients. In conclusion, receiving injectable contraceptives from CBRHAs proved as safe and acceptable to this sample of Ethiopian women as receiving them in health posts from health extension workers.
Little is known about psychological distress of patients on general wards in developing countries. This study aimed to determine the extent and associations of psychological distress among adult in-patients on medical and surgical wards of Mbarara hospital in Uganda. Researchers conducted a cross-sectional descriptive study among 258 adult in-patients. They used the WHO endorsed self report questionnaire (SRQ-25) to assess psychological distress with a cut off of 5/6, as well as the MINI International Neuropsychiatric Interview (MINI) to identify specific psychiatric disorders. Results indicated that 158 individuals (61%) had psychological distress. One hundred and nine (42%) met criteria for at least one major psychiatric diagnosis. Only 6% of these were recognised by the attending health workers. Psychological distress was significantly associated with previous hospitalisations, ward of admission and marital status. The authors conclude that despite high levels of psychological distress among the physically ill, it is often unrecognised and untreated.
South Africa's public health crisis is deep-rooted in systemic problems. Progress will require far-sighted, sustainable solutions. This requires a massive change in national consciousness. The authors suggest that one of the better measures of the state of a nation is its burden of disease. Health statistics are never just reflections of physical health alone. Instead, they also reflect, often quite precisely, issues like regional poverty, national inequity, unsound governmental policies, the fair distribution of resources, the quality of our leadership and the state of health services, amongst other things.
In this literature review, researchers investigated the systems and tools used by public health to generate public health emergency preparedness and response (PHEPR) communications to health care providers (HCPs), and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications. After a systematic review of peer- and non-peer-reviewed literature, they identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. They found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available, are rarely evaluated in any systematic fashion. Only one study compared the effectiveness of the delivery format, device or message itself. To meet present-day and future information needs for emergency preparedness, the authors argue that more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.