We assemble data developed between 2001 and 2002 in Kenya to describe treatment choices made by rural households to treat a child's fever and the related costs to households. Using a cost-of-illness approach, we estimate the expected cost of a childhood fever to Kenyan households in 2002. We develop two scenarios to explore how expected costs to households would change if more children were treated at a health care facility with an effective antimalarial within 48 hours of fever onset.
Equitable health services
The cost of uncomplicated childhood fevers to Kenyan households: implications for reaching international access targets
Larson BA, Amin AA, Noor AM, Zurovac D, Snow RW: BMC Public Health 6:314, 29 December 2006
The DDT debacle: Are we poisoning rural communities?
Basson W: Science in Africa, May 2010
This paper inputs to the debate on use of DDT in Africa. Its use has been promoted due to its effectiveness in controlling malaria at population level, with significant mortality declines. The author of this paper notes that DDT is used for malaria control in high-risk areas such as KwaZulu-Natal and Limpopo and that high levels of DDT and one of its byproducts, DDE were found in the water, sediment, soil, vegetables, chicken and fish meat in Limpopo, a province bordering Zimbabwe and Mozambique, with possible health and cancer risks. According to the Limpopo Malaria Control Programme, this area has been sprayed with DDT annually since 1966. The article recommends further research to focus on human exposure and health effects in communities where DDT is currently being sprayed for malaria control. Noting the effetiveness of spraying as a means of cintrol he argues for more research into the development of safe and effective alternatives to DDT.
The effects of health coverage on population outcomes: A country-level panel data analysis
Moreno-Serra R and Smith P: Results for Development Institute, December 2011
The main goal of this study was to provide robust empirical evidence on the causal link from national levels of health system coverage to population outcomes. The authors assembled annual data for the period 1995-2008 encompassing 153 developing and developed countries. Taken together, the results strongly indicate that expansions in health system coverage lead, on average, to improved general population health. Higher government health spending per capita is consistently found to reduce both child and adult mortality rates, the authors argue. The estimated gains are the largest when under-five mortality is examined and are larger for low- and middle-income countries than in the full sample. Based on the results for under-five mortality and public health spending, the implied marginal cost of saving a year of life is just around US$1,000 in the full sample of countries. For the average country, pre-paid public spending seems more effective in reducing mortality than prepaid private insurance funds. Higher immunisation coverage was also found to decrease mortality rates.
The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis
Kaiser J; Fong R; Ngoma T; McGlasson K; et al: Human Resources for Health 17(93) 1-12; 2019
This study assessed how maternity waiting homes (MWHs) affect the health workforce and maternal health service delivery at their associated rural health centres. Four rounds of in-depth interviews with district health staff and health centre staff were conducted at intervention and control sites over 24 months. Nearly all respondents expressed challenges with understaffing and overwork and reported that increasing numbers of facility-based deliveries driven by MWHs contributed substantively to their workload. Women waiting at MWHs allow staff to monitor a woman’s final stage of pregnancy and labour onset, detect complications earlier, and either more confidently manage those complications at the health centre or refer to higher level care. District, intervention, and control site respondents passionately discussed this benefit over all time points, describing it as outweighing challenges of additional work associated with MWHs. Intervention site staff repeatedly discussed the benefit of MWHs in providing a space for postpartum women to wait after the first few hours of clinical observation through the first 48 h after delivery. Additionally, intervention site staff perceived the ability to observe women for longer before and after delivery allowed them to better anticipate and plan their own work, adjust their workloads and mindset accordingly, and provide better and more timely care. The authors recommend future studies consider how MWHs impact the workforce, operations, and service delivery at their associated health facilities and strategic selection of locations for new MWHs.
The emergence of insecticide resistance in central Mozambique and potential threat on the successful indoor residual spraying malaria control programme
Abilio AP, Kleinschmidt I, Coleman M et al: Malaria Journal 10(110), May 2011
Malaria vector control by indoor residual spraying was reinitiated in 2006 with DDT in Zambezia province, Mozambique. In 2007, these efforts were strengthened by the President's Malaria Initiative. This paper reports on the monitoring and evaluation of this programme as carried out by the Malaria Decision Support Project. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 15 years. In 2006, the sporozoite rate in Anopheles gambiae s.s. was 4% and this reduced to 1% over 4 rounds of spraying. The sporozoite rate for An. funestus was also reduced from 2% to 0 by 2008. Of the 437 Anopheles arabiensis identified, none were infectious. Overall prevalence of P. falciparum in the sentinel sites fell from 60% to 32% between October 2006 and October 2008. In conclusion, it appears that both An. gambiae s.s. and An. funestus were controlled effectively with the DDT-based IRS programme in Zambezia, reducing disease transmission and burden. However, the discovery of pyrethroid resistance in the province and Mozambique's policy change away from DDT to pyrethroids for IRS may threaten the gains made.
The experiences of clients and healthcare providers regarding the provision of reproductive health services including the prevention of HIV and AIDS in an informal settlement in Tshwane
Mataboge M; Beukes S; Nolte A: Health S A 21(1) 67-76, 2016
Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV) and to acquired immunodeficiency syndrome (AIDS) than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. This study explored and described the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs, as were providers. The authors argue that inputs from people at grass roots level be integrated during policy development to ensure that informal settlement residents are provided with accessible reproductive health services. It was further found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.
The Global Plan to Stop TB 2011-2015
World Health Organization Stop TB Partnership: 2010
The Global Plan to Stop TB 2011-2015 is a new roadmap for curbing the global epidemic of tuberculosis, and it aims to save five million lives between 2011 and 2015 and eliminate TB as a public health problem by 2050 but comes with a price tag of US$47 billion, nearly half of which must still be found. The Plan builds on progress towards goals laid out in 2006 to halve TB prevalence and death rates by 2015 and scale up TB diagnosis, treatment and care, but adds essential research targets including the development of faster methods to test and treat TB and to prevent it through an effective vaccine. Specifically, the plan provides countries with guidance on how to improve TB control through scaling up existing interventions for its diagnosis and treatment and by making use of new diagnostic tests and drugs that will become available over the next five years. A new test that uses molecular line probe assays to detect multi-drug resistant (MDR) TB in a few days instead of the weeks needed using older testing methods has already been introduced in some countries. Other tests that will soon be available can detect TB in a matter of hours. The pipeline of new TB drugs promises shorter treatment times. Meanwhile, nine TB vaccine candidates are in clinical trials and a new generation of TB vaccines is expected to be available by 2020. Other major elements of the plan focus on efforts to combat drug-resistant TB and TB in people living with HIV. It calls for a scale-up in access to tests that can detect resistance to first- and second-line TB drugs, identifying limited laboratory capacity as the main reason why only 5% of the estimated 440,000 people who had MDR-TB in 2008 were diagnosed. It also recommends testing all TB patients for HIV and providing antiretroviral treatment to all those who test positive.
The growing caseload of chronic life-long conditions calls for a move towards full self-management in low-income countries
Van Olmen J, Ku GM, Bermejo R, Kegels G, Hermann K and van Damme W: Globalization and Health 7(38), 10 October 2011
The aim of this paper is to show that current provider-centred models of chronic care are not adequate and to propose 'full self-management' as an alternative for low-income countries. People with chronic life-long conditions need to 'rebalance' their life in order to combine the needs related to their chronic condition with other elements of their life, the authors argue. They have a crucial role in the management of their condition and the opportunity to gain knowledge and expertise in their condition and its management. Therefore, people with chronic life-long conditions should be empowered so that they become the centre of management of their condition. In full self-management, patients take full responsibility for their condition, supported by peers, professionals and information and communication tools. The authors examine two current trends to enhance the capacity for self-management and coping: the emergence of peer support and expert-patient networks, and the development and distribution of smart phone technology.
The health and health system of South Africa: Historical roots of current public health challenges
Coovadia H, Jewkes R, Barron P, Sanders D and McIntyre D: The Lancet 374(9692): (no page no’s), 5 September 2009
In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
The hidden inequity in health care
Starfield B: International Journal for Equity in Health 10:15, 2011
According to this article, inequity is built into western health systems, due to the disease focus that they have. Diseases are only a partial picture of peoples health, and low income populations experience multiple diseases. The author argues that the problems that bother and disable people, such as chronic pain, deserve more attention because many of these problems cannot be related to specific diseases. It is thus more useful for health services to focus on population health, and manage the multiple health challenges that people, especially poor people have, rather than tackle single diseases and leave the wider ill health burden unmanaged. The author calls on primary care physicians to take leadership in moving medical care where it needs to be: to the care of patients and populations and not the care of diseases. Primary health care that integrates disease with other aspects of patient health is seen as the way forward.