National Health Strategic Plan Research Articles

Prevalence and Incidence of Hypertension and Diabetes Mellitus Among HIV-Infected Individuals Receiving HAART in Chongwe District, Lusaka Province, Zambia

Background: The Zambia National Health Strategic Plan (ZNHSP) 2011–2017 underscores the need for community-level risk factor stratification to bolster insufficient incidence and prevalence data. This study evaluates the prevalence and incidence of hypertension and diabetes mellitus in HIV-infected patients on Highly Active Anti-Retroviral Therapy (HAART) and assesses associations with ARV use. Methodology: A retrospective cohort analysis was conducted using the SMART CARE database in Chongwe district, involving 2070 HIV-infected persons on HAART. Statistical analysis included Chi-square, Kruskal-Wallis tests, and logistic regression. Results: Among participants, 33.8% exhibited hypertension, with an incidence case fatality rate of 85.7 per 1000 person-years (PYFU). Hypertension was notably higher in men (64%) than women (49%) and prevalent in the 18–45 age group (57.2%). The incidence of type II diabetes was 37.4 per 1000 PYFU. Logistic regression highlighted significant predictors for both conditions, including ART combination, age, and smoking status. Conclusion: High prevalence and incidence rates of hypertension and type II diabetes were observed among HIV-positive individuals on HAART. Certain HAART combinations, particularly twoNRTIs plus a PI or INSTI, correlated with increased hypertension risk, while combinations including NNRTI or INSTI were linked to higher diabetes incidence.

Mental health service accessibility, development and research priority setting in Cambodia - a post-conflict nation

BackgroundThe limited health and social care infrastructure that existed in the 1970s in Cambodia was destroyed due to the Khmer Rouge. Mental Health service infrastructures have developed in Cambodia in the last twenty five years, however, they have been shaped significantly by very limited funding being made available for human resources, support services and research. The lack of research on Cambodia’s mental health systems and services is a significant barrier to the development of evidence-based mental health policies and practice. In order to address this barrier, effective research and development strategies are needed in Cambodia, which are based on locally well-informed research priorities. There are many possibilities for mental health research in LMIC countries such as Cambodia, therefore focused research priorities in these areas are needed to guide future research investment. This paper is the result of the development of international collaborative workshops, which focused on service mapping and research priority setting in the field of mental health in Cambodia. MethodsA nominal group technique was used to gather ideas and insights from a range of key mental health service stakeholders in Cambodia. Results: The key issues in service provisions for people with mental health issues and disorders, the interventions and programmes of support available, and currently needed, were identified. This paper also identifies five key mental health research priority areas which could form the basis for effective mental health research and development strategies in Cambodia. ConclusionThere is a clear need for the Cambodian government to devise a clear policy framework for health research. This framework could focus on the five research domains identified in this paper and could be incorporated within its National Health Strategic plans. The implementation of this approach would likely lead to the development of an evidence base which would allow the development of effective and sustainable strategies for mental health problem prevention and intervention. This would also contribute to promote the Cambodian government’s capacity to take the deliberate, concrete, and targeted steps necessary to address the complex mental health needs of its population.

Hospital Managers’ Perceptions Regarding Setting Healthcare Priorities in Kuwait

BACKGROUND & OBJECTIVE: In view of the budget limitations resulting from the downturn in the Kuwaiti economy, it is crucial to evaluate the process of priority setting within the health system to identify strengths and weaknesses of this process within both the public and private sectors. Once the weak points are identified, policy makers can work with hospital administration staff to upgrade the process with the aim of utilising health resources more efficiently. The purpose of this study is to give decision makers some insight on the perspective of hospital managers regarding the current process of priority setting, and suggest ways to improve this process. Additionally, this study will provide the opinions of hospital managers in questioning the effect of certain healthcare policies, currently given top priority, on healthcare system efficiency. The views of the hospital managers interviewed indicate their preferences in priority setting and the changes in health spending they believe are required.
 
 METHODS: A qualitative study was conducted using semi-structured, face-to-face interviews with 14 managers from public and private hospitals in Kuwait. Content analysis was used to produce major themes and sub-themes from the interview transcripts.
 
 RESULTS: While several similarities and differences in the priority-setting process between the public and private sectors were apparent, the main strength in the process that most managers from both sectors mentioned, was that it was simple, systematic, comprehensive and democratic. The several weaknesses of the process include it not being evidence-based due to the lack of accurate and up-to-date data. Also, the discrepancy between the official statements made and the actual practices of health decision makers in the country demonstrate the confusion around the priority-setting process. Most respondents, from both sectors, thought that the availability of a clear and well-communicated national health strategic plan would facilitate the necessary modifications in legislative, structural and administrative strategies to streamline the processes of allocating resources and setting priorities. For example, most respondents believed that the disadvantages of the costly practice of sending patients abroad for treatment and its effect on resource allocation outweighed its advantages. Further, the managers from both sectors had different perceptions regarding the policy of private health insurance for retirees. These two policies, according to some hospital managers, added strain to the health budget and undermined trust in the public-health sector.
 
 CONCLUSION: This study examined the perspective of hospital managers regarding the process of healthcare priority setting in Kuwait, and ways to improve it. Priority setting could be improved by having a better understanding of its strengths and weaknesses. The study concludes that health decision makers should remain responsible for accepting and implementing evidence-based, systematic processes of resource allocation. Additionally, continuous monitoring and evaluation of the impact of health policies will be required to improve overall health outcomes.        

Are low and middle-income countries prioritising high-value healthcare interventions?

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have...

Factors Associated with Agreeing to Early Childbearing Among School Girls of Selected Rural Districts in Zambia

Background: The Zambia Demographic Health survey conducted in 2014 reported a notable number of adolescent girls 3627(11.7%) who had their first sexual intercourse by age 15 and the Zambia National Health Strategic Plan 2017-2021 highlighted the high adolescent birth rate which stood at 141 per 1000 live births between the years 2013 and 2014. In this paper, we adopted the WHO definition of an Adolescent as any person between the ages of 10 to 19 years. This study aimed at investigating baseline factors that leads to agreeing into early childbearing practices among adolescent girls in selected rural districts of Zambia nested in the RISE cluster randomized trial. In this study early childbearing was taken to mean any pregnancy before the age of 16. Methods: This study is a nested quantitative cross-sectional design. Participants were girls attending grade seven at various schools in 2016. Information on factors that could influence the participants’ view on childbearing were collected at baseline. A complete enumeration of approximately 5000 girls recruited in 12 rural districts of Central and Southern provinces were analysed. Descriptive statistics were presented as frequencies and percentages in tables. To check for association with categorical variables, either Chi-squared or Fisher’s exact test was done depending on whether the assumptions for Chi-squared test were satisfied or not. Univariate and Multiple Logistic regression analysis was used to test the association between independent factors and early childbearing. Clustering in the study was accounted for using robust standard errors. Results: The findings showed that more than two-thirds 3189 (73.7%) of the participants had little or no knowledge regarding adolescent sexual and reproductive health services while less than one-third 1137 (26%) had knowledge regarding Adolescent Sexual and Reproductive Health services. Adolescents with mobile phones were 2.5 times more likely to have children early compared to adolescents without mobile phones. Majority 227 (69%) who agreed to early childbearing were aged 10 to 15 years, whilst the least 99(30.3%) were in the age range of 16 to 20 years. In addition, results revealed that one-year increase in age of an adolescent girl increases agreeing to early childbearing by 30% (OR=1.30, 95% CI (1.01, 1.67), p- value=0.03). Overall, very few factors (mobile phone and age) at baseline were found to be associated with agreeing to early childbearing. Conclusions: Only mobile phone use and age were associated with agreeing to early childbearing.

Healthcare Leaders Develop Strategies for Expanding National Surgical, Obstetric, and Anaesthesia Plans in WHO AFRO and EMRO Regions.

Worldwide, five billion people lack access to safe, affordable surgical, obstetric, and anaesthesia (SOA) care when needed. In many countries, a growing commitment to SOA care is culminating in the development of national surgical, obstetric, and anaesthesia plans (NSOAPs) that are fully embedded in the National Health Strategic Plan. This manuscript highlights the content and outputs from a World Health Organization (WHO) lead workshop that supported country-led plans for improving SOA care as a component of health system strengthening. In March 2018, a group of 79 high-level global SOA stakeholders from 25 countries in the WHO AFRO and EMRO regions gathered in Dubai to provide technical and strategic guidance for the creation and expansion of NSOAPs. Drawing on the experience and expertise of represented countries that are at different stages of the NSOAP process, topics covered included (1) the global burden of surgical, obstetric, and anaesthetic conditions; (2) the key principles and components of NSOAP development; (3) the critical evaluation and feasibility of different models of NSOAP implementation; and (4) innovative financing mechanisms to fund NSOAPs. Lessons learned include: (1) there is unmet need for the establishment of an NSOAP community in order to provide technical support, expertise, and mentorship at a regional level; (2) data should be used to inform future priorities, for monitoring and evaluation and to showcase advances in care following NSOAP implementation; and (3) SOA health system strengthening must be uniquely prioritized and not hidden within other health strategies.

An Assessment of the Demand-Side of the Monitoring and Evaluation System of the Health Sector in Zambia

This paper assesses the Monitoring and Evaluation (ME (ii) outputs and dissemination; (iii) integration with the budget process and parliament; and (iv) non-state actors as demand-side stakeholders. Fundamental issues brought out are that the ME the link between the National Health Strategic Plan (NHSP) and the budget process through the Mid Term Expenditure Framework (MTEF) mechanism; the presence of the National Decentralization Policy which could be used to strengthen the ME the fact that the MOH strategic plan is developed and implemented within the framework of the National Development Plan (NDP)(currently the 7NDP 2017-2021) and coupling this with the use of the MTEF, the arrangements could be used to lobby for resources to strengthen the sector ME (1) the need to conduct a thorough sector ME (2) to create a forum for inter-line ministry and stakeholder ME (3) to build the ME (4) to enhance the incentive structure for generating and using ME and (5) to engage both MNDP and MOF to provide M&E backstopping.

Estimating health plan costs with the OneHealth tool, Cambodia.

ObjectiveTo do resource and cost projections for the entire Cambodian health sector using the OneHealth tool, during the development of the third national health strategic plan 2016–2020.MethodsThrough a consultative process, the health ministry estimated the needed and available resources to implement the strategic plan. The health ministry used the OneHealth Tool to estimate costs of expanding public sector service provision and compared these to estimates of projected available financing. Cost estimates covered implementation of health programmes including commodities and programme management costs, and six cross-cutting health system strengthening components. The tool is populated with local demographic, epidemiological, programmatic and unit cost data. We present costs in constant 2015 United States dollars (US$).FindingsWe estimated the five-year cost of the strategic plan to be US$ 2973.8 million. Costs are split between health systems strengthening components (US$ 1516.3 million) and investments in individual disease or public health programmes (US$ 1457.5 million). Health programmes for maternal and neonatal health (US$ 367 million), child health and immunization (US$ 197 million) and noncommunicable disease (US$ 157 million) have the highest costs. Although projected resource needs increase over time, a financial space analysis with ambitious projected increases in government funding indicates that government and donor funding jointly could be sufficient to cover the cost of the strategic plan from 2018 to 2020.ConclusionThe results both informed development of the strategic plan, and contributed to the evidence base for improved budgeting, resource mobilization strategies and stronger overall public sector financial planning.

Spatial accessibility to basic public health services in South Sudan.

At independence in 2011, South Sudan’s health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.

Improving access to child health services at the community level in Zambia: a country case study on progress in child survival, 2000-2013.

Reductions in under-five mortality in Africa have not been sufficient to meet the Millennium Development Goal #4 (MDG#4) of reducing under-five mortality by two-thirds by 2015. Nevertheless, 12 African countries have met MDG#4. We undertook a four country study to examine barriers and facilitators of child survival prior to 2015, seeking to better understand variability in success across countries. The current analysis presents indicator, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve MDG#4. Results identified a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health. Zambia has also focused on bringing health services as close to the family as possible through specific community health strategies. This includes actively involving community health workers to provide health education, basic MNCH services, and linking women to health facilities, while supplementing community and health facility work with twice-yearly Child Health Weeks. External partners have contributed greatly to Zambia’s MNCH services, and their relationships with the government are generally positive. As government funding increases to sustain MNCH services, national health strategies/plans are being used to specify how partners can fill gaps in resources. Zambia’s continuing MNCH challenges include basic transportation, access-to-care, workforce shortages, and financing limitations. We highlight policies, programs, and implementation that facilitated reductions in under-five mortality in Zambia. These findings may inform how other countries in the African Region can increase progress in child survival in the post-MDG period.

Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review.

IntroductionDisease amenable to surgical intervention accounts for 11–15 % of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) reflect countries’ long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue in Africa.MethodsNHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources.Results19 % of NHSPs had no mention of surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets.DiscussionNHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems.

Prioritisation of surgery in the National Health Strategic Plans of Africa: a systematic review

BackgroundDisease amenable to surgical intervention accounts for 11–15% of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) have been established in most countries and reflect their long-term health priorities, plans, and targets. To assess surgery's perceived importance in Africa, we reviewed its place in all such available plans. MethodsWe analysed all 43 of the 55 independent countries in Africa that had NHSPs available in the public domain in March, 2014, in English or French. We searched for policies electronically with the search terms “surg*”, “ortho*”, “trauma”, “cancer”, “appendic*”, “laparotomy”, “HIV”, “tuberculosis”, and “malaria” and included those from 2002 to 2030. We then searched manually for disease prevalence, targets, and human resources. FindingsEight (19%)of 43 NHSPs had no mention of surgery or surgical conditions. 28 (65%) of 43 had five or less mentions of surgery. HIV and malaria had 3801 mentions across all the policies compared with surgery with only 379 mentions. Trauma had 243 mentions, while the common surgical conditions of appendicitis, laparotomy, and hernia had no mentions at all. More than 95% (41 of 43) of NHSPs specifically mentioned the prevalences of HIV, tuberculosis, malaria, infant mortality, and maternal mortality. The most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47% (23 of 43) of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis and all but one had targets for malaria, maternal mortality, and child mortality. Of the 4232 health targets across 43 NHSPs, only 96 (2·3%) were related to surgical conditions or surgical care. 14 (33%) of 43 policies had no surgical targets. InterpretationNHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. A paradigm shift is required if surgery is to be considered a public health concern, which should include greater prioritisation in national health strategic policies. FundingNone.

An overview of the malaria control programme in zambia.

The Zambian national malaria control programme has made great progress in the fight against Malaria. The country has solid, consistent, and coordinated policies, strategies, and guidelines for malaria control, with government prioritizing malaria in both the National Health Strategic Plan and the National Development Plan. This has translated into high coverage of proven and effective key preventive, curative, and supportive interventions with concomitant marked reduction in both malaria cases and deaths. The achievements attained can be attributed to increased advocacy, communication and behaviour changes, efficient partnership coordination including strong community engagement, increased financial resources, and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. The three-ones strategy has been key for increased and successful public-private sector partner coordination, strengthening, and mobilization. However, maintaining the momentum and the gains is critical as the programme strives to achieve universal coverage of evidence-based and proven interventions. The malaria control programme's focus is to maintain the accomplishments, by mobilizing more resources and partners, increasing the government funding towards malaria control, scaling up and directing interventions based on epidemiological evidence, and strengthen active malaria surveillance and response to reduce transmission and to begin considering elimination.

The human resource for health situation in Zambia: deficit and maldistribution

IntroductionCurrent health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care.Population and methodsWe used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them.ResultsThe highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers).The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces.This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763.In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other.The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus.Discussion and ConclusionsThis case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity.

Early results of integrated malaria control and implications for the management of fever in under-five children at a peripheral health facility: a case study of Chongwe rural health centre in Zambia

BackgroundZambia has taken lead in implementing integrated malaria control so as to attain the National Health Strategic Plan goal of "reducing malaria incidence by 75% and under-five mortality due to malaria by 20% by the year 2010". The strategic interventions include the use of long-lasting insecticide-treated nets and indoor residual spraying, the use of artemisinin-based combination therapies (ACT) for the treatment of uncomplicated malaria, improving diagnostic capacity (both microscopy and rapid diagnostic tests), use of intermittent presumptive treatment for pregnant women, research, monitoring and evaluation, and behaviour change communication. Financial barriers to access have been removed by providing free malaria prevention and treatment services.MethodsData involving all under-five children reporting at the health facility in the first quarter of 2008 was evaluated prospectively. Malaria morbidity, causes of non-malaria fever, prescription patterns treatment patterns and referral cases were evaluatedResultsMalaria infection was found only in 0.7% (10/1378), 1.8% (251378) received anti-malarial treatment, no severe malaria cases and deaths occurred among the under-five children with fever during the three months of the study in the high malaria transmission season. 42.5% (586/1378) of the cases were acute respiratory infections (non-pneumonia), while 5.7% (79/1378) were pneumonia. Amoxicillin was the most prescribed antibiotic followed by septrin.ConclusionMalaria related OPD visits have reduced at Chongwe rural health facility. The reduction in health facility malaria cases has led to an increase in diagnoses of respiratory infections. These findings have implications for the management of non-malaria fevers in children under the age of five years.