The authors applied Tanahashi’s equity model to review perceived equity of health services by actors across the health system and at community level, following changes to the priority-setting process at sub-national levels post devolution in Kenya. A qualitative study was implemented between March 2015 and April 2016, involving 269 key informant and in-depth interviews from different levels of the health system in ten counties and 14 focus group discussions with community members in two of these counties. Qualitative data were analysed using the framework approach. The findings revealed that devolution in Kenya has focused on improving the supply side of health services, by expanding the availability, geographic and financial accessibility of health services across many counties. However, there has been limited emphasis and investment in promoting the demand side, and limited efforts to promote acceptability or use of services. Respondents perceived that the quality of health services has typically been neglected within priority-setting to date. The authors suggest that if Kenya is to achieve universal health coverage, then county governments must address all aspects of equity, including quality, including through community health services.
Equitable health services
This study explored refugee caregivers’ perceptions of their children’s access to quality health service delivery to their young children in Durban, South Africa. This study used an explanatory mixed methods design, purposively sampling 120 and 10 participants for the quantitative and qualitative phases, respectively. The majority (89%) of caregivers were women, with over 70% of them aged between 30 and 35 years. Over 74% of caregivers visited public clinics for their children’s healthcare needs. The majority of caregivers (95%) were not satisfied with healthcare services delivery to their children due to the long waiting hours and the negative attitudes and discriminatory behaviours of healthcare workers, particularly in public healthcare facilities. These findings underscore the need to address health professionals’ attitudes when providing healthcare for refugees. The authors suggest that attitudinal change may improve the relationship between service providers and caregivers of refugee children in South Africa, which may improve the health-related outcomes in refugee children.
The health systems of nations around the world may be unsustainable if unchanged over the next 15 years. Globally, healthcare is threatened by a confluence of powerful trends -- increasing demand, rising costs, uneven quality, misaligned incentives. If ignored, these trends will overwhelm health systems, creating massive financial burdens as well as health problems for current and future generations.
Tremendous challenges remain for the most vulnerable populations, including women, children, and adolescents, to enjoy the healthy lives and well-being. Much of their poor health is caused by poverty, gender, lack of education, and social marginalization as well as inaccessible healthcare services. Strong, equitable, and well-governed health systems can contribute to sustainably improving their lives. But building strong health systems is challenging. This book draws on 15 years of IDRC-funded health systems research undertaken by researchers working closely with communities and decision-makers. They have generated contextually relevant evidence at local, national, regional, and global levels to tackle these entrenched health systems challenges. Six lessons have been distilled to inform and inspire a new generation of health leaders and researchers while some critical reflections on the remaining challenges are shared with others in the global health community, including funding organizations.
screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology and delivered by community health workers. The authors trained four community health workers to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017–December 2018. Community health workers screened children aged 4–7 years using mobile health technology software applications on smart-phones. Community health workers screened 94.4% of eligible children at 271 centres at a cost of US$5.63 per child. The number of children who failed an initial hearing and visual test was 435 and 170, respectively. Of the total screened, 111 children were diagnosed with a hearing and/or visual impairment. Mobile health technology supported community health worker delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.
Landmines are the third leading cause of amputations in Mozambique, after diabetes and road accidents, and the threat they still pose – more than 17 years after peace came to the country following four decades of independence and civil wars – still looms large. There are no benefits for the survivors of landmine blasts, nor for those who died or their next of kin, so there is no incentive to report incidents of landmine accidents to the authorities. In one of the world's poorest nations, assistance for the disabled is often far down the list of priorities. There are government-run orthopaedic centres in the ten provincial capitals, except Manica Province, where it is situated in Chimoio, but essential equipment is faulty or lacking entirely. For example, in Inhambane (in central Mozambique, currently the most mined province) the orthopaedic centre is not open. In Beira, Mozambique's second-largest city, the oven to make prosthetics is broken and has not been replaced. The situation at orthopaedic centres in Mozambique does not meet minimum standards.
The authors of this study set out to define the patient population at Cape Town’s district-level hospital offering specialist tuberculosis (TB) services, concerning the noted increase in complex, sick HIV-TB co-infected patients requiring increased levels of care. They surveyed all hospitalised adult patients in Brooklyn Chest Hospital, a district-level hospital offering specialist TB services, from 27-30 October 2008. They found that more than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant co-morbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multi-drug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of co-morbidity. Overall, one-fifth of patients required up-referral to higher levels of care. In conclusion, the authors note that district-level hospitals, such as Brooklyn Chest Hospital, that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required, they argue.
This paper reports on a meeting co-organised by the World Health Organization, UNAIDS and international organisations, to accelerate an effective and joint response to the epidemic of HIV-related tuberculosis (TB). The paper highlights the achievements of the global TB/HIV working group from the Stop TB Partnership, and discusses the concept of universal access to HIV services and its importance and contribution to TB prevention, diagnosis and treatment services. It also highlights some critical issues that have been neglected in the global response to HIV-related TB, including the optimal treatment regimens to use when treating TB and HIV at the same time.
Ten per cent of individuals infected with TB develop the active disease but this is greatly increased in those whose immune systems have been weakened by HIV. This report highlights the difficulty in managing the co-epidemic of HIV and TB and identifies priority areas in need of further research: better population-based data on the incidence of drug-resistant TB is required, increased laboratory capacity is needed to make the currently difficult diagnosis of co-infection of HIV-TB accessible to a larger proportion of Africans, more child-specific research is needed especially on paediatric drug formulations. The low uptake of drugs that treat co-infection remains a real problem, with concerns over drug efficacy and the creation of drug resistant strains of TB cited as the main reasons. The report concludes that strategies for dealing with TB and HIV currently exist in isolation, often reinforced by vertical programme financing. Efforts must be made to integrate these disease treatment programmes which will involve stakeholders working together within an evidence based collaborative framework.
Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem.