South Africa witnessed a 20% increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV and AIDS accounting for 43.7% of all deaths. Almost four (38.4%) out of every 10 deaths were ‘clearly avoidable within the health care system’, according to researchers, which means they could have been prevented with proper care. The report recommends that the department of health addresses maternal deaths by: improving health care provider knowledge and skills in providing emergency care and ensuring adequate screening and treatment of the major causes of maternal death; improving the quality and coverage of reproductive health services, namely contraceptive and termination of pregnancy services; better management of staffing and equipment norms, transport and availability of blood for transfusion; and community involvement and empowerment regarding maternal, neonatal and reproductive health in general.
Equitable health services
Between a quarter and half of maternal, neonatal, and child deaths in South Africa’s national audits have an avoidable health-system factor contributing to the death. Using the LiST model, the researchers estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is US$220 million per year. Such progress would put South Africa squarely on track to meet Millennium Development Goal (MDG) 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.
Mental disorders constitute a huge global burden of disease, and there is a large treatment gap, particularly in low-income and middle-income countries. This paper assesses the progress in scaling up mental health services worldwide, using a survey of key national stakeholders in mental health. The authors note that major barriers to scaling up of mental health services in countries with low and middle incomes include absence of financial resources and government commitment and over-centralisation. In addition, challenges of integration of mental health care into primary care settings, scarcity of trained mental health personnel and shortage of public health expertise among mental health leaders are tangible barriers as well. As a result, the authors argue that a systemic and strategic approach to scaling up is needed.
This research, set in public primary care services in Cape Town, South Africa, set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities) was done in February 2006. While the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care). Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols) and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility.
This research was set in public primary care services in Cape Town, South Africa and aims to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004. A subsequent evaluation of 16 clinics was done in February 2006. While the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training. Weaknesses were identified in quality of care and continuity of care (only 24% of clients diagnosed with HIV were followed up for medical assessment). Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew up action plans to address three areas of weakness within their own facility. This use of the tool which is designed to empower programme and facility managers demonstrates how engaging middle managers is crucial in translating policies into relevant actions.
Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation methods used in conjunction with a well-designed educational package in the scaling up of mother care. A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, does not affect implementation abilities at the hospital service level. The choice of outreach strategy should be guided by local circumstances, cost and the availability of skilled facilitators.
This study aimed to extract criteria used in health systems for defining the benefit package in different countries around the world using scoping review method. A systematic search was carried out in online libraries and databases between January and April 2016. After studying the articles’ titles, abstracts, and full texts, 9 articles and 14 reports were selected for final analysis. In the final analysis, 19 criteria were extracted. Due to diversity of criteria in terms of number and nature, they were divided into three categories. The categories included intervention-related criteria, disease-related criteria, and community-related criteria. The largest number of criteria belonged to the first category. Indeed, the most widely applied criteria included cost-effectiveness, effectiveness, budget impact, equity, and burden of disease. According to the results, different criteria were identified in terms of number and nature in developing benefit package in world health systems. The authors conclude that it seems that certain criteria, such as cost-effectiveness, effectiveness, budget impact, burden of disease, equity, and necessity, that were most widely utilized in countries under study could be for designing benefit package with regard to social, cultural, and economic considerations.
This study was initiated to establish if any South African ethnomedicinal plants (indigenous or exotic) that have been reported to be used traditionally to repel or kill mosquitoes may exhibit effective mosquito larvicidal properties. Researchers tested extracts of a selection of plant taxa sourced in South Africa for larvicidal properties. Preliminary screening of crude extracts revealed substantial variation in toxicity with 24 of the 381 samples displaying 100% larval mortality within the seven-day exposure period. The researchers then selected four of the high-activity plants and subjected them to bioassay guided fractionation. The results of the testing of the fractions generated identified one fraction of the plant Toddalia asiatica as being very potent against the An. arabiensis larvae. These results have initiated further research into isolating the active compound and developing a malaria vector control tool.
Households in malaria endemic countries experience considerable costs in accessing formal health facilities because of childhood malaria. The Ministry of Health in Malawi has defined certain villages as hard-to-reach (HTR) on the basis of either their distance from health facilities or inaccessibility. Some of these villages have been assigned a community health worker, responsible for referring febrile children to a health facility. In this study, researchers compared health facility utilisation and household costs of attending a health facility between individuals living near the district hospital and those in HTR villages. Two cross-sectional household surveys were conducted in the Chikhwawa district of Malawi; one during each of the wet and dry seasons. Half the participating villages were located near the hospital, the others were in HTR areas. The researchers found that those people living in HTR villages were less likely to attend a formal health facility compared to those living near the hospital. Analyses including community health workers (CHWs) as a source of formal health-care decreased the strength of this relationship, and suggested that consulting a CHW may reduce attendance at health facilities, even if indicated. Household costs for those who attended a health facility were greater for those in HTR villages than for those living near the district hospital. The researchers call on health service planners to consider geographic and financial barriers to accessing public health facilities in designing appropriate interventions.
Inequity in reproductive health between and within countries is well documented, and even where indicators improve, disparities between rich and poor are as likely to be increasing as decreasing. In addition to improving access, it must also be ensured that services are widely used. Because advantaged groups are known to be more apt at using preventive services, the disparity in outcome measures between rich and poor is likely to increase.