A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre which provides Emergency Obstetric Care (EmOC). The aim of the MWH is to improve accessibility and thus reduce morbidity and mortality for mother and neonate should complications arise. This study assessed the effects of a maternity waiting facility on maternal and perinatal health. The authors searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), African Journals Online (AJOL) (April 2009), POPLINE (April 2009), Dissertation Abstracts (April 2009) and the National Research Register archive (March 2008) for conducted randomised controlled trials that compared perinatal and maternal outcome in women using a MWH and women who did not. There were no randomised controlled trials or cluster-randomised trials identified from the search. They found from this evidence that there is insufficient evidence to determine the effectiveness of Maternity Waiting Facilities for improving maternal and neonatal outcomes.
Equitable health services
Growing awareness of the need for health systems and GHIs to operate in ways that are mutually supportive has prompted those who are responsible for health systems to actively adopt measures that can help integrate and maximise the impact of global health initiatives (GHIs). This report looks at a number of country-specific interventions. In sub-Saharan Africa, political commitment and creativity have helped Malawi to negotiate a successful collaboration with GHIs to strengthen and expand human resources for health – a key element of the health system. Faced with a severe HIV epidemic and crippling health workforce shortages, Malawi has collaborated with GHIs and other donors to overcome fiscal constraints and to implement an Emergency Human Resource Plan. Through task shifting, training and salary top-ups Malawi has been able to expand the health workforce to deliver HIV services and has also been able to meet new demand for a range of health services at the community level. There are widespread concerns around the effects of the proliferation of actors in global public health and the complexity of the channels and systems through which funds and commodities are now provided. The need for coordination, harmonisation and alignment is strongly felt. In particular, countries face the challenges of excessive reporting requirements, conflicting time frames in planning and funding cycles and parallel bureaucracies.
This community survey was conducted in measles high-incidence areas in the Western Cape, South Africa, to assess measles vaccination coverage attained by routine and campaign services among children aged 6 months to 59 months at the time of a mass campaign in the areas. Of 8,332 households visited, there was no response at 3,435 (41.2%); 95.1% of eligible households participated; and 91.2% of children received a campaign vaccination. Before the campaign, 33% of 917-month-olds had not received a measles vaccination, and this was reduced to 4.5% after the campaign. Of a total of 1,587 children, 61.5% were estimated to have measles immunity before the campaign, and this increased to 94% after the campaign. It appears that routine services had failed to achieve adequate herd immunity in areas with suspected highly mobile populations. This study shows that mass campaigns in such areas in the Western Cape significantly increased coverage. The authors conclude that extra vigilance is required to monitor and sustain adequate coverage in these areas.
In this paper, the primary health-care (PHC) systems in 20 low- and middle-income countries were analysed using a semi-grounded approach. Options for strengthening PHC were identified by thematic content analysis. The authors found that despite the growing burden of non-communicable disease, many low- and middle-income countries lacked funds for preventive services; community health workers were often under-resourced, poorly supported and lacked training; out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in PHC was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of PHC. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. The authors argue for policy-making to be supported by adequate resources for PHC implementation and that government spending on PHC should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of PHC management is also said to be needed.
In this study, researchers analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009, disaggregating data according to age, sex, medical specialty, date of admission and discharge, and socio-economic status (SES). There were 42,582 first admissions. Patient demographics shifted towards a lower SES. Median age decreased from 52 years in 2002 to 49 years in 2009, while patients aged 20-39 years increased in proportion from 26% to 31%. The unadjusted proportion of admissions which resulted in in-hospital deaths increased from 12% in 2002 to 17% in 2009. Corresponding mortality rates per 1,000 patient days were 17 and 23.4, respectively. Annual increases in mortality rates were highest during the first two days following admission (increasing from 30.1 to 50.3 deaths per 1,000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward.
The World Psychiatry Association program seeks to initiate mental health policies and their integration in primary health care, to promote adoption of mental health legislation, equity in the provision of mental health services and adequate funding of those services. In the early 1990s, only 23% of member states of the African Region of WHO were reported to have a mental health legislation. Mental health legislation in Africa needs to be updated to secure the rights of mentally ill people, and support to their families. An integrated mental health policy reduces morbidity and burden by emphasising primary and secondary prevention and all forms of mental rehabilitative care of the more severely ill. Policy goals may include bringing families with mentally ill members together, encouraging the creation of common interest groups, and developing broader views of rehabilitation.
This briefing paper provides an overview of existing literature on the mental health effects of sexual violence and rape, a summary of effective interventions, and outlines a brief research agenda for mental health responses to sexual violence in resource-poor settings. The authors found that, in resource-poor settings, most efforts to strengthen responses to survivors of sexual violence have so far focused on the training of specialised staff based in hospitals or crisis centres who administer limited services – immediate care and a forensic exam – before referring patients to mental health practitioners or social workers for mental health interventions, if the latter are available. Most therapies and treatments for mental health problems have been implemented in the developed world and may require multiple counselling sessions over the long-term with professional staff, but developing countries generally lack capacity to provide psychological interventions. Of the various approaches, evidence consistently points to cognitive behavioural therapies as being more effective in reducing symptoms of post-traumatic stress than counselling. Sexual violence is an under-researched area across the globe but there is a particular lack of research from resource poor countries on the mental health aftermath of sexual violence. The authors call for further research, providing a basic research agenda at the end of the paper.
The primary aim of this study was to identify progress and challenges in mental healthcare in South Africa, as well as future mental health services research priorities. A systematic literature review of mental health services research was conducted, including studies from January 2000 to October 2010. Hand searches of key local journals were also conducted. Of 215 articles retrieved, 92 were included. The authors found that, while progress in epidemiological studies has been good, there was a paucity of intervention and economic evaluation studies. Most studies reviewed were on the status of mental healthcare services, which indicated some progress in decentralised care for severe mental disorders, but also insufficient resources to adequately support community-based services, resulting in the classic ‘revolving-door’ phenomenon. Common mental disorders remain largely undetected and untreated in primary healthcare. Cross-cutting issues included the need for promoting culturally congruent services, as well as mental health literacy to assist in improving help-seeking behaviour, stigma reduction, and reducing defaulting and human rights abuses. Intervention research is needed to provide evidence of the organisational and human resource mix requirements, as well as cost-effectiveness of a culturally appropriate, task shifting and stepped care approach for severe and common mental disorders at primary healthcare level.
As a signatory to the UN Convention on the Rights of Persons with Disabilities, South Africa has committed itself to transformation aimed at ending the inequities that characterise mental health service provision and ‘closing the gap’. To measure South Africa’s progress, this study compared budget allocations over a five-year period to six psychiatric and six general hospitals in KwaZulu-Natal (KZN) and contrasted current numbers of psychiatric beds and psychiatric personnel in that province with the numbers required to comply with national norms. It found that the mean increase in budget allocations to public psychiatric hospitals was 3.8% per annum, while that to general hospitals over the same period was 10.2% per annum. The median cumulative budget increase for psychiatric hospitals was significantly lower than that of general hospitals. No psychiatric hospitals received specific funding for tertiary services development. KZN has 25% of the acute psychiatric beds and 25% of the psychiatrists required to comply with national norms, with the most serious shortages experienced in northern KZN. There are 0.38 psychiatrists per 100 000 population in KZN. In conclusion, the author argues that inequitable funding, inadequate facilities and significant shortages of mental health professionals pervade the mental health and psychiatric services in KZN; and that there is little evidence of government abiding by its public commitments to redress the inequities that characterise mental health services.
This policy brief by the Chronic Poverty Research Centre, examines the link between mental health and chronic poverty in Uganda. It outlines challenges to implementing effective services for people affected by mental disorders and actions that are needed to promote mental health in the country. The paper shows that mental health and chronic poverty are linked in a vicious cycle of exclusion, poor access to services, low productivity, diminished livelihoods and assets depletion. People with mental disorders in Uganda also experience some of the worst forms of stigma and discrimination linked to lack of awareness, misinformation and stereotyping about their condition.