Presidential communication approaches and the impact on public health: a comparative analysis of three South African presidents' communication on AIDS and COVID-19

The HIV response in the African continent over past decades demonstrates the potency that the words and actions of political leaders have in either expediting or impeding the implementation and adoption of preventive measures at the individual and community levels. The article explores the health communication approaches employed by two South African past presidents (Thabo Mbeki and jacob Zuma) in responding to the HIV epidemic, and contrasts these with the communicative approach of President Cyril Ramaphosa during the COVID-19 pandemic. Approached from this understanding, this article provides a comparative analysis of the communication approaches of these three presidencies across the two pandemics, and considers the variously trusted sources of top-down, government-driven and bottom-up, community-informed approaches to health communication. Critical lessons that emerged in South Africa during the HIV epidemic regarding the need to include communities in communicating about risks and behaviour change have not been adopted into the COVID-19 response. Political leaders are not best placed to communicate about these issues, and, in the context of pandemics, there is a clear need to reconsider top-down communication approaches that are designed without the participation of communities and ignore the interconnected nature of health and other social determinants of health.

National policy framework and strategy on palliative care 2017-2022

Palliative care is a multidisciplinary approach to the holistic care and support for patients and families facing a life-threatening illness, improving quality of life while maintaining dignity from the time of diagnosis until death. For children, the spectrum of illness includes life limiting illnesses/conditions which may progress to death or may be severely disabling. Palliative care should be available to all patients as needed from birth until death and should be accessible at all levels of the health care service. Palliative care cuts across all health programs in the delivery of services. With the quadruple burden of disease in South Africa, an estimated 50% of all people who die in South Africa could benefit from palliative care services. While there are health system challenges to providing equitable access to quality palliative care services, there are available resources as well as existing legislation and policies which support the principles of palliative care and will enable the implementation of the palliative care policy and strategy using the existing service delivery platform. With guiding principles such as the right to health, patient centred and ethical care, equitable access, and quality evidence-based care, the vision of this policy is that all adults and children, including their families, facing the problems associated with life-threatening or life limiting illness will receive palliative care to maintain quality of life, dignity and comfort as well as manage pain throughout the course of the illness. The needs of palliative care patients at different stages of the illness trajectory are described. Referral pathways have been identified. The services available will range from a palliative care approach in the community and clinics to a generalist palliative care service at district hospitals to a specialist palliative care service at regional and tertiary hospitals. Centres of excellence will be established at academic hospitals to support education and research in palliative care. Access to hospices or sub-acute facilities will be availablefrom all levels of the health service. Packages of care for patients at different stages of the trajectory as well as at different levels of the service have been described. Training in palliative care is essential and includes in-service training of existing health care workers in the palliative approach, undergraduate training, postgraduate training and the development of a palliative care specialty to support the need for the different levels of services and to provide a career path for interested health professionals, ensuring sustainability of services. The goals and objectives have been developed based on the WHO health system building blocks for health services. The responsibilities of the National Department of Health are outlined with activities and targeted outcomes, which then guide the implementation plan for the provinces. The costs of setting up the service as well as of continued service delivery have been estimated, although ongoing mapping of services within provinces is required. The National Policy Framework and Strategy for Palliative Care is intended to assist policy makers, all relevant health programmes, professionals and workers in the health department as well as NGOs to understand the need for palliative care and to provide a guide to providing such care so that patients will experience a greater quality of life with less suffering while retaining their dignity when faced with a life-threatening illness.

Strengthening the monitoring of progress on the health-related MDGs in the African Region

There is an emerging view that progress on achieving the Millennium Development Goals (MDGs) in the African Region may be better than what is currently being reflected by official statistics. This is believed to be a result of the lack of recently updated data on the MDGs in the Region. In order to strengthen the monitoring of the MDGs; it is important to look for viable options for the timely collection; processing; analysis of relevant and quality data; and the dissemination of information products based on this data. It is essential to improve the institutional capacities in countries in order to overcome the weak data sources and data management. The monitoring of progress on the MDGs could be strengthened by: improving the content; frequency; quality and efficiency of national health surveys; strengthening birth and death registration and cause of death scertainment; improving the availability of demographic data by completing the 2010 census round; improving surveillance and service statistics; enhancing the monitoring of health systems strengthening; and; strengthening country analytical and evaluation capacity; and data use for decision-making. The latter requires the establishment and strengthening of national health observatories charged with health statistics analysis; synthesis; dissemination; sharing; and use of information and evidence

The cost of health-related brain drain to the WHO African Region

The African Region continues to experience loss of a sizeable number of highly skilled health professionals (physicians, nurses, dentists and pharmacists) to Australia, North America and European Union. Past attempts to estimate cost of migration were limited to education cost only and did not include the lost returns from investment. The objective of this study was to estimate the social cost of emigration of doctors and nurses from the African Region to the developed countries. The cost information used in this study was obtained from one nonprofit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by African countries through emigration is obtained by compounding the cost of educating a medical doctor and a nurse over the period between the age of emigration and the retirement age in recipient countries. The main findings were as follows: total cost of educating a single medical doctor from primary school to university is US$65,997; for every doctor that emigrates, a country loses about US$1,854,677 returns from investment; total cost of educating one nurse from primary school to college of health sciences is US$43,180; for every nurse that emigrates, a country loses about US$1,213,463 returns from investment. Developed countries continue to deprive African countries of billions of dollars worth of invaluable investments embodied in their human resources. If the current trend of poaching of scarce human resources for health (and other professionals) from African countries is not curtailed, the chances of achieving the Millennium Development Goals would remain dismal. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Africa and to keeping majority of her people in the vicious circle of poverty. Therefore, both developed and developing countries need to urgently develop and implement strategies for addressing this issue.

Health in Lesotho: 1993 profile

The Lesotho Health Profile represents the most comprehensive information package about the health situation of the Basotho; the efforts made by the health services to achieve the Health for All goal; and the future orientation for the national health development process. In this sense; the Profile shall facilitate the review and formulation of national health policies and strategies and; hence; the consolidation of the Primary Health care approach as the means to reach Health for All by 2000