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What Works – the African Regional Health Report

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What Works – the African Regional Health Report The health of the people What works The African Regional Health Report 2014 WHO/AFRO Library Cataloguing – in – Publication The health of the people: what works – the African Regional Health Report 2014 Public health – organization and administration Delivery of health care – organization and administration Health status Africa I. World Health Organization. Regional Office for Africa ISBN: 978 929 023 261 2 (NLM Classification: WA 541 HA1) Acknowledgements This report has been prepared by a core team from the World Health Organization Regional Office for Africa under the general guidance of Luis G Sambo. The core team was coordinated by Derege Kebede and included Delanyo Yao Tsidi Dovlo, Francis Chisaka Kasolo, Tigest Ketsela Mengestu, Matshidiso Rebecca Moeti, Deo Nshimirimana, Bokar Touré and Yves Turgeon. The following also contributed to the report: Abdikamal Alisalad, Assamala Amoi-Seminet, Emil Asamoah-Odei, Djona A Avocksouma, Magaran Monzon Bagayoko, Collins Boakye-Agyemang, Bernardino Cardoso, Mercy Chikoko, Sheick Oumar Coulibaly, Jean-Marie Dango, Abayneh Tamir Desta, Martin Ekeke Monono, Tharcisse Elongo, Phanuel Habimana, Benido Impouma, Daniel Karimi Kibuga, Ossy Muganga Julius Kasilo, Joses Kirigia, Georges Alfred Ki-zerbo, Davy Liboko Gnekabassa, Frank John Lule, Lucien Manga, Jason Mwenda Mathiu, Monde Mambimongo Wangou, Peter Mbondji Ebongue, Richard Mihigo, Bénito Harris Koubemba Mona, Pascal Mouhouelo, Davison Munodawafa, Assumpta Muriithi, Laurent Musango, Juliet Nabyonga, Jean Bosco Ndihokubwayo, Anaclet Nganga Koubemba, Jean Baptiste Nikiema, Triphonie Nkurunziza, Alice Ntamwishimiro Soumare, Jennifer Nyoni, Adiele Onyeze, Martin Matthew Okechukwu Ota, Bérence Ouaya Besso, Miguel Peixoto, Charles Sagoe-Moses, Issa Sanou, Alexandre Tiendrebeogo and Ali Ahmed Yahaya. The assistance of the following staff from the WHO Regional Office for Africa is gratefully acknowledged: Samuel Ajibola, Marcelline Itoua and Wenceslas H Kouvividila. Claire Keeton and Peter Mwaura also assisted in collecting case reports. This report was edited by Margaret Harris and Maggie Beveridge, proofread by Amanda Milligan, indexed by James Lamb and produced by the team from the Bulletin of the World Health Organization: Fiona Fleck, Laragh Gollogly, Sophie Guetaneh Aguettant, Melanie Lauckner, Hooman Momen and Kaylene Selleck. © WHO Regional Office for Africa, 2014 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; +242 06 5081114; Fax: +47 241 39501; E-mail: [email protected]). Requests for permission to reproduce or translate this publication – whether for sale or for non-commercial distribution – should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. Printed in Luxembourg Contents Message from the Regional Director xi Abbreviations and acronyms xiii Executive summary xv Chapter 1. Introduction xvi Chapter 2. Partnerships – working together to achieve health for all xvi Chapter 3. Health through the life course xvii Chapter 4. Disease threats xvii Chapter 5. Health determinants xviii Chapter 6. Improving access to health care xix Chapter 7. Conclusion: what works xx Good governance for health xxi Health in all policies xxi Data-driven decision-making xxi Find and fill the gaps xxii Staff properly paid xxii Harnessing local technological capacity xxii Quality in all things xxii Performance-based health management xxiii Community-based intervention xxiii Scaling up better xxiv 1. Introduction 5 The investment case for good health 6 Progress on health outcomes 7 Progress towards the health-related MDGs 9 2. Partnerships – working together to achieve health for all 19 What works? 25 Optimizing global health partnerships at country level 25 HHA: a “one-stop shop” for strengthening health systems 25 iii IHP+ country compacts 26 Meningitis Vaccine Project 26 Partnering to end NTDs 27 3. Health through the life course 33 Children 34 Newborn babies 34 Infants and young children 35 Immunization 39 Young people 41 What works? 43 Adult women 44 Family planning 44 Pregnancy and childbirth 45 Adult males 47 Violence 48 Older men and women 48 4. Disease threats 59 Communicable diseases 59 HIV/AIDS 59 Tuberculosis 61 Malaria 63 Epidemic- and pandemic-prone diseases 67 What works? 67 Neglected tropical diseases 69 What works? 70 Noncommunicable diseases 72 Cardiovascular diseases 74 Chronic respiratory diseases 74 Cancer 75 Sickle cell disease 76 Noma 77 Mental and neurological disorders 77 Road traffic injuries 78 Complex disease interactions 79 5. Health determinants 87 Introduction 87 Social determinants 88 A strategy for addressing the key determinants of health 89 Health in all policies 89 iv Social participation and dialogue in policy-making and implementation 90 Occupational risks to health 90 Food and nutrition 90 Nutrition 90 Food security 92 Food safety 92 The physical environment 94 Water, sanitation and hygiene 94 Indoor air pollution 95 Climate change 96 Toxic substances 97 Lifestyle risks 98 Harmful use of alcohol 98 Substance abuse 99 Tobacco use 100 Physical inactivity 101 Unhealthy diet 102 Sexual behaviour 102 Disasters – including conflict 103 6. Improving access to health care Leadership and governance 114 Strengthening human resources for health 115 What works? 117 Who pays for health care? 117 What works? 117 Access to essential medicines 120 Use of national essential medicine lists 121 Traditional medicine 121 Access to health technologies, including diagnostics 122 Use of technologies 123 Blood and blood products 124 Patient safety 124 Service delivery: reaching everyone 125 What works? 126 Information: better data, better health care 126 e-Health 127 Research 128 What works? 130 v 7. Conclusion: what works? 137 Good governance for health 138 Health in all policies 138 Data-driven decision-making 139 Find and fill the gaps 139 Staff properly paid 140 Harnessing local technological capacity 140 Quality in all things 141 Performance-based health management 141 Community-based intervention 142 Scaling up better 142 Statistical annex 143 1. Demographic and socioeconomic statistics 146 2. Life expectancy and mortality 148 3. Cause-specific mortality and morbidity 150 4. Selected infectious diseases 154 5. Health service coverage 156 6. Risk factors 158 7. Health systems 160 8. Health expenditure 162 9. Health inequities 164 Endnotes 166 Glossary 171 Index 179 vi Boxes Box 1.1. Some of the major initiatives and commitments made in support of the Millennium Development Goals (MDGs) by countries of the WHO African Region 11 Box 3.1. Kangaroo mother care in Malawi 35 Box 3.2. Child survival programme in Niger 38 Box 3.3. Adolescent and youth-friendly health services in Zimbabwe 44 Box 3.4. Maternity waiting homes–a strategy to improve access to emergency obstetric care in Eritrea 47 Box 3.5. Impact of national health system reforms on maternal and child health in Rwanda 47 Box 4.1. Reducing mother-to-child transmission rates of HIV in Ghana 60 Box 4.2. Increasing access to antiretroviral treatment (ART) in South Africa 61 Box 4.3. Successful implementation of integrated community case management (iCCM) of childhood illness in Senegal 66 Box 4.4. Country project to strengthen capacity for vector control 66 Box 4.5. Elimination of lymphatic filariasis in Togo: a success story 70 Box 4.6. Elimination of blinding trachoma in Ghana 72 Box 4.7. Social mobilization and community participation: the COMBI project in northern provinces of Mozambique 74 Box 5.1. Changing the diet in Kenya 89 Box 5.2. How Ethiopia used a comprehensive national strategy to reduce undernutrition 91 Box 5.3. Improving access to drinking water, sanitation and hygiene in health-care facilities during emergencies in northern Mali 95 Box 5.4. Strengthening national adaptive capacity to prevent epidemic highland malaria in Kenya 97 Box 5.5. Identification and management of mass poisoning by bromide in Angola 97 Box 6.1. Burundi’s adoption of results-based financing (RBF) 114 Box 6.2. The six strategic areas of the human resources for health roadmap 115 Box 6.3. Health financing in Botswana 118 Box 6.4. Promotion of traditional medicine (PROMETRA), Senegal 122 Figures Fig. 1.1. Under-five mortality rate (per 1000 live births), both sexes, by WHO region, 1990 and 2012 8 Fig. 1.2. Maternal mortality ratio (per 100 000 live births) by WHO region, 1990–2013 9 Fig. 1.3. Regional ranking of leading causes of disease burden, measured in disability-adjusted life-years (DALYs), 2011 10 vii Fig. 2.1. External resources on health as a percentage of total health expenditure in he WHO African Region, 2012 20 Fig. 2.2. The meningitis A conjugate vaccine roll out in the WHO African Region, 2010–2013 27 Fig.
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