South Africa’s health minister, Dr Aaron Motsoaledi, is reported as having called for South Africa’s health system to make a 180 turn away from the dominant curative health system, which is unsustainable and unaffordable, to a health system where prevention is the cornerstone. This and the primary health care approach is argued by the Minister to make the national health insurance system an affordable option and to improve equity and universal coverage.
Equitable health services
Preventive health services are the future, says South African health minister
Thom A: Health-e News, 10 March 2010
Primary care morbidity in Eastern Cape Province
Brueton V, Yogeswaran P, Chandia J, Mfenyana K, Modell B, Modell M, Nazareth I: South African Medical Journal 100:309-312, 2010
Primary health care in rural South Africa is predominantly provided by remote clinics and health centres. In 1994, health centres were upgraded and new health centres developed to serve as a health care filter between community clinics and district hospitals. This study set out to describe the spectrum of clinical problems encountered at a new health centre in an area of high economic deprivation and compare this with an adjacent community clinic and district hospital. The International Classification of Primary Care-2 (ICPC-2) was used to code data collected over a 13-week period from patients presenting at a community clinic, health centre and district hospital. Altogether, 4,383 patient encounters were recorded across all three sites in 2001. Most contacts at the clinic (97%) and the health centre (80%) were with a nurse. Females over 15 years of age comprised over half of all contacts at health facilities (53%). The most common diagnosis category was respiratory (23%). Cough was the most common symptom. Thirty per cent of children up to 5 years of age were seen for immunisations. Most childhood immunisations (79%) were carried out at the health centre. The study concluded that, of all the health care facilities surveyed, the health centre had the highest throughput of patients, indicating that the health centre is an efficient filter between the community and hospital. In this light, the ICPC-2 system can be successfully used to monitor encounters at similar African health care facilities.
Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop
Shadmi E, Wong W, Kinder K, Heath I, Kidd M: Int Jo for Equity in Health 13;104, November 2014
Research consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country’s primary health care system and its primary care attributes significantly improves populations’ health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training pro-grams geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed. This paper summarizes the work performed at the World World Organization of National Colleges and Academies of Family Medicine 2013 Meetings’ Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers /general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs.
Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal Provinces, South Africa
Schoeman S, Smuts CM, Faber M, Van Stuijvenberg M, Oelofse A, Laubscher JA, Benadé AJS and Dhansay MA: South African Journal of Clinical Nutrition 23(1):21-27, 2010
The objective of this study was to assess primary health care (PHC) facility infrastructure and services, and the nutritional status of 0 to 71-month-old children and their caregivers attending PHC facilities in the Eastern Cape (EC) and KwaZulu-Natal (KZN) provinces in South Africa. Structured interviewer-administered questionnaires and an anthropometric survey were administered. Of the 40 PHC facilities, 14 had been built or renovated after 1994. Only a quarter of PHC facilities had access safe drinking water and fewer had operational telephones. According to more than 80% of the nurses, problems with basic resources and existing cultural practices influenced the quality of services. Few households reported that they had enough food at all times, while the reported prevalence of diarrhoea was high at 34–38%. The study concluded that problems regarding infrastructure, basic resources and services adversely affected PHC service delivery and the well-being of rural people, and therefore need urgent attention.
Primary health care in Mozambique: Service delivery in a complex hierarcy
Lindelow M, Ward P, Zorzi N: World Bank, Africa Region: Human Development Working paper series: 1-112, April 2004
This report presents finding of a nationwide Expenditure Tracking and Service Delivery Survey in Mozambique from August to Ocotober 2002. The study focuses on the primary health care system, which is often the only source of health care for most Mozambicans. The data offers a unique perspective on interactions between different levels of the health system, particularly related to financing, allocation, distribution and use of resources. The report covers a broad set of issues including institutional context, budget managemet, cost recovery, drug allocation and distribution, human resources, infrastructure and equipment, and service outputs.
Primary school children's perspectives on common diseases and medicines used: implications for school healthcare programmes and priority setting in Uganda
Akello G, Reis R, Ovuga E, Rwabukwali CB, Kabonesa C, Richters A: African Health Sciences 7 (2): 73-79, 2007
Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. This study assessed primary school children's perspectives on common diseases they experience and medicines used in order to suggest reforms for school healthcare programmes and priority setting. Children named and ranked malaria as the most severe and frequently experienced disease. Other diseases mentioned included diarrhoea, skin fungal infections, flu, and typhoid.The symptoms children recognised in case of illness were high body temperature, vomiting, headache, weakness, appetite loss and diarrhoea. Children were either given medicines by the school nurse or they selfmedicated using pharmaceuticals including chloroquine, panadol, flagyl, fansidar, quinine injections, capsules (amoxicillin and ampicillin) obtained from the clinics, drug shops, pharmacies,and other unspecified indigenous medicines from their home and markets.
Prison over-crowding spreads TB and HIV in South African province
Cullinan K: Health-e News, 2 September 2010
Severe overcrowding in KwaZulu-Natal’s prisons is contributing to the spread of HIV and tuberculosis and driving the high death toll in prisons, according to King Kumalo, provincial deputy director of health services in the Department of Correctional Services (DCS), in his address to the annual meeting of Hospice Palliative Care Association on 1 September 2010. So far this year, 120 prisoners have died of ‘natural causes’ (diseases) and eight of unnatural causes in KwaZulu-Natal, he reported. In the past, there were more unnatural deaths such as murder and suicide than natural deaths, said King. Last year, 168 prisoners died of natural causes while 14 died of natural causes. As a result of the high death toll, the DCS has brought in hospice workers to assist them to treat people with advanced disease who are in need of pain relief. The HPCA, cares for over 70,000 patients at 200 sites countrywide, also has a memorandum of understanding with the SA National Defence Force to provide palliative care (pain relief). However, hospice workers reported that HIV and TB – particularly drug-resistant TB - were challenging their resources. A shortage of beds for patients, long travelling distances to treatment centres were cited as obstacles, while many of the local clinics were reported to not offer monthly tests on people with drug-resistant TB because staff are scared of becoming infected.
PRO2000 vaginal gel for prevention of HIV-1 infection (Microbicides Development Programme 301): A phase 3, randomised, double-blind, parallel-group trial
Sheena McCormack, Gita Ramjee, Anatoli Kamali, Helen Rees, Angela M Crook, Mitzy Gafos et al: The Lancet 376(9749): 1329 - 1337, 16 Oct 2010
Microbicides Development Programme 301 was a phase 3, randomised, double-blind, parallel-group trial, undertaken at thirteen clinics in South Africa, Tanzania, Uganda, and Zambia. The study enrolled 9,385 of the initial 15,818 women who were screened. Mean reported gel use at last sex act was 89%. HIV-1 incidence was much the same between groups at study end, for placebo, for hazard ratio 1.05, and at discontinuation. Incidence of the primary safety endpoint at study end was 4.6 per 100 woman-years in the 0.5% PRO2000 group and 3.9 in the placebo group; and was 4.5 in the 2% PRO2000 group at discontinuation. The study concludes that, although they are safe, 0.5% PRO2000 and 2% PRO2000 gels are not efficacious against vaginal HIV-1 transmission and are not indicated for this use.
Problems in providing universal access to services highlighted at UNCTAD meeting
Tayob R: Third World Network, 21 November 2006
A recent United Nations Conference on Trade and Development (UNCTAD) expert meeting discussed how developing countries face challenges and problems in providing universal access to services to their people. The meeting comprised panels looking at general issues as well as various sectors, including water, health, education and telecommunication services. It also had a session on the WTO's General Agreement on Trade in Services (GATS). Among the problems highlighted were the adverse effects of user fees, with the imposition of charges and fees to citizens in exchange for public services, introduced in many countries as part of World Bank-IMF programmes, the effects of privatisation of services, and the negative effects of patents and bilateral free trade agreements on access to medicines and health services.
Process and impact of the scale up of a youth friendly health services initiative in Northern Tanzania
Renju J, Andrew B, Nyalali K, Kishamawe C, Kato C, Changalucha J and Obasi A: Journal of the International AIDS Society 13(32), 23 August 2010
This study took the form of a process evaluation of the tenfold scale-up of an evaluated Youth Friendly Service (YFS) intervention in Mwanza Region, Tanzania to identify key facilitating and inhibitory factors from both user and provider perspectives. The intervention was scaled up in two training rounds lasting six and ten months and evaluated through a simulated patient study, focus group discussions and semi-structured interviews with health workers and trainers, training observations and pre- and post-training questionnaires. The study found that, between 2004 and 2007, local government officials trained 429 health workers. The training was well implemented and over time trainers' confidence and ability to lead sessions improved. The scale-up faced challenges in the selection and retention of trained health workers, however, and was limited by various contextual factors and structural constraints. The study concludes that YFS interventions can remain well delivered even after expansion through existing systems. The scaling up process did affect some aspects of intervention quality and the findings emphasise the need to train more staff (both clinical and non-clinical) per facility in order to ensure YFS delivery. Further research is needed to identify effective strategies to address structural constraints and broader social norms that hampered the scale-up.