This policy brief analyses the relationships between Universal Health Coverage (UHC) and Non-Communicable Diseases (NCDs). It covers the unique challenges the NCD epidemic poses to achieving UHC, and the role of UHC in strengthening the NCD response. It also explores the implications and possible position of health, NCDs and UHC in the post-2015 development agenda. The key messages from the report include: UHC is a goal that all governments should commit to. It can help focus greater attention on coverage of quality services, health equity, and guar-anteeing financial-risk protection. The NCD epidemic poses unique challenges to the three dimensions of UHC. Access and availability to essential NCD services remains unacceptably low in many LMICs; major inequalities exist in terms of NCD risk, access to services, and health outcomes; and the epidemic imposes a huge economic burden on national budgets and can push households into poverty. Attainment of UHC will be dependent on prioritising NCD prevention and control in UHC design and implementation. When achieved, UHC can provide a powerful vehicle to accelerate progress on NCD outcomes, inequalities, and socio-economic impact. Lessons learnt from the NCD response can help support pathways to UHC. These include a focus on health promotion and prevention, multi-sectoral approach-es, addressing the social determinants of health, and domestic innovative financing mechanisms (including taxation on unhealthy products). For the post-2015 development agenda to be truly transformative for health, NCDs must be recognised as a priority and UHC must be articulated as a means to achieve improved health outcomes.
Equitable health services
Induction of labour is being increasingly used to prevent adverse outcomes in the mother and the newborn. In this study, researchers assessed the prevalence of induction of labour and determinants of its use in Africa. They performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005 and assessed unmet needs for specific obstetric indications at country level. A total of 83,437 deliveries were recorded in the seven participating countries, including Angola, the Democratic Republic of Congo, Kenya and Uganda. The average rate of induction was 4.4% and the researchers found that induction was associated with reduction of stillbirths and perinatal deaths. Unmet need for induction ranged between 66% and 80.2% across countries. Determinants of having an induction were place of residence, duration of schooling, type of health facility and level of antenatal care. As utilisation of induction of labour in health facilities in Africa is very low and unmet need very high, the authors call for improvements in social and health infrastructure.
Adherence to antiretroviral therapy (ART) is important to optimise treatment outcomes and prevent the development of drug resistance. It is however compromised under a number of situations in the countries most heavily affected by HIV and AIDS. The question this paper is concerned with is: ‘How do we keep people on treatment?’ It proposes that the answer to this question is an improved understanding of why adherence is important; what levels of adherence are needed to ensure that treatment remains effective; how different types of crisis affect access to treatment; and how patients and service providers respond to difficulties. The paper considers the longer-term impact of unplanned ART treatment interruptions and offers suggestions as to how they might be avoided and managed in future. It considers three case studies, by looking at the problems with health system functioning and ART delivery during the 2007 public sector strike in South Africa, the ongoing political and economic crisis in Zimbabwe and the 2008 floods in Mozambique. It is based on a literature review and a relatively small number of interviews with health managers and clinicians in each country.
This study assessed uptake and correlates of cervical screening among HIV-infected women in care in Uganda. A nationally representative cross-sectional survey of HIV-infected women in care was conducted from August to November 2016. Structured interviews were conducted with 5198 women aged 15–49 years, from 245 HIV clinics. Knowledge and uptake of cervical screening and human papillomavirus (HPV) vaccination were determined. Overall, 94% had ever heard of cervical screening and 66% knew a screening site. However, 47% did not know the schedule for screening and 50% did not know the symptoms of cervical cancer. One-third rated their risk of cervical cancer as low. Uptake of screening was 30%. Women who had never been screened cited lack of information and no time as the main reasons. Increased likelihood of screening was associated with receipt of HIV care at a level II health center and private facilities, knowledge of cervical screening, where to go for screening, and low perception of risk. HPV vaccination was 2%. Cervical screening and HPV vaccination uptake were very low among HIV-infected women in care in Uganda. Improved knowledge of cervical screening schedules and sites, and addressing fears and risk perception are thus seen to potentially increase uptake of cervical screening in this vulnerable population.
Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda. Mixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents. This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3–6 hours before receipt of services although this was more common at public facilities. Only 33% of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% of the survey respondents used these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities. Complex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, the authors find that governments should strengthen health systems to cater for increasing urban populations.
The US House of Representatives passed HR5501, the US Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2008 on April 2 by a vote of 308-116. Amongst other things, the bill: authorises US$50billion for AIDS, TB, and malaria programs including US$9billion for TB and malaria; links AIDS, TB, and malaria programs to broader health and development programs; formalises activities currently operating under the President’s Malaria Initiative which includes a five-year malaria strategy and a malaria coordinator; calls for enhanced coordination within US government agencies in planning and implementing all three disease areas and with other global health and development programs.
Medecins Sans Frontieres (MSF) has made an urgent call for the wider implementation of the newer and more effective anti-malaria strategies in an effort to save lives. Malaria still kills a child every 30 seconds worldwide while nine out 10 of these deaths occur in sub-Saharan Africa, predominantly among young children. According to the World Health Organisation, one in every five childhood deaths is due to the effects of malaria. An MSF report released in Johannesburg on 31 September shows that unnecessary illness and death can be avoided with simple, affordable treatment and diagnostic tools that are currently available. The report follows the launch of an ambitious new Global Malaria Action Plan aimed at reducing the number of malaria deaths to near zero by 2015, with world leaders committing nearly US$3-billion to ensure it succeeds.
In 2007, a randomised controlled study was performed among a cohort of French soldiers returning from Cote d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Among 424 volunteers randomised to the study, 47.6 % were assigned to the SMS group and 52.3 % to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. In conclusion, SMSes did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. Another study should be done to confirm these results on soldiers or other types of individual travellers.
According the South African Health Minister Manto Tshabalala-Msimang the use of health care services has almost doubled over the past eight years with 101 million visits to clinics in the 2006/07 financial year. Addressing the opening of the National Consultative Health Forum (NCHF) recently, the minister said the increase was due to improved access as a result of building more than 1 600 clinics closer to the communities, improved package of care available at clinics and the removal of user fees. Efforts have also been made to decrease the inequalities in the funding amongst health districts and have led to significant improvement in service delivery and health outcomes.
KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. The authors conducted qualitative interviews with children, their primary caregivers, and KidzAlive trained healthcare workers using and providing child-friendly spaces, respectively. Child-friendly spaces contributed to child-centred care in primary healthcare centres. This was evidenced by the increased involvement and participation of children, increased primary caregivers participation in the care of their children and a positive transformation of the primary healthcare centre to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children. Child-friendly spaces are observed to promote HIV positive children’s right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children’s HIV-related health outcomes.