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Functional health delivery system is the right answer, not legislation

I would like to respond to the story titled, ‘Kabale considers a by-law to force pregnant women into hospital’ in the Daily Monitor of July 27. The story said the by-law will compel pregnant mothers to deliver in a health facility and penalise those who deliver under the care of a traditional birth attendants.

Experience from around the world suggests that about 15 per cent of all pregnant women will develop obstetric complications and that not all these complications can be predicted. Delivery under the care of a skilled health care provider – midwife, doctor, or nurse with midwifery skills – is the safest method for saving the lives of mothers and their newborn.

Countries with the highest skilled attended deliveries such as Sweden and Malaysia are also the nations with the lowest maternal and newborn deaths. Every year, 350,000 women worldwide die during pregnancy, or during labour, almost 1,000 a day. Of these deaths, 99 per cent occur in developing countries such as Uganda.

Every year, up to 2 million newborns die within the first 24 hours of life. Uganda looses 45,000 newborns annually; many more suffer birth trauma that impairs their development and future productivity.

In recognition of the critical role of skilled care in reducing maternal and newborn mortality and morbidity; Uganda has committed itself to increasing skilled attended deliveries from 53 per cent to 90 per cent by 2015.

I would like to commend the local leadership in Kabale District for recognising the importance of skilled healthcare and their intentions to encourage mothers to deliver in a health facility instead of under a traditional birth attendant. However, enforcing skilled attended delivery through a by-law is not the answer.

A survey conducted by White Ribbon Alliance for Safe Motherhood in six districts in Uganda (Assessment of Maternal Health Services in Six Districts in Uganda, 2010) showed that health facilities in Kabale had only 2 per cent of the required midwives and only one doctor. None of the health centre IVs could provide blood transfusion services or caesarian sections. Many facilities lacked essential supplies, transport for referral of obstetric emergencies at HC4 and 3.

I would like to request the decision makers in Kabale District to examine the current healthcare delivery system and make it attractive to the clients by providing an attractive healthcare delivery package to women. That means adequate supplies, equipment, provision of emergency obstetric at HC 3 and 4, adequate midwives. Conduct community awareness raising about the benefits of skilled attended births in addition to addressing social-cultural factors that limit a woman’s ability to access her maternity care services.

The government should play its role of ensuring adequate financial and human resources towards meeting its national and international commitments on Millennium Development Goal 5 and support local governments to deliver quality services to its citizens. Uganda committed itself to giving the health sector 15 per cent of its annual budget.

Robina Biteyi,
biteyi.robina@gmail.com

Source: http://www.monitor.co.ug/OpEd/Letters/Functional+health+delivery+system+is+the+right+answer/-/806314/1470142/-/4crjqsz/-/index.html

Technology opens the doors of Africa’s health sector

By Fiona Graham
Technology of business reporter, Nairobi and Kampala

WATCH: In Kenya, only the very richest are guaranteed quality healthcare. The BBC’s Fiona Graham looks at the technology that could change that
“I had just attended too many funerals, people dying from completely preventable causes and treatable diseases.

“Standing at the sides of the graves and holding the babies of parents who had died from basic infections that are treatable in other parts of the world.” Stephanie Koczela is one of the founders of Penda Health, and she’s explaining what motivated her and her colleagues to open their first clinic in the town of Kitengela.

It’s a huge, sprawling, dusty conurbation that’s growing explosively, absorbing the overflow of people from nearby Nairobi.

A trip to the doctor’s in much of East Africa can be something of a game of Russian roulette.

As co-founder Beatrice Ongoce puts it: “In Kenya, healthcare quality is associated with being rich, being able to pay more, and bad options are related to being poor.”

Stephanie Koczela and Beatrice Ongoce at the Penda Health Clinic
The start-up aims to provide quality, affordable healthcare for the middle and lower income segments of Kenyan society. And to do this technology plays a big part.

“The surprising thing is that middle 70%, they spend about $1bn a year on outpatient healthcare alone in Kenya,” according to the third part of the team, Nicholas Sowden.

Lock, stock
This means there’s plenty of incentive to find ways to cut costs while keeping standards high.

“I think that most of the health care providers that we’re competing with don’t use technology at all to supplement their systems,” says Ms Koczela.

“They’re all paper records, their drugs are often out of stock.

Kitengela lies next to the Nairobi National Park, and is growing fast, as its neighbour Nairobi continues to expand
“We have a system that gives us a warning if any of our drugs are expired, and it forces our providers to dispose of those drugs immediately.”

Penda Health’s system is bespoke, tracking stock and expiry dates through a simple interface accessible from a PC. When supplies run low, this triggers a warning to make sure more is ordered.

“It raises our medical quality. One of the most common problems with healthcare providers in Kenya is that they don’t have the equipment that’s necessary to provide medical care.

The start-up had originally focused on women’s healthcare, including family planning and reproductive health, but soon realised that to attract women you need to treat the whole family
“This system ensures that we will always have what’s necessary for our patients.”

The clinic uses mobile broadband, meaning the system is completely portable – and mobile technology is useful in other ways.

Staff text patients to make sure they’re taking their drugs at the right times and in the right way, or to tell groups of patients that a specialist is visiting. Investing in an internet connection means accessing online resources to build up-to-date treatment protocols is fairly straightforward.

The start-up is now working on developing their own electronic medical records system – that ultimately will allow them to share those records if need be with specialists both within Kenya and internationally.

“We want to be the most friendly and highest quality provider for the low and middle-income Kenyan, and in order to do that we need to have tech systems that are backing our chain,” says Ms Koczela.

Right of way
For some Kenyans even the most basic clinic can seem out of reach. For many people living in rural areas, the nearest hospital could be many days’ journey away. Living in a rural area can mean that a trip to a doctor could take days. If you need to see a specialist, this means a referral, another long journey and probably a lengthy wait.

So to tackle this Amref – the African Medical and Research Foundation – is using computers and the internet to let local healthcare professionals consult urban experts.

The next step is to build an online knowledge base, says Amref’s Frank Odhiambo
“This technology is important because it helps cover the great distance that the poor have to cover while seeking healthcare,” says Frank Odhiambo, Amref’s telemedicine project officer.

The telemedicine equipment – computers, printers, scanners, and digital cameras – is provided by Computer Aid International.

The technology has been installed in around 50 hospitals in Kenya, as well as in Ethiopia, Tanzania, and Uganda, with more planned.

Operating in rural areas means connectivity is one of the project’s biggest challenges.

Although fibre-optic cable is gradually being rolled out through the region, large areas are still reliant on 2G mobile broadband, and even satellite broadband, which is pricey.

The telemedicine technology lets rural doctors share pictures and x-rays with specialists to find the right diagnosis. A reliable electricity supply is the other conundrum in rural areas. So Computer Aid is supplying Amref with solar-powered Zuba boxes – shipping containers fitted out as cyber cafes.

For Mr Odhiambo, the rewards of the project are clear.

“What I find most rewarding is availing a solution to someone in the most remote location, who does not have hope. IT just does it like magic.”

Beat of your heart
The mobile phone in your pocket can also prove an effective way to give people in isolated areas access to healthcare technology.

“Africa has a high mobile penetration rate,” says Aaron Tsushabe, an app developer with Uganda start-up ThinVoid.

The team behind WinSenga got the idea for the app after watching a nurse using a pinard horn . “They actually say that in about three years’ time there will be more phones in Africa than in the US.”

Mr Tsushabe and his team – all students at Makere University in Kampala – have developed an app that matches smartphone technology with the pinard horn, which has been in use for over 100 years to monitor the heart rate of unborn babies.

Joseph Kaizzi and Aaron Tsushabe have renamed the adapted pinard horn the senga horn
It resembles an old-fashioned ear horn, and is used by placing the wide end of the cone on the abdomen of a pregnant woman, and listening.

You then count the beats to calculate the fetal heartrate – one of the primary indicators of the health of the child.

This simple piece of technology is still widely used in developing countries.

The students took the pinard horn, and fitted it with a microphone, which plugs into the phone. The app monitors the sound of the baby’s heart, and can then indicate if there is any cause for concern.

The team recently took part in Microsoft’s Imagine Cup, the student technology competition, placing in the top 20 globally.

WinSenga is still in the prototype stage, although ThinVoid’s Joseph Kaizzi says they hope that it will be available generally very soon.

WinSenga takes smartphone technology and matches it with a pinard horn, a device invented in the 19th century by a French obstetrician, Dr Adolphe Pinard
“We’re working hard with the consultant from Unicef trying to make this as adaptable as possible, and we’re trying to localise it.

“It’s currently in English, we’re trying to get it in some of our local dialects.”

Dr Felix Olale is executive chairman at investment banking firm Excelsior Firm, based in Nairobi. He is also an adviser to the Kenyan government.

He says the future for healthcare in the regions depends heavily on investment in technology innovation.

“Ultimately it’s about patients and outcomes.

“It’s about increasing access to care for these folks who may not have access to facilities. It’s about increasing the socio-economic growth of these communities. Technology allows you to do all these things, right?

Dr Felix Olale: The future for healthcare in rural areas depends on investment in technology
“If we can take technology and build off of the infrastructure that’s already in place, what that does, it allows us to push these at a low investment for the amount of return that you actually get.”

In Kitengela, Penda Health has taken its reliance on technology one step further, issuing what they call “social shares” to fund their first clinic.

They used social media platform Facebook to find investors prepared to lend them the money to pay for the bricks, mortar and equipment needed.

They have big ambitions – and those ambitions rely heavily on technology to push growth.

“Technology allows us to have quality healthcare at scale,” says Penda Health’s Stephanie Koczela.

“With one clinic you could imagine we could monitor our drug supplies and do chart review with paper and all those things.

“But with a hundred clinics that’s just not possible. The only way to do that is to leverage amazing systems.”

Source: http://www.bbc.co.uk/news/business-18969646

Natco ‘admission’ on cancer drug could hurt public health

P.T.JYOTHI DATTA, MUMBAI, AUG 2:
It may be an “important lesson” for Hyderabad-based drug company Natco in terms of legal strategy, but a possible setback for public health, say experts dealing with intellectual property issues.

In an on-going case between Natco and multinational Bristol-Myers Squibb in the Delhi High Court, Natco has admitted that it is selling dasatinib, a generic version of BMS’s cancer drug, though it did not infringe the latter’s patent.

The problem, however, is that Natco had in 2009 told the court that it was challenging the validity of BMS’s patent on this drug, and did not plan to launch the drug in the local market. But in June this year, Natco did in fact launch a generic version of the drug.

Since the case is in court, Natco did not want to comment on the development.

Intellectual property experts say the unfortunate development on Natco’s part could lead to see an interim set-back, both for the company and for public health. Natco sells the generic version of the drug for about Rs 9,000 per month, while the patented drug sells at about Rs 2 lakh.

POSTER-BOY

Natco was issued the country’s first-ever compulsory licence for public health in the country. The compulsory licence allows Natco to make a similar version of Bayer’s Nexavar, an advanced kidney cancer medicine, on payment of a six per cent royalty to Bayer.

In intellectual property circles, Natco is increasingly being seen as the poster boy of the domestic pharmaceutical industry for taking on patent challenges against multinational companies.

No one knows why Natco did what it did, says IP expert Shamnad Basheer, referring to Natco’s earlier stand that it was not interested in selling the drug locally.

The company should have said its seeking regulatory approval to sell the drug had no connection with its challenge on the validity of the patent. Specially so, since Indian law does not link issuance of a patent by the Patent office with marketing approvals, given by the Drug Controller’s office.

More clarity will dawn on the development as the case comes up in court later this month.

Source: http://www.thehindubusinessline.com/companies/article3718347.ece?ref=wl_opinion

 

Government should look beyond salaries to motivate the health workers

Talk about staff motivation and nearly everybody – employees and managers alike – will think of increasing staff salaries. Well, salaries are good but not the only major factor influencing the morale of health workers in Uganda.

Amy Hagopian noted in a 2009 study that Ugandan health workers are dissatisfied with their jobs, especially their compensation and working conditions. About one in four would like to leave the country to improve their outlook, including more than half of all the physicians. The same study highlighted reasons for staff attrition as better opportunities, contract expired, dismissed, domestic problems and going for further studies.

Having a team of well paid health workers in poorly facilitated health units will in itself de-motivate them. A doctor in a Health Centre IV, which has no gloves, medicines, unequipped theatres, and poor diagnostic facilities, will have every reason to miss duty even if they are paid well. Studies have shown that in poor countries, especially in sub-Saharan Africa, doctors and nurses, along with their colleagues in labs and pharmacies, face shortages of supplies, poor compensation, inadequate management systems, and burdensome workloads. The solution to our health workforce challenges is to strengthen health systems and the professionals who work in them.

No one would love to continue pouring water in a leaking pot before sealing the hole. As we train more health workers, let us not lose the ones we have. “Now is no time to think of what you do not have. Think of what you can do with what there is.” These words of Ernest Hemingway, a 20th Century American author and journalist, should not escape the notice of health managers and policy makers in this country.

In addition to improved remuneration, policy reforms to strengthen human resources for health in Uganda should focus on improving working conditions, workload and facility infrastructure (including water and electricity). An incentive like providing access to a computer and the Internet can attract and retain young computer literate graduates.

Dr Jairus Mugadu,
Makerere School of Public Health
mugadujb@gmail.com

Source: http://www.monitor.co.ug/OpEd/Letters/Government+look+beyond+salaries+to+motivate+the+health+workers/-/806314/1467820/-/cka0co/-/index.html

Kabale considers law to force pregnant women into hospitals

 By Robert Muhereza

Kabale District is working on a by-law to compel pregnant women to give birth at health facilities and penalise those who deliver aided by traditional birth attendants (TBAs).

District speaker Pastoli Twinomuhangi said on Wednesday that he is ready to present the draft by-law for the council’s consideration. This follows a recent survey in Rukiga, one of the four counties in Kabale District, where it was found that nearly one in every two expectant women that TBAs help to give birth, die.

“An ordinance is already being drafted to compel mothers in labour to deliver at the established government health centers in order to save their lives and that of the babies,” Mr Twinomuhangi said.

However, according to District Health Officer Patrick Tusiime, the number of women delivered by TBAs has reduced due to intensified mobilisation through media and community meetings.

Half of pregnant women in the district now deliver at health facilities, up from 12 per cent five years ago, the doctor said.

Complaints
However, Ms Allen Busingye, a businesswoman in Kabale town, said some of them prefer the services of TBAs because they offer “motherly care unlike in the health centres where we are attended to by young and abusive nurses.

“The young nurses are rude to the mothers in labour pains,” she said.

The government outlawed the traditional birth attendants, but they continue to thrive especially in rural areas where public health services are either lacking or unaffordable.

The District Deputy Resident District Commissioner, Mr Nickson Kabuye, said his office is investigating reports that some health workers in the district on government payroll extort money from women seeking antenatal care, forcing them to turn to TBAs. The culprits, he said, will soon be exposed.

TBA head responds
The head of TBAs in the district, Mr Charity Mugisha, said an accusation pinning them on causing maternal deaths is baseless because reports of women dying in labour at hospitals are a common place hence not of their (TBAs) own making.

“Traditional Birth Attendants are complementing the government efforts in assisting pregnant mothers to have safe deliveries,” he said.

District vice chairperson Mary Bebwajuba noted that a shortage of qualified staff coupled with lack of ambulances are the reasons behind the delay of referrals, leading to many deaths of expectant women in the area due to delayed birth.

Source: http://www.monitor.co.ug/News/National/Kabale+considers+law+to+force+pregnant+women+into+hospitals/-/688334/1463854/-/iox4poz/-/index.html