This study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource constrained setting in Malawi. A qualitative study was conducted which involved patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients, 14 in-depth interviews, and four focus-group discussions with patients. Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included ability to acquire appropriate disease knowledge, poverty level, the presence of support from family caregivers and community-based support initiatives, the nature of one’s social relations; and the ability to deal with stressors and stigma. Non-communicable diseases and HIV co-infected people were more disadvantaged in their access to care, as they experienced frequent drug stockouts and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of care challenges. The authors’ findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. They recommended expanding current peer-patient and support group initiatives to patients with non-communicable diseases, and further investments in the decentralization of integrated health services to primary care level in Malawi.
Equitable health services
This study set out to investigate the relationship between the syndromic management of STI, specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic in Dar es Salaam, Tanzania. Findings reflected that the burden of STIs in this youth population is large indicating that youth are at increased risk of STIs and will certainly require youth friendly clinics, and the need to refine the current syndromic management guidelines.
A two-day long People’s Commission of Inquiry into the Free State Health System was held in Bloemfontein, Free State on July 7th and 8th 2015. The inquiry was organised and hosted by the Treatment Action Campaign (TAC) but was set up as a public forum to enable people in the province to give testimony in front of an independent commission of inquiry through verbal and written testimony from more than 60 people representing 15 communities in the province. Civil society, activists and healthcare professionals also spoke or made submissions to the commissioners and the Free State Department of Health was also invited to testify and to make submissions. The key findings that emerged from the testimonies were that: The South African government, in particular the provincial Free State government, are failing to assume their responsibility to protect access to healthcare services, especially for the poor in the province. It reports shortages and stock outs of medication and medical supplies; broken or unavailable equipment; inadequate health workers; long waiting times for provincial emergency medical services and patient transport systems and unreliability and indignity experienced in these services. Many of the oral testimonies spoke of people having to pay out-of-pocket payments for transport to health facilities. Whistle-blowing and engagement is reported to be discouraged and at times met with intimidation. The report offers recommendations to improve access to quality services. The report indicates that the commission is committed to working together with communities, healthcare professionals, the provincial government and all other interested parties to improve conditions.
This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB), and treatment seeking behaviour, among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. Fifty-nine (84.1%) patients had good knowledge on the transmission of TB. The majority (75%) of the respondents were of the opinion that the incidence of TB was on the increase mainly due to the AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60%) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68%) visited public health facilities for treatment as their first action. Overall, 83.8% respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Most of the respondents said they were well attended by service providers. Half and 59.3% of the males and females, respectively, mentioned good patient-service provider relationship as an important reason for satisfaction of the service. Twenty-nine respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. There is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care.
Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers’ compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and inadequate assessment of disability. These and other systemic deficiencies in administration of the Compensation for Occupational Injuries and Diseases Act of 1993 (COIDA) reduce access by workers with occupational disease to private medical care, and shift costs to workers and to public sector medical care. Another unintended effect is to promote underreporting of occupational disease by employers and medical practitioners. Reforms have been tried or proposed over the years, including decentralisation of medical assessment to specialised units, which showed promise but were closed. Improved annual performance reporting by the Compensation Commissioner on the processing of occupational disease claims would promote greater public accountability. Given the perennial failings of the system, a debate on outsourcing or partial privatisation of COIDA’s functions is due, the author concludes.
In this study the authors use facility-level data from nationally representative surveys conducted in Ghana, Kenya, and Uganda in 2012 to understand pharmaceutical availability within the three countries. The authors both availability of essential medicines, as defined by the various essential medicine lists (EMLs) of each respective country, and availability of all surveyed pharmaceuticals deemed important for treatment of various high-burden diseases, including those on the EMLs. The authors find that there is heterogeneity with respect to availability across the three countries with Ghana generally having better availability than Uganda and Kenya. They found that the factors associated with stock-out vary by country, but across all countries both presence of a laboratory at the facility and of a vehicle at the facility are significantly associated with reduced stock-out. The study highlights poor availability of essential medicines across these three countries and suggest more needs to be done to strengthen the supply system so that stock remains uninterrupted.
In spring 2009, the EU’s executive branch will present the findings of an investigation into the pharmaceutical sector. This is a preliminary report of this probe, launched in January this year, which found that leading pharmaceutical companies are using the patent system to delay the entry of generic medicines onto the market. Patent holders tend to embark on a long, legal battle to delay the release of a generic. Examining a sample worth about 10% of the Union’s €150 billion-a-year prescription drugs market, the Commission estimated that €3 billion could have been saved to public health budgets if generic entry had taken place immediately once patents expired. This is based on data indicating that the price of a drug falls by about 20% after a year once it moves from being branded to generic.
In this study from Rwanda, researchers aimed to establish the relationship between physical activity levels of physiotherapists and their physical activity promotion strategies. They drew data from 92 self-administered questionnaires and a focus group discussion of 10 purposively selected physiotherapists. The findings revealed that 64% of the participants were physically active both within the work and recreation domains and 65% of the participants had good physical activity promoting practices. Discussing physical activity and giving out information regarding physical activity were most common methods used in promotion of physical activity. Policies on physical activity, cultural influence, and nature of work, time management as well as the environment were the barriers highlighted. In conclusion, although physiotherapists experience barriers to promoting physical activity, they have good physical activity promoting practices.
Physical inactivity has been identified as the fourth leading risk factor for the prevention of non-communicable diseases (NCDs), preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than three million preventable deaths globally in 2010. Physical inactivity is a global public health priority but, in most countries, this has not yet resulted in widespread recognition nor specific physical activity–related policy action at the necessary scale, the authors of this article argue. The authors identify and discuss eight possible explanations why inactivity is overlooked and the need for more effective communication on the importance of physical activity in the NCD prevention context. Although not all of the issues identified will be relevant for any one country, it is likely that at different times and in different combinations these problems continue to delay national-level progress on addressing physical inactivity in many countries. The authors confirm that there is sufficient evidence to act, and that much better use of well-planned, coherent communication strategies are needed in most countries and at the international level. Significant opportunities exist. The Toronto Charter on Physical Activity and the Seven Investments that Work are two useful tools to support increased advocacy on physical activity within and beyond the context of the crucial UN High-Level Meeting on NCDs in September 2011.
This study sought to assess progress in South Africa with respect to deinstitutionalisation and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The decentralisation process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilised chronic conditions. Similar to other low- to middle-income countries, deinstitutionalisation and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.