The 63rd World Health Assembly raised concern that access globally to blood products is unequal and that access to these products by developing countries needs to be escalated. A major factor limiting the global availability of plasma-derived medicinal products is an inadequate supply of plasma meeting internationally recognised standards for fractionation, usually in developing countries, which lack blood components separation technology and fractionation capacity. The resolution of the Assembly calls for good practices to be implemented in recruiting voluntary healthy blood and plasma donors from low-risk donor populations and in testing and processing to be covered by relevant, reliable quality-assurance systems. Stringent regulatory control is vital in assuring the quality and safety of blood products, as well as of related in vitro diagnostic devices, and special effort will be needed to strengthen globally the technical capacity of regulatory authorities to assure the appropriate control worldwide.
Equitable health services
This paper argues that general practice is potentially an important social determinant of health and health inequalities. The way it is influential is consistent with models of causal pathways in the way social and societal factors influence health. General practice clinical care can be thought of as a material resource. Evidence exists at many levels that this resource is inequitably distributed. But encounters in general practice are profoundly social processes, embedded in wider society. Debating and reflecting on the values underpinning relations between GP and patient may help challenge and illuminate wider inequitable processes in society that sustain inequalities in health.
The dominant approach used to promote sexual health relies on centralised public clinic service delivery, unisectoral implementation, and vertically organised support (national/state/local public health structures). But the authors of this study argue that these systems have failed to test, link and retain a large portion of most-at-risk populations. Instead, the authors favour a social entrepreneurship for sexual health (SESH) approach, which focuses on decentralised community delivery, multisectoral networks, and horizontal collaboration (business, technology, and academia). Although SESH approaches have yet to be widely implemented, they show great promise, according to this study. Social marketing and sales of point-of-care, community-based tests for HIV and other sexually transmitted diseases, conditional cash transfers to incentivise safe sex, and microenterprise among most-at-risk-populations are all SESH tools that can optimise the delivery of comprehensive sexual health interventions.
Millie Balamu goes from door to door providing life-saving health care for about 200 households in the Wakiso district of Uganda. Villagers call her masawu (“doctor” in the local Luganda language), but she is a community health worker. She has tests and drugs with her to diagnose and treat malaria, diarrhoea and pneumonia and uses her mobile phone to diagnose these diseases and register pregnant women for follow up. This paper reports on the Social Innovation in Health Initiative. The concept of social innovation is taken from economics and business studies and refers to efforts to mobilise and incentivise communities. In health, social innovation may refer to low-fee private delivery of health care, using mobile phone applications – such as the one Balamu uses to diagnose common childhood diseases – and other novel ways to make health-care delivery more accessible and affordable in low-income communities. According to a working paper presenting the results of a randomised controlled trial in Uganda of more than 8000 households, published in 2016 the social innovation project helped to reduce child mortality across those households by 27% between 2011 and 2013.
The principal challenge to achieving the Abuja Declaration goal was to develop an efficient, equitable and sustainable mechanism to deliver insecticide treated nets to the poor and most vulnerable segments of the population. One method—social marketing, employs the principles and practices of commercial marketing techniques to deliver socially beneficial goods at affordable, and often, at subsidized prices to particular groups. Social marketing of insecticide treated nets, through a public-private partnership and meaningful community participation in Tanzania, has successfully and quickly increased the distribution of mosquito nets among the poorest populations, particularly children and pregnantwomen. This program has resulted in improved health outcomes with respect to morbidity and mortality impact of Malaria on the population of children.
This paper investigated socio-demographic inequities in cervical cancer screening and utilization of treatment among women in Harare, Zimbabwe. Two cross sectional surveys were conducted in Harare with a total sample of 277 women aged at least 25 years from high, medium, low density suburbs and rural areas. Only 29% of women reported ever screening for cervical cancer. Cervical cancer screening was less likely in women affiliated to major religions and those who never visited health facilities or doctors or visited once in previous 6 months. Ninety-two of selected patients were on treatment. Women with cervical cancer affiliated to protestant churches were 68 times more likely to utilize treatment and care services compared to those in other religions. Province of residence, education, occupation, marital status, income, wealth, medical aid status, having a regular doctor, frequency of visiting health facilities, sources of cervical cancer information and knowledge of treatability of cervical cancer were not associated with cervical cancer screening and treatment respectively. The authors recommend strengthening health education in communities, including in churches, to improve uptake of screening and treatment of cervical cancer.
This study investigated associations between patients’ socioeconomic status and characteristics of primary healthcare facilities, and control and treatment of blood pressure in hypertensive patients in South Africa. The authors enrolled hypertensive patients attending 38 public sector primary care clinics in the Western Cape, SA, in 2011, and followed them up 14 months later as part of a randomised controlled trial. Blood pressure was measured and prescriptions for anti-hypertension medications were recorded at baseline and follow-up. Logistic regression models assessed associations between patients’ socioeconomic status, characteristics of primary healthcare facilities, and control and treatment of blood pressure. Blood pressure was uncontrolled in 60% of patients at baseline, which was less likely in patients with a higher level of education and in English compared with Afrikaans respondents. Treatment was intensified in 48% of patients with uncontrolled blood pressure at baseline, which was more likely in patients with higher blood pressure at baseline, concurrent diabetes, more education, and those who attended clinics offering off-site drug supply, with a doctor every day, or with more nurses. Patient and clinic factors influence blood pressure control and treatment in primary care clinics in SA. Potential modifiable factors include ensuring effective communication of health messages, providing convenient access to medications, and addressing staff shortages in primary care clinics.
There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA). This study investigated associations between patients’ socioeconomic status and characteristics of primary healthcare facilities, and control and treatment of blood pressure in hypertensive patients. The authors enrolled hypertensive patients attending 38 public sector primary care clinics in the Western Cape, SA, in 2011, and followed them up 14 months later as part of a randomised controlled trial. Blood pressure was measured and prescriptions for antihypertension medications were recorded at baseline and follow-up. Blood pressure was uncontrolled in 60% of patients at baseline, less likely in patients with a higher level of education or in English compared with Afrikaans respondents. Treatment was intensified in 48% of patients with uncontrolled blood pressure at baseline, more likely in patients with higher blood pressure at baseline, concurrent diabetes, more education and those who attended clinics offering off-site drug supply, with a doctor every day or with more nurses. Patient and clinic factors influence blood pressure control and treatment in primary care clinics in SA. Potential modifiable factors include ensuring effective communication of health messages, providing convenient access to medications, and addressing staff shortages in primary care clinics.
Little is known about socioeconomic differences in access to life-saving obstetric surgery, yet access to a caesarean for women is essential to achieve low levels of maternal mortality. The study examined population based caesarean rates by socioeconomic groups in various developing countries. In the poorest countries-mostly in sub-Saharan Africa-large segments of the population have almost no access to potentially life saving caesareans, whereas in some mid-income countries more than half the population has rates in excess of medical need. These data deserve the attention of policymakers at national and international levels.
This study measures and describes socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over, in China, Ghana and India. The prevalence of unmet need was 60, 80, and 62% in China, Ghana and India respectively. The adjusted relative index of inequality for education was statistically significant for China, Ghana, and India, whereas the adjusted relative index of inequality for wealth was significant only in Ghana. Male sex was significantly associated with self-reported unmet need for oral health services in India. Given rapid population ageing, the author argues that further evidence of socioeconomic inequalities in unmet need for oral health services by older adults in low to medium income countries are needed to inform policies to mitigate inequalities in the availability of oral health services.