Browsing by Author "Sanders, David"

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    Addressing inequalities in child health: opportunities and challenges
    (Children's Institute, 2012) Sanders, David; Reynolds, Louis; Lake, Lori
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    Mwebu ducks AIDS deaths
    (2005) Ehrlich, Rodney; Myers, Jonny; Sanders, David; Carstens, Sydney
    As public health specialists we read with dismay a recent Medical Research Council (MRC) media release, later reprinted in the press, written by Mbewu in both his personal and official capacities as the interim president of the MRC. Entitled ‘Deaths, causes of deaths and rumours of deaths’, the piece appeared to be an intervention in a debate on whether the burden of AIDS deaths can be inferred from explicit death certification alone. It asserts, inter alia, that ‘cause of death information from death certificates are the most reliable and validated measures of mortality and changes in mortality’. We conclude from the timing of the release that it was produced in anticipation of a report on death certifications by Stats SA requested by President Mbeki and that it was directed, inter alia, at a publication by MRC and University of Cape Town researchers of an empirical analysis of death certifications designed to arrive at a complete picture of HIVrelated deaths.
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    Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis
    (Public Library of Science, 2016) Besada, Donela; Kerber, Kate; Leon, Natalie; Sanders, David; Daviaud, Emmanuelle; Rohde, Sarah; Rohde, Jon; Damme, Wim van; Kinney, Mary; Manda, Samuel; Oliphant, Nicholas P; Hachimou, Fatima; Ouedraogo, Adama; Ghali, Asma Yaroh; Doherty, Tanya
    BACKGROUND: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered. Methods and FINDINGS: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme. CONCLUSION: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding.
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    The draft charter of the private and public health sectors of the Republic of South Africa: Health for all, or profits for few?
    (2005) Reynolds, Louis; London, Leslie; Sanders, David
    The central aim of the Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) is to address the legacy of apartheid regarding access to health care for all South Africans. It commits the public and private sectors to create ‘a health care system that is coherent, cost effective and quality driven … for the benefit of the entire population’ and to work together ‘to improve the scope, accessibility and quality of care at all levels’. These are laudable goals and we express our wholehearted support for them. The CPPHS specifies four ‘key areas’ of transformation: access to health services, equity in health services, quality of health services, and black economic empowerment (BEE). Among these the first three – access to, equity in, and quality of health care services - are essential (though not sufficient) to meeting the goal of health for all in South Africa. The fourth, however, is problematic.
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    Valuing and sustaining (or not) the ability of volunteer community health workers to deliver integrated community case management in Northern Ghana: A qualitative study
    (Public Library of Science, 2015) Daniels, Karen; Sanders, David; Daviaud, Emmanuelle; Doherty, Tanya
    BACKGROUND: Within the integrated community case management of childhood illnesses (iCCM) programme, the traditional health promotion and prevention role of community health workers (CHWs) has been expanded to treatment. Understanding both the impact and the implementation experience of this expanded role are important. In evaluating UNICEF’s implementation of iCCM, this qualitative case study explores the implementation experience in Ghana. Methods and FINDINGS: Data were collected through a rapid appraisal using focus groups and individual interviews during a field visit in May 2013 to Accra and the Northern Region of Ghana. We sought to understand the experience of iCCM from the perspective of locally based UNICEF staff, their partners, researchers, Ghana health services management staff, CHWs and their supervisors, nurses in health facilities and mothers receiving the service. Our analysis of the findings showed that there is an appreciation both by mothers and by facility level staff for the contribution of CHWs. Appreciation was expressed for the localisation of the treatment of childhood illness, thus saving mothers from the effort and expense of having to seek treatment outside of the village. Despite an overall expression of value for the expanded role of CHWs, we also found that there were problems in supporting and sustaining their efforts. The data showed concern around CHWs being unpaid, poorly supervised, regularly out of stock, lacking in essential equipment and remaining outside the formal health system. CONCLUSIONS: Expanding the roles of CHWs is important and can be valuable, but contextual and health system factors threaten the sustainability of iCCM in Ghana. In this and other implementation sites, policymakers and key donors need to take into account historical lessons from the CHW literature, while exploring innovative and sustainable mechanisms to secure the programme as part of a government owned and government led strategy.