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
Inter Press Service reports on the successful efforts of Tanzania’s Kigoma Region “to train assistant medical officers to conduct life-saving c-sections at its rural health centers,” allowing pregnant women with complications to deliver at more local facilities instead of having to travel to regional or district hospitals. Tanzania’s maternal mortality rate is high, at 578 deaths for every 100,000 live births, IPS notes. “[A]t one point the Kigoma Region had the highest rate in the country, at 933 per 100,000 live births in the early 1980s,” but “maternal mortality in this region [now] is considered to be lower than in the rest of the country,” according to the news service.
The U.S. Government Accountability Office (GAO) recently released two reports on issues related to global health. In “Ensuring Drug Quality in Global Health Programs,” the agency writes, “Concerns have been raised about the potential for substandard drugs to enter the supply chains of global health programs,” and notes that it concluded, “U.S.-funded global health programs have put regulatory and policy requirements in place to help prevent procurement of substandard drugs” (8/1). In another report looking at the WHO, titled “Reform Agenda Developed, but U.S. Actions to Monitor Progress Could be Enhanced,” GAO found, “The United States has provided input into WHO’s reform agenda, particularly in the areas of transparency and accountability, but the Department of State’s (State) tool for assessing progress in the area of management reform could be enhanced” (7/23).
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).
Namibian High Court Rules HIV-Positive Women Were Improperly Counseled Before Sterilization Procedures, But Not Based On HIV Status
“The Namibian High Court has ruled that the human rights of three HIV-positive women were violated when they were coerced into being sterilized while they gave birth, but the judge dismissed claims that the sterilization amounted to discrimination based on their HIV status,” PlusNews reports (7/30). “The court ruled the three were sterilized without being adequately informed,” Reuters notes. “There should be unhurried counseling in a language that is clearly understood by the patient,” Windhoek High Court Judge Elton Hoff said, adding, “I am not convinced that informed consent was given,” the news service reports (7/30).
Inter Press Service examines efforts Laos is taking to improve its maternal mortality ratio (MMR) of 470 deaths per 100,000 live births, especially among rural populations that do not have access to health care services. “A majority of the country’s 6.5 million people live in rural communities scattered across this mountainous Southeast Asian nation, and over 80 percent of the women give birth at home, according to studies by the United Nations Population Fund (UNFPA),” the news service writes. “June saw 80 midwives graduate from a special program shaped by the ministry of health, international donors and the UNFPA, … add[ing] to the initial group of 140 midwives who qualified last year,” IPS notes. The news service continues, “And as the community midwives program forges ahead, focus is shifting to more professional care in isolated communities in the mountainous areas and rural lowlands,” with the goal of reaching the U.N. Millennium Development Goal of reducing MMR by 75 percent between 1990 and 2015 (Macan-Markar, 7/31).
The Associated Press on Saturday examined the HIV/AIDS epidemic in Uganda, where “[a] new government report says the prevalence of HIV in this East African nation increased from 6.4 percent in 2004 to 7.3 percent in 2011, a shocking statistic for a country once praised for its global leadership in controlling AIDS.” The news service highlights PEPFAR’s contributions to fighting the epidemic in Uganda, noting that “[a]t least half of the 600,000 Ugandans in need of AIDS treatment are able to access the drugs, mostly through PEPFAR.” According to the AP, “U.S. government officials have been pressing Uganda to devote more resources to AIDS and issues such as maternal health, saying dependency on foreign support is unsustainable in the long term.” On a recent trip to the country, Rep. Barbara Lee (D-Calif.) said meeting patients benefitting from PEPFAR-funded treatment “was confirmation of the fact that United States foreign aid works,” the AP writes (Muhumuza, 7/21).
More widespread use of antiretroviral drugs (ARVs) to treat HIV infection has led to drug resistance in low- and middle-income countries, but the level “is not steep enough to cause alarm, said a survey released by the World Health Organization on Wednesday,” Agence France-Presse reports. “In low- and middle-income countries, drug resistance stood at 6.8 percent in 2010, the WHO said in its first-ever report on the matter,” the news agency writes, adding, “High-income countries, many of which began widescale treatment for HIV years earlier and used single or dual therapies that can also encourage resistance, face higher rates of resistance, from eight to 14 percent, said the study” (Sheridan, 7/18).
The WHO “says comprehensive HIV treatment strategies are needed in developing countries to overcome stigma and discrimination,” because “often those in need of HIV treatment and prevention are unable to receive [the services] because of their social status,” VOA News reports. Certain populations, such as sex workers, men who have sex with men (MSM), and people who inject drugs, sometimes face “barriers … to access services,” Gottfried Hirnschall, director of the WHO HIV/AIDS Department, said, adding, “And we obviously see that as a consequence in many places these groups have higher infection rates. They have higher mortality, etcetera,â€ according to the news service.