Equitable health services

In August 2018, the Uganda Ministry of Health activated the Public Health Emergency Operations Centre and the National Task Force for public health emergencies to plan, guide, and coordinate Ebola Virus Disease (EVD) preparedness in the country. The National Task Force selected an Incident Management Team, constituting a National Rapid Response Team that supported activation of the District Task Forces and District Rapid Response Teams that jointly assessed levels of preparedness in 30 designated high-risk districts. The Ministry of Health, with technical guidance from the World Health Organisation, led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at points of entry and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. The authors observe the need to sustain these efforts as a multi-hazard framework to avail resources for preparedness and management of incidents at the source, effectively cutting costs of using a “fire-fighting” approach during public health emergencies.

Two United Nations agencies have launched a $44 million programme to reduce female genital mutilation/cutting (FGM/C) by 40 per cent by 2015 and to end the harmful traditional practice within a generation. Launched by the UN Population Fund (UNFPA) and the UN Children’s Fund (UNICEF), the initiative will encourage communities in 16 African countries with high prevalence to abandon the practice, which has serious physical and psychological effects. Partnering with the agencies will be Governments, religious leaders, reproductive health providers, media and civil society.

Despite being central to achieving improved population health outcomes, primary health centres in low- and middle-income settings continue to underperform. Little research exists to adequately explain how and why this is the case. This study aimed to test the relevance and usefulness of an adapted conceptual framework for improving understanding of the mechanisms and causal pathways influencing primary health centre performance. A theory-driven, case-study approach was adopted. Four Zambian health centres were purposefully selected with case data including health-care worker, patient and key informant interviews; direct observation of facility operations. Structural constraints included limited resources creating challenging service environments in which work overload and stockouts were common. Health workers’ frustration with such conditions interacted with dissatisfaction with salary levels eroding service values and acting as a catalyst for different forms of absenteeism. Such behaviours exacerbated patient–provider ratios and increased the frequency of clinical and administrative shortcuts. Weak health information systems and lack of performance data undermined providers’ answerability to their employer and clients, and a lack of effective sanctions undermined supervisors’ ability to hold providers accountable for these transgressions. Weak answerability and enforceability contributed to a culture of impunity that masked and condoned weak service performance in all four sites.

African Ministers of Health, Finance, Education, Social Affairs, Local Governments attended the Ministerial Conference on Immunization in Africa in February 2016 in Addis Ababa, Ethiopia, convened by the World Health Organization in collaboration with the African Union Commission. The ministers collectively and individually commited themselves to keeping universal access to immunisation at the forefront of efforts to reduce child mortality, morbidity and disability; to increasing and sustaining domestic investments and funding, including innovative financing, to meet the cost of traditional vaccines and fulfil new vaccine financing requirements, and to support EPI programs. They sought to address persistent barriers in vaccine and healthcare delivery systems, especially in the poorest, vulnerable and most marginalized communities, including through strengthening data collection, reporting and use and building effective and efficient supply chains and integrated procurement systems as part of strong and sustainable primary health care systems. The agreed to develop a capacitated African research sector and to work with communities, civil society organizations, traditional and religious leaders, health professional associations and parliamentarians to promote universal access to vaccines, and to invest in regional capacities for the development and production of vaccines in line with the African Union Pharmaceutical Manufacturing Plan. They called on African development banks and regional economic communities to support the implementation of the Declaration, and on member states and partners to negotiate with vaccine manufacturers to facilitate access to vaccines at affordable prices and to increase price transparency in line with resolution WHA68.6. They called on GAVI to consider refugees and internally displaced populations as eligible recipients of support for vaccines and operational costs.