Browsing by Subject "Access to health care"

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    Delivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol
    (BioMed Central, 2016) Watkins, David A; Tulloch, Nathaniel L; Anderson, Molly E; Barnhart, Scott; Steyn, Krisela; Levitt, Naomi S
    Background: People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV. Methods/design: We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the “cascade of care”—i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective). Discussion: CMDs and other NCDs are becoming major health concerns for African PLHIV. The results of our review will inform the development of research into chronic care models that integrate care for HIV/AIDS and CMDs among PLHIV. Our findings will be highly relevant to health policymakers, administrators, and practitioners in African settings.
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    Open Access
    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.