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Socialist government health policy reforms in Bolivia and Ecuador: the underrated potential of comprehensive primary health care to tackle the social determinants of health
No full textBackground: Selective vertical programs have
prevailed over comprehensive primary health care in Latin America. In Bolivia and Ecuador, socialist governments intend to redirect health policy. We outline key features of both countries’ health systems after reform, explore their efforts to rebuild primary health care, identify and explain policy gaps, and offer considerations for improvement. Methods: Qualitative document analysis. Findings: Neoliberal reforms left Bolivia’s and Ecuador’s population in bad health, with limited access to a fragmented health system. Today, both countries focus their policy on household and community-based promotion and prevention. The negative effects on access to care of decentralization, dual employment, vertical programming, and targeting have been not received much attention. The neglect of health care services can be understood in the light of a particular, rigid interpretation of social medicine and social
determinants, international policy pressures, reliance on external funding, and institutional inertia. Current policy choices preserve key elements of selective care and consolidate commodification.
These reforms might not improve health and may worsen poverty. Conclusions: Health care can be considered as a social determinant in its own right. Primary care needs to be founded on an integrated model of family medicine, taking advantage of individual care
as one of the ways to act on social determinants. It deserves a central place on the policy-makers’ priority list in Bolivia and Ecuador as elsewhere
Treatment of chronic hepatitis C in patients with human immunodeficiency virus (HIV) with weekly peginterferon alpha-2b plus ribavirin: a multi-centred Belgian study
No full textPrevalence of bovine cysticercosis and hydatidosis in Jimma municipal abattoir, South West Ethiopia
No full textA cross-sectional study to determine the prevalence of bovine cysticercosis and hydatidosis was conducted from October 2007 to March 2008 in cattle slaughtered at the Jimma municipal abattoir. Cyst distribution and viability of bovine cysticercosis and hydatidosis were also determined. A total of 512 carcasses were inspected of which 15 (2.93 %) and 161 (31.44 %) were infected with Taenia saginata metacestodes and hydatid cysts, respectively. From a total of 109 cysticerci collected from infected carcasses, 47 (43.12 %) were viable. The anatomical distribution of the cysticerci was, shoulder muscle (39.5 %), heart (33.9 %), neck muscle (13.8 %), tongue (10.1 %), masseter muscles (1.8 %) and diaphragm (0.9 %). Of the 1171 hydatid cysts collected 223 (19.0 %) were fertile, 505 (43.1 %) sterile, 49 (29.8 %) calcified and 94 (8.0 %) contained pus. A greater proportion of fertile cysts were found in the lungs than in other organs. It was concluded that these zoonotic cestodes deserve due attention to safeguard public health, and that further studies are needed on genotyping, epidemiology and public health importance of Echinococcus granulosus in the study area
Removing user fees in the health sector in low-income countries: a policy guidance note for programme managers
No full textContracting experiences in Sub Saharan Africa: the case of Cameroon, Tanzania, Chad and Uganda; main findings of a Medicus Mundi International network study
No full textChallenges in assesing sexual behaviour and prevalence of HIV infection in young people in African countries
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Estimating the capacity for ART provision in Tanzania with the use of data on staff productivity and patient losses
No full textBACKGROUND: International targets for access to antiretroviral therapy (ART) have over-estimated the capacity of health systems in low-income countries in Sub-Saharan Africa. The WHO target for number on treatment by end 2005 for Tanzania was 10 times higher than actually achieved. The target of the national Care and Treatment Plan (CTP) was also not reached. We aimed at estimating the capacity for ART provision and created five scenarios for ART production given existing resource limitations. METHODS: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up, assuming that sufficient drugs and supplies are provided by donors. We created a simple formula to estimate the number of patients on ART based on availability and productivity of clinical staff, time needed to initiate vs maintain a patient on ART and patient losses using five different scenarios with varying levels of these parameters. FINDINGS: Our scenario assuming medium productivity (40% higher than that observed in 2002) and medium loss of patients (20% in addition to 15% first-year mortality) coincides with the actual reported number of patients initiated on ART up to 2008, but is considerably below the national CTP target of 90% coverage for 2009, corresponding to 420,000 on ART and 710,000 life-years saved (LY's). Our analysis suggests that a coverage of 40% or 175,000 on treatment and 350,000 LY's saved is more achievable. CONCLUSION: A comparison of our scenario estimations and actual output 2006-2008 indicates that a simple user-friendly dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting staff factor and information on availability of this staff and patient losses. Thus, it is possible to set more achievable targets
