The country should move to promote self HIV testing, according to South African National AIDS Council HCT Advisor Rev Zwoitwaho Nevhutalu who spoke at a recent meeting of the Mpumalanga Provincial AIDS Council. “More people on treatment with suppressed viral loads and this means lesser infections,” said Nevhutalu, describing how adhering to HIV treatment can lower the amount of a HI virus in a person’s blood. This, in turn, makes them less infectious, according to recent studies. “The country needs to start thinking about the model of testing and treating in dealing with HIV. ….more
Author Archives: Shabir Moosa
Trevor Noah proves that ‘we’ve been having it’
I was so happy when Trevor Noah admitted on his debut The Daily Show in the US this week that growing up in Soweto, one dream he shared with many of his neighbours was that of an indoor toilet….more
Health department mulls new HIV treatment protocols
THE Department of Health is weighing up the practical and financial implications of expanding HIV treatment to more people, following the release of new guidelines from the World Health Organisation (WHO) this week. The guidelines recommend that patients start treatment as soon as they are diagnosed with HIV, rather than waiting until their immune systems weaken, and say high-risk groups should have access to preventative drug therapy….more
Value of Information: A Tool to Improve Research Prioritization and Reduce Waste
At a time when the scale of investments has raised justifiable concerns about the ability of ongoing research to fulfill expectations [1], the long-run sustainability of research programs will depend on demonstration of value for money. Yet, there has been remarkably little recognition of the need to formally assess research value for money in funding allocation by national governments, funding agencies, and research institutions.
Currently, research priorities are mostly decided using subjective approaches based on consensus among experts, decision makers, and other stakeholders, which tend to lack transparency and may be unduly influenced by special interest groups. More objective measures have been developed based either on the burden of disease or on variations in clinical practice [2]. Prioritization of diseases with the highest burden (morbidity, mortality, or aggregate societal costs) is useful in selecting general areas of neglect [3], but does not help identify what research should be undertaken within these areas. Prioritizing research in areas of disagreement in clinical practice can help practitioners decide between different clinical strategies and, by clarifying what is best practice, reduce variations. In the “clinical variations” method, priorities are defined based on welfare losses due to disagreement [4], with a cost-effectiveness element added in the “payback from research” method (“payback” referring to future savings as a result of the research investment) [5,6]. Setting research priorities based on variations in clinical practice, however, may not be ideal. Scientific uncertainty is not the only cause of clinical variations, which can also be due to poor implementation of research findings. Arguably, only the first should be addressed through additional research, and the second should be dealt with using more efficient means to promote good practice [7].
A decision-theoretic tool, known as “Value of Information” (VOI) [8,9], has been proposed to tackle the complexities of research prioritization in a more comprehensive way. Despite having been promoted and used for over a decade by the National Institute for Health and Care Excellence (NICE) in the United Kingdom [7], VOI is still relatively unknown to the medical scientific community.
Computation without electricity?
Imagine a laptop or smartphone that uses almost no power to perform computations. It’s still decades away, but it’s the logical conclusion of a technique that’s already under development using the spin of electrons in graphene….more
Say goodbye to knobs and buttons
If you’ve ever stood close to a bass speaker in a nightclub, you know what it’s like to feel sound. A UK-based start-up is rolling out technology that uses this principle to let you feel and manipulate shapes in mid-air, and it’s going to change the way you interact with your car, your home and even how you play computer games…..more
Interested in venomous animals and poisonous plants
I plan to present one more VAPP course this year. If you are interested in venomous animals and poisonous plants come and join us on Friday the 20th of November. Please make your booking with Thobile Tshela. All contact details and payment instructions are in the attached brochure. Please forward to anyone who may be interested.
Kind regards,
Prof Andreas Engelbrecht
Adjunct Professor
Head: Divsion of Emergency Medicine, Dept. of Family Medicine
University of Pretoria / Steve Biko Academic Hospital
Tel: +2712 354 2147 / Cell: +2784 789 7364
New HIFA sponsored discussion: Achieving the new global health targets
http://www.hifa2015.org/sponsored-discussions/achieving-the-new-global-health-targets
On 25th September 2015, governments launched the 2030 Sustainable Development (SDG) Agenda, committing all to work together for 17 SDGs encompassing poverty eradication, health, education, food security and nutrition, as well as a broad range of economic, social and environmental objectives, and the promise of more peaceful and inclusive societies.
SDG 3 is specifically on health: “Ensure healthy lives and promote well-being for all at all ages” (see list of health targets below). Health is also recognised as a key input to other SDGs.
On 5 October 2015, HIFA will launch a major thematic discussion to explore what is needed to achieve SDG 3 and its constituent health targets, and to examine in particular the role of university-based global health programs.
The discussion is supported by the Canadian Society for International Health, the Global Health Research – Capacity Strengthening (GHR-CAPS) Program and The Lancet, and will lead into the 22nd Canadian Conference on Global Health, Montreal, 5-7 November 2015 (see below). The key points will be synthesise and made available at the upcoming Canadian Global Health Conference, with a view to bring in the perspectives of stakeholders who may not be able to attend the conference in person, and thereby help inform future efforts by global health programmes and others towards the achievement of the new global health targets. It will run for 5 weeks, addressing the 5 questions below.
QUESTIONS FOR DISCUSSION
1. Agenda 2030 has defined a number of targets for global health (below). This will be the main global health agenda for the next 15 years. What is needed to ensure that we make rapid progress towards these targets collectively? What is needed for rapid progress towards individual targets?
2. What skills and competencies are needed among policymakers, researchers, health professionals and others to drive progress on Agenda 2030 targets? In particular, what is the role of University-based Global Health Programs (UGHs)?
3. What is needed to promote global health research that matters? What is the role of UGHs?
4. What is needed to promote uptake of research into policy and practice? What is the role of UGHs?
5. What is needed to promote global partnerships, collaboration and communication? What is the role of UGHs?
SDG 3: “ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES”
3.1. By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2. By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births
3.3. By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
3.4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being
3.5. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
3.6. By 2020, halve the number of global deaths and injuries from road traffic accidents
3.7. By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes 3.8. Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all 3.9. By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
3.9a. Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate
3.9b. Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
3.9c. Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States 3.9d. Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.
22ND CANADIAN CONFERENCE ON GLOBAL HEALTH, 5-7 NOVEMBER 2015 This year, the 22nd Canadian Conference on Global Health will be held in Montreal, from November 5th to November 7th, 2015, a partnership between the Canadian Society for International Health
(CSIH) and the Global Health Research-Capacity strengthening Program. The conference theme for
2015 is Capacity Building for Global Health: Research & Practice.
This conference will provide a forum for practitioners, researchers, educators, students, policy makers and community mobilizers interested in primary health care to share knowledge, experience and promote innovation and collaborative action.
For more info on CSIH and the conference:
http://www.ccgh-csih.ca/ccgh2015/index/&lang=en
With thanks,
HIFA profile: Sarah Brown is Conference Manager for the Canadian Society for International Health. www.csih.org sbrown AT csih.org
ICT for innovation: e-Learning for Africa in the cyber-age
Several alternatives have been put across for Africa’s development agenda: industrialization, infrastructure, agriculture, universal primary education, universal secondary education, aid, trade and Millennium Development Goals (MDGs) among others. The debate continues, especially after the expiry of the MD Gs. The immediate context of this discussion is the UN Summit scheduled in September 2015 on the Sustainable Development Goals (SDGs). I want to suggest a bold idea of promoting e-learning or distance learning at tertiary level based on the concept of ICT for innovation. By this I want to reduce the SDGs to one: quality and affordable education for job creation for all. We are living in an age of cyberspace where computer and mobile applications are spurring innovation in health, education, agriculture, commerce, banking and technological innovation. But for this ICT for innovation to succeed there is need for a paradigm shift in how tertiary education is conducted in Africa. The called for paradigm shift includes development of online or distance learning courses of high quality that are affordable, since there is less dependence on physical infrastructure, transport costs and hard copy learning materials…..more
Transforming Turkey’s Health System — Lessons for Universal Coverage
In 2003, Turkey embarked on ambitious health system reform to overcome major inequities in health outcomes and to protect all citizens against financial risk. Within 10 years, it had achieved universal health coverage and notable improvements in outcomes and equity….more
CIOMS Working Group on the Revision of CIOMS 2002 International Ethical Guidelines for Biomedical Research Involving Human Subjects
Dear reader,
In 2010 the Executive Committee of CIOMS decided to revise the CIOMS Ethical Guidelines for Biomedical Research. The document was last revised in 2002. Since then, several developments have taken place, both in the field of biomedical research itself and in the field of research ethics. Among the latter developments is the recent revision of the Declaration of Helsinki in 2013.
The research and research ethics community, as well as the wider public, are now cordially invited to provide the Working Group of CIOMS with comments until 1 March 2016. The Working Group will then process the comments and suggestions, and submit the final document to the Executive Committee of CIOMS. This Committee will approve the document.
The Working Group
The Working Group consists of 10 members, one chair (President of CIOMS), four advisers (from WHO, UNESCO, COHRED and WMA) and one scientific secretary. The composition of the Working Group ensures that different cultural perspectives are present, members vary in age and expertise, and a gender balance is reached. One of the members represents the patient perspective. The group has met three times each year from September 2012 until September 2015.
Status of the current draft
The current version of the CIOMS guidelines is a draft. Although guidelines address specific issues, such as choice of the control, individual informed consent, and research with children, the CIOMS guidelines should be read and understood as a whole.
In the final version the Working Group will add introductory texts and appendices.
Literature and guidance documents
The draft guidelines have been based on the results of literature searches and ethical reflection within the Working Group. Certain papers and guidelines have been particularly valuable for the current draft guidelines, such as the Declaration of Helsinki of the WMA, the Ethical considerations in biomedical HIV prevention trials of UNAIDS and Standards and operational guidance for ethics review of health-related research with human participants of the WHO. All sources used will be acknowledged in the final document.
Major changes
Most guidelines have been substantially revised. Guidelines have also been merged where possible. At the same time, new guidelines have been added to address new, pressing issues that require ethical guidance (such as disaster research or implementation research). The Working Group has also decided to merge the “Green Book” (the CIOMS Guidelines for Biomedical Research, 2002) with the “Blue Book” (the CIOMS Guidelines for Epidemiological Research, 2009) since the two guidelines substantially overlap each other. The scope of the guidelines has been broadened from biomedical research to health-related research with humans.
Providing feedback
The proposal of the Working Group is now open for comments. Below each guideline there are two boxes: one for general comments and one for specific comments. Please provide us as much as possible with concrete, specific comments and text proposals. Since we expect to receive a great number of suggestions, we would like to caution that we will not be able to respond individually to each commentator.
We are grateful for your support of this important project and hope the revised CIOMS Guidelines will help to foster ethical research worldwide.
Yours sincerely,
Dr. J.J.M. van Delden
President of CIOMS
Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach
Abstract
Background
There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.
Methods
We explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component.
Results
We identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system.
Conclusions
We believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.
Using a human resource management approach to support community health workers: experiences from five African countries
Abstract
Background
Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance.
Methods
Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach.
Results
CHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs.
Conclusions
This study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities.
Towards an international taxonomy of integrated primary care: a Delphi consensus approach
Abstract
Background
Developing integrated service models in a primary care setting is considered an essential strategy for establishing a sustainable and affordable health care system. The Rainbow Model of Integrated Care (RMIC) describes the theoretical foundations of integrated primary care. The aim of this study is to refine the RMIC by developing a consensus-based taxonomy of key features.
Methods
First, the appropriateness of previously identified key features was retested by conducting an international Delphi study that was built on the results of a previous national Delphi study. Second, categorisation of the features among the RMIC integrated care domains was assessed in a second international Delphi study. Finally, a taxonomy was constructed by the researchers based on the results of the three Delphi studies.
Results
The final taxonomy consists of 21 key features distributed over eight integration domains which are organised into three main categories: scope (person-focused vs. population-based), type (clinical, professional, organisational and system) and enablers (functional vs. normative) of an integrated primary care service model.
Conclusions
The taxonomy provides a crucial differentiation that clarifies and supports implementation, policy formulation and research regarding the organisation of integrated primary care. Further research is needed to develop instruments based on the taxonomy that can reveal the realm of integrated primary care in practice.
Can Mobile Health Applications Facilitate Meaningful Behavior Change?: Time for Answers.
Massive problems require pragmatic, scalable, and evidence-based solutions. Cardiovascular disease (CVD), the world’s leading cause of death, is the epitome of such a problem in need of such a solution.1 The World Health Organization and American Heart Association have both set goals of reducing CVD mortality 25% by 2025.2,3 Achieving the requisite success in CVD prevention, however, will be challenging and will require approaches and tools that (1) have proven clinical benefit, (2) can be scaled to reach a global population, and (3) are affordable. Mobile technologies provide a potentially scalable and cost-effective platform to facilitate these needs. In 2014, there were more than 5 billion mobile phone users worldwide, representing approximately 3 of 4 adults on earth.4 Mobile phones have already had a profound influence on human connectivity, commerce, media, and finance. Although health care has been somewhat slow to incorporate mobile technology, the potential effect of digital medical tools is similarly huge.5 What is still needed, however, is evidence that mobile technologies can indeed facilitate improvements in health….more
Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.
BACKGROUND
An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality.
An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality.
OBJECTIVES
The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates.
DESIGN AND PARTICIPANTS
This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate.
MAIN MEASURES
The study analyzed ratings of hospitals on Facebook’s five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type.
KEY RESULTS
Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p < 0.01). The average rating for hospitals with low readmission rates (4.15?±?0.31) was higher than that for hospitals with higher readmission rates (4.05?±?0.41, p < 0.01). Major teaching hospitals were 14.3 times more likely to be in the high readmission rate group. A one-star increase in Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p < ?0.01), when controlling for hospital characteristics and Facebook-related variables.
CONCLUSIONS
Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.
Financial woes may be fuelling hidden depression
About 20 percent of South Africans live on less than R350 per month and this kind of poverty could be having real impacts not only on people’s physical health but also their mental well being. Each month, Mary* collects a child grant for her three-year-old daughter. Within hours of collecting the grant, Mary is queuing at the door of the local loan shark in an effort to pay off debts that began last Christmas. “I had to buy Christmas clothes and groceries for myself and my girl,” said Mary, who lives in Kuruman, Northern Cape. “I needed more than the grant itself.” ….more
The Three Major Trends that Shaped the Global Economy for Decades Are About to Change
Demographics can explain two-thirds of everything, University of Toronto professor David K. Foot famously quipped. And according to Charles Goodhart, professor at the London School of Economics and senior economic consultant to Morgan Stanley, demographics explain the vast majority of three major trends that have shaped the socioeconomic and political environments across advanced economies over the past few decades. Those three would be declining real interest rates, shrinking real wages, and increasing inequality…..more
Health is key to growth
Leading economists, including eight South Africans, have called on world leaders to spend more on health and ensure that “essential” health services are free. A petition calling for universal healthcare, drafted by former Harvard economics professor Lawrence Summers, was signed by 257 economists on Friday, ahead of a UN meeting this week. Global leaders will commit themselves to 17 goals intended to end poverty and ensure “sustainable development” by 2030 – and economists want them to prioritise health…..more
Developing the evidentiary basis for family medicine in the global context: The Besrour Papers: a series on the state of family medicine in the world
ABSTRACT
Objective:
To provide an overview of the main methodologic challenges to finding definitive evidence of the positive effects of family medicine and family medicine training on a global scale.
To provide an overview of the main methodologic challenges to finding definitive evidence of the positive effects of family medicine and family medicine training on a global scale.
Composition of the committee:
In 2012, 2013, and 2014, the College of Family Physicians of Canada hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences.
Methods:
We performed a scoping review to determine the methodologic obstacles to understanding the positive effects of family medicine globally.
Report:
The main obstacle to evaluating family medicine globally is that one of its core dimensions and assets is its local adaptability. Family medicine takes on very different roles in different health systems, making aggregation of data difficult. In many countries family medicine competes with other disciplines rather than performing a gatekeeping role. Further, most research that has been conducted thus far comes from industrialized contexts, and patient continuity and its benefits might not be achievable in the short term in developing countries when clinical demands are great. We must find frameworks to permit strengthening the evidentiary basis of the discipline across different contexts without sacrificing its beneficial adaptability.
Conclusion:
We believe that developing family medicine and its attributes is one of the keys to achieving global health. These attributes—including its comprehensiveness, adaptability, and attention to both local and patient needs—are key to advancing global health priorities, but make common evaluative frameworks for the discipline a challenge. The spread of family medicine over the past decades is indirect evidence of its utility, but we need to generate more evidence. We present some of the initial challenges to a broader and more rigorous evaluative framework.
AfroPHC 