January 2009 - Health Systems and Health Services


HLT/056 - January 2009



BMC Complementary and Alternative Medicine 8(66); December 2008

Oshikoya, K.A. et al. Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria

The use of complementary and alternative medicine (CAM) is on the increase globally with a high prevalence in children and adults with chronic illnesses. Many studies have evaluated the epidemiology of medicine use for children in developing countries but none has evaluated the use of CAM for children with chronic illnesses. The aim of this study was therefore to determine the prevalence, pattern of use, parental sources of information, perceived benefits, cost, and adverse effects of CAM in children with epilepsy, sickle cell anaemia and asthma in Lagos, Nigeria. Parents of children with epilepsy (122), asthma (78) or sickle cell anaemia (118) who presented consecutively to the paediatric neurology, respiratory and haematology clinics of the Lagos State University Teaching Hospital (LASUTH), Ikeja were interviewed with a structured open- and close-ended questionnaire. The majority (84%) of these patients were currently using CAM. The use of CAM was stopped six months prior to the study by 16 patients (16%). Parental use of CAMs to treat their children with epilepsy, asthma and sickle cell anaemia is common in Nigeria. Efforts should be made by doctors taking care of these patients to identify those CAM therapies that are beneficial, harmless and cheap for possible integration with conventional therapy… http://www.biomedcentral.com/content/pdf/1472-6882-8-66.pdf


Journal of Ethnobiology and Ethnomedicine 4(26); December 2008

Grønhaug, T.E. et al. Ethnopharmacological survey of six medicinal plants from Mali, West-Africa.

An ethnopharmacological survey was carried out to collect information about the use of six medicinal plants in the regions around Siby and Dioila, Mali. The plants investigated were Biopyhtum petersianum, Cola cordifolia, Combretum molle, Opilia celtidifolia, Parkia biglobosa and Ximenia americana. More than 60 medical indications were reported for the use of these plants in traditional medicine. The most frequently reported ailments were malaria (25.6 %), different types of pain (14.0 %) and dermatitis (7.4 %). The main forms for preparation were decoction (58.1 %) and powdered plant material (28.4 %). The most frequent used plant parts were leaves (37.7 %) and stem bark (18.6 %). The healers' consensus for the main indications is fairly high for the four plants B. petersianum, C. cordifolia, C. molle and O. celtidifolia, and this supports the traditional use of these plants. However for P. biglobosa and X. americana the healers consensus is less consistent and it is more difficult to draw conclusions about the most important traditional use of these two plants… http://www.ethnobiomed.com/content/pdf/1746-4269-4-26.pdf



Human Resources for Health 7(1); January 2009

Sherk, K.E. et al. An experience of virtual leadership development for human resource managers

Problem Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. Approach Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (USAID). Relevant changes The USAID-funded Leadership, Management and Sustainability (LMS) Program, implemented by MSH, and the USAID-funded Capacity Project, implemented by IntraHealth, adapted the VLDP for HR managers to help them identify and address HR challenges that ministries of health, other

public-sector organizations and nongovernmental organizations are facing. Local settings three examples illustrate the results of the VLDP for teams of HR managers: 1. the Uganda Protestant and Catholic Medical Bureaus 2. the Christian Health Association of Malawi 3. the Developing Human Resources for Health Project in Uganda. Lessons learnt The VLDP is an effective programme for developing the management and leadership capacity of HR managers in health… http://www.human-resources-health.com/content/pdf/1478-4491-7-1.pdf


Human Resources for Health 7(3); January 2009

Ridde, V. et al. Programme evaluation training for health professionals in francophone Africa: process, competence acquisition and use

While evaluation is, in theory, a component of training programmes in health planning, training needs in this area remain significant. Improving health systems necessarily calls for having more professionals who are skilled in evaluation. Thus, the Universite de Ouagadougou (Burkina Faso) and the Universite de Montreal (Canada) have partnered to establish, in Burkina Faso, a master's-degree programme in population and health with a course in programme evaluation. This article describes the four-week (150-hour) course taken by two cohorts (2005-2006/2006-2007) of health professionals from 11 francophone African countries. We discuss how the course came to be, its content, its teaching processes and the master's programme results for students.The teaching is skills-based, interactive and participative. Students of the first cohort gave the evaluation course the highest score (4.4/5) for overall satisfaction among the 16 courses (3.4-4.4) in the master's programme. This study shows the importance of integrating summative evaluation into the learning process. Skills-based teaching is much appreciated and well-adapted. Creating a master's programme in population and health in Africa and providing training in evaluation to high-level health professionals from many countries augurs well for scaling up the practice of evaluation in African health systems… http://www.human-resources-health.com/content/pdf/1478-4491-7-3.pdf


Human Resources for Health 7(4); January 2009

Munga, M.A.; Maestad, O.  Measuring inequalities in the distribution of health workers: the case of Tanzania.

The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities.We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce… http://www.human-resources-health.com/content/pdf/1478-4491-7-4.pdf



Geoforum 40 (1); January 2009

Raghurama, P.; MadgebC.; Noxoloc, P. Rethinking responsibility and care for a postcolonial world Pp 5-13

Both responsibility and care have much to offer in thinking through the relationalities that make up a postcolonial world. Although contemporary political systems often posit responsibility and care within the context of individuated and autonomous selves, geographers have done much to relocate responsibility and care within narratives of interdependency – spatially and temporally. They have argued that both terms offer a route for thinking about ethical geographical relations between myriad places. In this article we take this project further, by looking at how the nature and shape of these relationships might be construed in a postcolonial world. We suggest that, through a more critical engagement with postcolonial thinking, any exploration of existing practices of responsibility and care will not only reveal the enormous potential of imagining these geographies as forms of existing and evolving relationalities, but will also lead us to interrogate the deployments of these terms in the context of past and present inequalities. We show that routing care and responsibility through postcolonial geographies moves us towards a more pragmatic responsiveness, one that involves a ‘care-full’ recognition of postcolonial interaction… http://www.elsevier.com/wps/find/journaldescription.cws_home/344/description#


PloS Medicine 6 (1); January 2009

Ansah, E. K. et al. Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial

Delays in accessing care for malaria and other diseases can lead to disease progression, and user fees are a known barrier to accessing health care. Governments are introducing free health care to improve health outcomes. Free health care affects treatment seeking, and it is therefore assumed to lead to improved health outcomes, but there is no direct trial evidence of the impact of removing out-of-pocket payments on health outcomes in developing countries. This trial was designed to test the impact of free health care on health outcomes directly.2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice); 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl); major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. In the study setting, removing out-of-pocket payments for health care had an impact on health care-seeking behaviour but not on the health outcomes measured…



PloS Medicine 6 (1); January 2009

Ridde, V.; Haddad, S. Abolishing User Fees in Africa

In its 2008 annual report, the World Health Organization (WHO) urged countries to “resist the temptation to rely on user fees”. Indeed, the consensus in the scientific community is that user fees have harmful effects on health care use and household budgets, especially for the poorest.Still, as the WHO observes, “…most of the world's health-care systems continue to rely on the most inequitable method for financing health-care services: out-of-pocket payments by the sick or their families at the point of service”.In Africa, where states lack either the will or the capacity to apply tax revenues to counter the exclusion caused by user fees, there are two broad alternatives to user fees at the local level. Ansah and colleagues' study did not examine wide-scale national experiences of abolishing user fees, as happened in countries such as Niger and Uganda. Rather, the study was a pilot project on free access to a prepayment scheme in the Dangme West District in southern Ghana. In the trial, 2,194 households containing 2,592 Ghanaian children under five years old were randomised into a pre-payment scheme allowing free primary care, or into a control group whose families paid user fees for health care (normal practice).The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl); secondary outcomes were health care utilisation, severe anaemia, and mortality… http://medicine.plosjournals.org/perlserv/?request=get-pdf&file=10.1371_journal.pmed.1000008-L.pdf


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