Building on its seven-year-old National Rural Health Mission (NRHM), India’s government plans to launch the National Urban Health Mission (NUHM), which “will focus on improving health care delivery and public health systems,” the Lancet reports. Prime Minister Manmohan Singh recently “expressed hope that the two programs together will in the future lead to a unified National Health Mission,” according to the journal. “Unplanned urbanization brings forth a whole set of new health problems. [The] urban poor are three times more likely to die before attaining the age of five years, 20 times more likely not to have any antenatal care, three times less likely to get primary immunization, and two and a half to three times more likely to be stunted and wasted than urban richest,” Chandrakant Pandav, head of the Centre for Community Medicine at the All India Institute of Medical Sciences, New Delhi, said, citing the third National Family Health Survey, the Lancet notes (Bhaumik, 8/11).
Quality of Care
Study Finds 'Inconclusive' Evidence To Support Use Of WHO-Backed Drug To Prevent Hemorrhage During Labor
According to a study published Monday in the Journal of the Royal Society of Medicine, “[t]he World Health Organization [WHO] should review its approval of a drug used to prevent life-threatening bleeding in women in childbirth because there is not enough evidence that it is effective,” Reuters reports. The study finds that “the evidence to support the use of misoprostol is ‘at best inconclusive,’ yet it is increasingly used in poorer countries to prevent postpartum hemorrhage (PPH),” the news service writes, noting “researchers analyzed 172 previous studies on the use of misoprostol during labor and found that only six had enough information to say whether or not the drug was effective in preventing PPH in rural and community settings in poor countries” (Kelland, 8/20).
BBC News reports on a $15 million college in northern Nigeria’s Jigawa state that is working to train nurses and midwives. The first class of the three-year program is expected to graduate in September, and “[t]he hope is these new nurses and midwives will stay in Jigawa’s villages once their training is complete, rather than drifting to towns and cities where the work is usually better paid,” BBC notes, adding, “The college represents a start in addressing what has been a gaping lack of resources.” Four years ago, there were 14 midwives trying to serve “the state’s population of 4.5 million people” and “cover more than 600 small health centers,” BBC continues. However, a British-funded project called Paths 2, which aims “to reduce the state’s high level of preventable deaths among pregnant women,” has helped facilitate the creation of training programs for local health care workers, the news service notes (Dreaper, 8/2).
On the first stop of a 10-day tour of Africa, Secretary of State Hillary Clinton stopped at the Phillipe Maguilen Senghor Health Center in Dakar, Senegal, where Awa Marie Coll-Seck, the country’s minister of health, “explained to Secretary Clinton how these operational centers dramatically improve maternal and child health,” according to a post in USAID’s “IMPACTblog.” Coll-Seck “also noted that USAID-supported distribution of insecticide impregnated mosquito nets across the country had drastically reduced the incidence of malaria,” according to the blog, which adds that Clinton “was pleased to hear that the United States is playing a key role in helping meet one of its biggest challenges: decentralizing services so they are available at the village level throughout the country.” In an address several hours later, “Clinton invoked the Senghor center … saying she was highly impressed by the integrated nature of the facility” and that “[i]t was a successful model she hoped could be duplicated throughout Senegal and the entire West African region” (Taylor, 8/1).
“Ethiopia is preparing for a flood of medical doctors within ‘three to four years,’ an influx meant to save a public health system that has been losing doctors and specialists to internal and external migration,” IRIN reports. “‘We are now implementing strategies that intend to increase the current below-World Health Organization [WHO] standard number of medical doctors and retaining them in public hospitals,’ Tedros Adhanom, Ethiopia’s minister of health, told IRIN,” the news service writes. “‘We have now reached an enrollment rate of more than 3,100,’ [Adhanom] said,” adding, “The rate of enrollment in the country’s medical schools has increased tenfold from 2005, when it was below 300,” according to the news service.
Though many pregnant women are aware that treatment could save their lives and the lives of their infants if they test HIV-positive during prenatal care, a new study and literature review have found that a “[f]ear of being stigmatized as an AIDS patient is still a major barrier to good medical care for pregnant young women in many countries,” the New York Times reports. The study, published last week in PLoS Medicine, was “based on a survey of 1,777 women in rural Nyanza Province in Kenya,” according to the newspaper, which adds, “Only 44 percent of mothers in the province delivered in clinics, and the study found that a major obstacle was that they feared HIV tests.” The study’s author, Janet Turan, a professor of public health at the University of Alabama at Birmingham, in July also published “a review of multiple studies in many countries” that documented multiple accounts of “stigmatizing behavior,” the newspaper notes (McNeil, 8/27).
Ugandan Parliamentarians Threaten To Hold Up National Budget Unless More Funding Committed To Health Care
In Uganda, where “there are fewer than two health workers for every 1,000 people — a level the World Health Organization defines as a severe shortage” — the nation’s parliamentary “social services committee, which has initial oversight of the country’s health budget, pushed a resolution through parliament last week threatening to hold up approval of the entire budget unless funding to recruit and retain new health workers is increased,” VOA News reports. “Committee members, with support from the Women’s Parliamentary Association, called for a specific increase of at least $103 million to the sector,” the news service notes. “In addition to the funding increase, the parliamentarians are calling for an end to a wage freeze for current employees and a ban on recruiting new health workers,” as well as “demanding a supplementary pool of money to improve health care in communities that are particularly short staffed,” according to the news service.
In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health “seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy,” they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, “[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, “In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.”
“Following criticism over a spate of patient deaths from adverse events during clinical trials, India has begun tightening up rules for clinical research and compensation as well as expanding its pool of medical experts,” SciDev.Net reports. A health ministry official said the ministry would submit to Parliament amendments to existing laws with the aim of strengthening the approval process for clinical trials, according to the news service. In addition, the Central Drugs Standard Control Organisation (CDSCO) is expanding its pool of experts, “has asked ethics committees for tougher inspection regimes,” and in August “issued guidelines on compensation to be paid in case of clinical trials-related death or injury,” the news service notes. According to SciDev.Net, “These steps follow the report of a parliamentary committee, in May 2012, which found that a large number of imported drugs had been cleared without trials,” “includ[ing] drugs that had failed to be cleared for use in the parent countries” (Sreelata, 9/12).
Approximately one-third of children under the age of five in southern Afghanistan, about one million, have acute malnutrition, “with a level of deprivation similar to that found in famine zones, a government survey has found, despite the hundreds of millions of dollars in foreign aid that has been poured into the region,” the Guardian reports. The U.N.-supported “Afghanistan Multiple Indicator Cluster Survey (MICS) found 29.5 percent of children are suffering from acute malnutrition there,” the newspaper states, noting that a level of more than 30 percent is one indicator of famine, as are death rates and families’ access to food.