Health officials in Tanzania are confident they are on track to eradicate malaria deaths by 2015, even if significant challenges stand in the way of the target. The National Malaria Control Programme (NMCP) says malaria is a leading killer in the East African country, infecting about 18 million people annually, and 30–40% of attendance at health centres and hospitals are related to malaria cases, burdening overstretched facilities. Malaria, according to the National Planning Commission (NPC) costs the country an estimated loss that is equivalent to 3.4% of gross domestic product. Alex Mwita, a senior NMCP official, said initiatives being implemented under the Roll Back Malaria programme, such as insecticide-treated bed nets and indoor residual spraying (IRS), had helped reduce malaria cases, along with deaths of children under five and infants (younger than one). ‘Under-five deaths have dropped to 91 per 1,000 live births in 2008, down from 147 in 1999,’ he said. Although the decline could not be attributed to a fall in malaria cases alone, research showed a decline in prevalence of the disease had a big impact on childhood and maternal mortality.
Equitable health services
At least 6,000 people have been displaced by inter-clan fighting in Kenya's southwestern district of Kuria East, on the Tanzania border, according to humanitarian officials. The Red Cross has provided emergency relief aid for the displaced. The worst affected areas include Wagirabosi/Targai location in Ntimaru Division, inhabited by the Buirege clan; and Girigiri sub-location, and the villages of Nguruna, Getongoroma and Kebaroti in Kegonga Division. The Kenyan Red Cross said there were reports of gunshots along the Nyabasi-Buirege border on 22 June and that attacks and counter-attacks since late May had resulted in the displacement of at least 6,290 people and the burning of 765 homes. According to the Red Cross, health services have taken a knock, as there is no ambulance in Kuria East to support referrals and patients, while water and sanitation facilities remain critical, especially in camps for internally displaced people.
Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease. In this study, researchers conducted focus group discussions with men, women and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Participants had very low awareness of cervical cancer. The perceived benefits of modern treatment were also very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behaviour and alternated between traditional remedies and modern treatment methods. Prior to the introduction or scale up of cervical cancer prevention programmes, socio-cultural barriers and health service related factors that influence health seeking behaviour must be addressed through appropriate community level behaviour change communications.
European executive directors and alternates have written a letter to staff in the World Bank human development network to explain their rejection of the draft health, nutrition and population strategy. Gender and reproductive health groups have been bombarding the directors with complaints over the alleged watering down of the strategy. In their letter, the directors raise concern that the strategy makes virtually no reference to sexual and reproductive health.
Health system weaknesses in Africa are well known, constraining progress in reducing the burden of both communicable and non-communicable disease. This paper used a focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care in Kenya. The discussions found weaknesses in the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, especially in district level targets, resulting in the exclusion of mental health from such district level supervision and a lack of awareness in the district management team about mental health. Generic health system weaknesses in Kenya are reported to impact on efforts for horizontal integration of mental health into routine primary care practice, and to frustrate health worker efforts. The authors report that a major lever for horizontal integration of mental health into the health system would be the inclusion of mental health in the national health sector reform strategy at community, primary care and district levels rather than just at the higher provincial and national levels.
This study investigated health system constraints affecting treatment and care by women with cervical cancer in Harare, Zimbabwe. A sequential explanatory mixed methods design was used. Phase 1 comprised of two surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain survey results. Health system constraints identified were: limited or lack of training for health workers, weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health workers, reliance of patients on out-of-pocket funding for treatment services and lack of back-up for major equipment. The qualitative inquiry found barriers to be: high costs of treatment and care, lack of knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located mostly in urban areas, lack of clear referral system resulting in bureaucratic processes and limited screening and treating capacities in health facilities due to lack of resources. The study showed that the health system and its organization present barriers to access of cervical cancer treatment and care among women.
This study examined the experiences of sixty HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. The authors conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. The authors suggest that health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.
A widespread cholera outbreak, under-resourced and under-staffed health system, and inadequate access to safe drinking water and hygiene are threatening the wellbeing of thousands of Zimbabweans. As of 9 December, 16,141 suspected cases of cholera and 775 resultant deaths (case fatality rate of 4.8%) had been recorded since August in two-thirds of the country's 62 districts. WHO is establishing a cholera control and command centre, in conjunction with the Ministry of Health and Child Welfare (MoHCW) and other health partners, to respond in a coordinated manner to Zimbabwe's health challenges. WHO is seeking donor support for a US$6 million proposal for its cholera response plan. Approximately half of cholera cases have been recorded in Budiriro, a heavily populated suburb on the western outskirts of the capital, Harare. Other major concentrations of reported cases include Beitbridge, on the South African border, and Mudzi, on the border with Mozambique.
Sub-Saharan Africa (SSA) has had more major armed conflicts (wars) in the past two decades – including 13 wars during 1990–2015 – than any other part of the world, and this has had an adverse effect on health systems in the region. This study aimed to understand the best health system practices in five SSA countries that experienced wars during 1990–2015, and yet managed to achieve a maternal mortality reduction – equal to or greater than 50% during the same period – according to the Maternal Mortality Estimation Inter-Agency Group (MMEIG). The study showed three general health system reforms across all five countries that could explain MMR reduction: health systems decentralisation, the innovation related to the WHO workforce health system building block such as training of community healthcare workers, and governments-financing reforms. Restoring health systems after disasters is an urgent concern, especially in countries that have experienced wars.
This paper captures common implementation experiences and lessons learned to understand core elements of successful health systems interventions. Qualitative data was used rom key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through African Health Initiative in Ghana, Mozambique, Rwanda, Tanzania, and Zambia. Four major overarching lessons were highlighted. First, a variety and inclusiveness of concerned key players are necessary to address complex health system issues at all levels, with a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Also identified was inclusion of strong implementation science tools and strategies that allowed informed and measured learning processes and efficient dissemination of best practices. Five to seven years was seen to be the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects. The authors conclude that the African Health Initiative experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.