Interview: Dr Matshidiso Moeti, Regional Director for Africa, World Health Organisation
How has access to health care improved over the last decade in sub-Saharan Africa?
MATSHIDISO MOETI: Health care access includes the availability of health infrastructure, which is commonly measured by bed density, health facility density and the population living within a 5-km radius. Access also comprises service utilisation, which is assessed using inpatient admission rates and per capita outpatient utilisation rates. There is also service availability, which is measured by the percentage and density of facilities with specific services, and the coverage of various health interventions, which equates to the proportion of the population receiving specific services. Sub-Saharan Africa has generally made good progress in all the above areas, but a lot of work remains. In the future we will use predefined criteria to classify each indicator of health care access to clearly show areas and countries with good and poor health care.
Progress with HIV-related indicators has, on the whole, been remarkable, with coverage of HIV-related interventions increasing steadily over the last decade. For instance, the number of HIV patients receiving antiretroviral therapy (ART) rose from 2.1m in 2007 to about 13.8m by the end of 2016. The low percentage after 2010 follows a change that was made to ART guidelines, which recommended early initiation of antiretroviral treatment, altering the earlier guidelines that had recommended that only patients with advanced stage HIV receive antiretroviral treatment. Prevention of mother-to-child transmission coverage also continues to rise, with the figure now above 95% in eight countries: Cabo Verde, Namibia, South Africa, Togo, Uganda, Mozambique, Swaziland and Rwanda. Moreover, coverage is at 80-93% in 11 other sub-Saharan African countries. The prevalence of HIV among people aged 15-49 in the sub-Saharan region has largely stagnated at around 4.2%, which is somewhat expected given the low incidence of HIV – currently at 2.7 per 1000 people – and low HIV-related mortality.
How is the private sector helping to reduce the incidence of vector-borne diseases in Africa?
MOETI: Public-private partnerships (PPPs) played an important role in increasing the access and availability of long-lasting insecticidal nets. This intervention has contributed significantly to the reduction of malaria in a number of countries, including Kenya, Tanzania and Zambia. Monitoring the insecticide resistance of malaria vectors ensures the selection and application of effective insecticides against the vector; this is another area where the public and the private sectors, such as pesticide companies, have collaborated and achieved good results. Community education to create an awareness and knowledge of malaria prevention and control, through integrated vector management, has also been aided by successful PPP programmes. These collaborations are challenged by different priorities between the sectors, weak information sharing, and a lack of coordination and consolidation.
What sort of impact have you seen from rapid malaria testing in areas like Zanzibar?
MOETI: Improving the parasite-based diagnosis of malaria remains an important component of global control and elimination strategies for the disease. It is essential in ensuring appropriate treatment and prompt identification of malaria-transmission hot spots in lower transmission settings, as found in areas such as Zanzibar. While recognising there may be a few minor limitations in using rapid test kits for accurate identification, for every single case of malaria infection, prompt diagnosis using the available tools still helps improve operational delivery of recommended interventions. Improving the capacities of available health workers both at community and facility levels is also improving the broader quality of health care. Several studies are under way to investigate new tools that could build upon the significant gains that are being made by using the rapid malaria tests available.
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