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[Support program for the implementation of the Bamako initiative: analysis of the creation of eight health districts, Gnagna province].

The implementation of the Bamako initiative is a central pillar of the health policy of Burkina Faso. The NGO, ASI, working with the health authorities, has set up a program involving the creation of eight health districts in the province of Gnagna. The program covers a population of 115,000 inhabitants in 134 villages and was progressively established between 1994 and 1997. The health districts were set up in phases (2 in the first year and 3 in each of the following two years). The method used to select the members of the village management committees is one of the key aspects of the program. It required a large amount of effort to increase the awareness of villages, and much activity because each committee is elected by the various villages of the district. The training of the managers of these committees and of the managers of the pharmaceutical warehouses in each district is also a key element. In our initial assessment, we noted balance in the accounting of the pharmaceutical warehouses of each district, adhesion of the population to the program, dynamics in the management committees and, above all, the autonomy of the committees. The first results in terms of health are very fragmentary and difficult to interpret because the program has been running for such a short time. We considered the long-term elements of the program, the necessity to set up a system for monitoring activities and the quality of care. An initial assessment showed a clear improvement in the availability of drugs in the 8 districts. Health promotion activities have not yet been developed in these districts. This type of program requires the follow up and support of the management committees, and will be the object of the second phase, begun in 1998.

Burkina Faso↗
PubMed2000

[Early diagnosis and early intervention for mentally handicapped children].

To support a mentally handicapped child and his/her family, it is very important to understand problems concerning the first-step of life-long help: early detection, intervention and treatment of the child in infancy or toddlers. The author discussed these problems based on his 20-year-long experience in community-based approach.

Child↗
PubMed2000

Control of onchocerciasis in Nzerem-Ikpem, Nigeria: baseline prevalence and mass distribution of ivermectin.

Data from a survey of endemicity of human onchocerciasis and subsequent mass distribution of ivermectin to control this disease in 9 villages of the Nzerem-Ikpem community in the Imo River basin of Nigeria are presented. Of the 1126 persons examined, 46.2% were positive for skin microfilarial, 29.2% for leopard skin, 34.2% for palpable subcutaneous nodules and 14.8% for various types of onchodermatitis. Ivermectin was distributed to a total of 1934 persons living in 233 households. The treatment coverage rate was 51%. 12.8% of those treated reported various mild reactions to the microfilaricide. Implications for community participation and long term sustenance of mass distribution programs are discussed.

Adult↗
PubMed2000

Partnership of the community in support of health for all.

Health for all is a people-based approach to health which considers the community as its focus. Community partnership is an important principle of health for all. This paper describes the many aspects of community partnership and gives examples of community partnerships initiatives in the World Health Organization Eastern Mediterranean Region, such as the basic development needs approach. The main agenda of community partnership for health for all is discussed and some opportunities conducive to community partnership in the Region are outlined.

Attitude to Health↗
PubMed2002

Staff/population ratios in South African public sector mental health services.

OBJECTIVE: To document existing staff/population ratios per 100,000 population in South African public sector mental health services. DESIGN: Cross-sectional survey. METHOD: A questionnaire was distributed to provincial mental health co-ordinators requesting them to provide the number of full-time equivalent (FTE) staff responsible for mental health care at all service levels. These data were supplemented by consultations with mental health co-ordinators in each of the nine provinces. Population data were obtained from preliminary findings of the 1996 census. RESULTS: The overall staff/population ratio per 100,000 population was 19.5, with an interprovincial range of 5.7-31.5. The staff/population ratios per 100,000 population for selected personnel categories (with the interprovincial ranges in brackets) were as follows: total nursing staff 15.6 (4.4-28.4), occupational therapists 0.4 (0.1-0.8), occupational therapy assistants 0.5 (0.0-1.3), social workers 0.5 (0.1-0.9), community health workers 0.3 (0.0-1.0), psychologists 0.3 (0.0-0.7), intern psychologists 0.3 (0.0-0.7), psychiatrists 0.4 (0.1-0.8), psychiatric registrars 0.4 (0.0-1.2), medical officers 0.4 (0.2-1.3), pharmacists 0.2 (0.1-1.1), and pharmacy assistants 0.2 (0.0-0.6). CONCLUSIONS: Relative to international settings, there are low levels of mental health staff provision in South Africa, and there is a large amount of variability between provinces. There are considerable challenges in monitoring mental health staff resources within an integrated health service.

Cross-Sectional Studies↗
PubMed2002

Community participation in primary health care (PHC) programmes: lessons from tuberculosis treatment delivery in South Africa.

BACKGROUND: Currently, there is renewed interest in the role community participation can play in Primary Health Care (PHC) programmes such as the delivery of effective anti-TB treatment to patients in high-burden settings. OBJECTIVES: To explore the feasibility of community participation in a high-burden Tuberculosis Control Programme and to establish how supervision of treatment by lay volunteers compares with other methods of tuberculosis treatment delivery in the Northern Cape province of South Africa. METHODS: Prospective study involving 769 patients with confirmed pulmonary TB who were followed-up over a one-year period. Questionnaire interviews were also carried out with 135 lay volunteers participating in the TB programme. RESULTS: One-third of the TB patients in the study received their treatment from lay volunteers in the community. Treatment outcomes for new patients supervised from the community were found to be equivalent to those who received treatment through other modes of treatment delivery (RR=1.04[0.94-1.16], p=0.435). For the re-treatment patients, community-based treatment was found to be superior (RR=5.89[2.30-15.09], p<0.001), to self-administered therapy. CONCLUSIONS: Health care planners should consider community participation as a viable way of ensuring accessibility and effectiveness in PHC programmes. There is need for more research into ways of achieving sustainability in resource-limited but high disease burden settings.

Adolescent↗