Moral Challenges in Managed Care

Managed health care in South Africa is faced with complex moral challenges; where different stakeholders appeal to different ethics principles to guide decision making. The traditional bio-medical ethics principles of beneficence; non-maleficence and respect for autonomy are typically emphasised in clinical practice; while third party funders appeal to the principle of justice to guide the allocation of limited; pooled resources. Health care professionals working in managed care are particularly exposed to these conflicts; vis-a-vis incongruence between the ethics guidelines from their professional bodies and the legislation pertaining to managed care. Common understanding of the claims and responsibilities of each of the stakeholders may promote a more coherent; sustainable health care system

Evaluation de la prise en charge intégrée du paludisme, de la diarrhée et de la pneumonie chez les enfants de 0 à 5 ans en milieu communautaire : Cas du district sanitaire de Dosso

Au Niger, la lutte contre les maladies de l'enfant au niveau communautaire occupe une place de choix parmi les priorités en matière de santé publique. L'Etat du Niger a introduit une nouvelle initiative visant à renforcer la prise en charge intégrée de la pneumonie, de la Diarrhée et du Paludisme chez les enfants de moins de 5 ans au niveau communautaire par des relais communautaires. Cette nouvelle initiative est pilotée par l'ONG World Vision dans le District sanitaire de Dosso. Après un (1) an de mise en œuvre de cette stratégie, il est important d'évaluer et d'analyser les progrès accomplis à fin de déterminer le degré de satisfaction des mères ; des relais communautaires ; des responsables des CSI Cases de santé et des autorités coutumières. Il s'agit d'une étude transversale. La population de notre étude est composée :  Des mères/ gardiennes d'enfants de 0 à 5 ans dans les villages du district sanitaire de Dosso;  Les chefs coutumiers ;  Les responsables des CSI ;  Les responsables des Cases de santé du District sanitaire de Dosso ;  Les relais communautaires du District sanitaire de Dosso. ⇨Pour le choix des mères/ gardiennes d'enfants âgés de 0 à 5 ans, nous avons combiné la méthode d'échantillonnage en grappe à quatre (4) degrés avec la méthode de commodité. ⇨Pour le choix des relais communautaires ; des chefs coutumiers, les responsables CSI/CS et les membres des Comités de Gestion de santé villageois c'est la technique d'échantillonnage exhaustive. Les données ont été saisies ; traitées et analysées à l'aide du logiciel Epi_info et Excel, ensuite transférées sur le logiciel STATA 12 pour faire certaines analyses. MS Word est utilisé pour la rédaction du rapport. La présente étude, nous a permis d'aboutir aux principaux 95% de mères/gardiennes d'enfant enquêtées sont satisfait des messages véhiculés par les relais communautaires 98% de mères/gardiennes d'enfant enquêtées sont satisfait des traitements administrés par les relais communautaires ; 89,1% des enfants pris en charge par les relais communautaire sont guéris après le traitement ; 83,6% des mères/gardiennes d'enfants enquêtées n'ont jamais été référées. 100% des relais communautaires enquêtés ont un niveau d'instruction secondaire; 81% des relais communautaires enquêtés ont reçu 3 à 4 formations pendant les 12 mois précédents ; 93% des relais sont satisfait des services qu'ils rendent pour la communauté ; 75% des agents de santé du CSI/CS enquêtés ont affirmés que les services offerts par les relais sont bonnes. Pour améliorer cette prise en charge, il est recommandé de :  Résoudre les problèmes de gestion logistique, en particulier les ruptures de stock en médicaments ;  Renforcer activement les séances de sensibilisation ;  Assurer une supervision formative des relais communautaires ;  Revoir le système de motivation des relais communautaire

Expansion of HIV-1 Screening and Anti-Retroviral Treatment Programs in a Resource-Poor Setting: Results from a Faith-Based Organization in Jos; Plateau State; Nigeria

Background: Until recently; availability of anti-retroviral therapy (ART) in Nigeria has been limited to government and university based programs. Through the United States' President's Emergency Plan For AIDS Relief (PEPFAR); additional funding has become available for the treatment of HIV-positive patients. Objective: To report the expansion of HIV-1 screening; enrollment in an ART program; and treatment outcomes over twelve months among HIV-positive patients at a nonprofit; non-governmental faith-based clinic providing free and holistic care in Jos City; Plateau State; Nigeria. Design: This was a retrospective analysis of HIV-1 screening and ART received by patients at Faith Alive Foundation Hospital (FAFH). From January through December 2005; voluntary counseling and testing (VCT) was freely available to all patients who requested it. Also beginning in December 2004; HIV-1 infected patients were enrolled in an expanded HIV/AIDS program at FAFH; where patients in clinical stages 3 or 4 based on World Health Organiza- tion (WHO) clinical classification; or had a CD4+ cell count of less than 200/ ml; were initiated on a simplified highly active ART (HAART) regimen through PEPFAR funding. Data from the first six quarters of the FAFH-PEPFAR ART program are presented here. Additionally; analysis of 645 patients who have received ART for one year; including changes in CD4+ cell count from baseline is shown. Results: In 2005; a total of 7672 persons received VCT and 3869 (50.4) HIV-1 positive results were found. From October 2004 to March 2006; the total number of patients enrolled in the FAFH HIV/AIDS program rose from 1330 to 5946 people. Over the same period; the number of patients who received ART increased from 302 to 1667. A majority of patients received an oral ART regimen consisting of generic nevirapine; lamivudine; and stavudine. The number of patients initiated on ART each quarter ranged from 57-578; and the number of deaths of patients on ART was between 12 and 21 people per quarter. Analysis of 645 patients initiated on ART during the first quarter of the FAFH-PEPFAR ART program revealed that the median CD4+ cell count at baseline was 106/ml and the median increase was 173/ml (median time of follow-up; 7.0 months). Conclusions: Comprehensive HIV/AIDS care has been significantly expanded at FAFH; a free and holistic medical center in Jos; Nigeria. Cumulative data from the first year of this PEPFAR-funded ART program indicated that promising outcomes are achievable through delivery of care at this faith-based medical center

Primary Care as a Means of Decreasing Health Care costs

The study was focussed at furthering the health objectives of the Government's Reconstruction and Development Programme in the area of primary care. The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary care; so that medical scheme benefits do not become exhausted so rapidly. A quantitative approach; using an explorative and descriptive design was used. A survey was done by means of a questionnaire which was distributed to 250 principle members of the medical scheme in four selected divisions of a private organisation. Thereafter; a limited clinical assessment was done on the participants. In addition; case studies were used to illustrate the cost savings that could be obtained by the delivery of managed primary care of cardiovascular (CVD) conditions. Twenty-seven percent of the participants had current; or a history of cardio-related conditions; and 32.15 percent of the participants were identified as having an overall high risk for CVD. Contributing circumstances aggravating these conditions were life style-related issues. Nurse-based primary care should focus on primary prevention; for example; taking personal responsibility weight management; sufficient exercise; discontinuing smoking habits; stress management; and secondary prevention which involves annual medicals; and a focussed approach of specific screening protocols

Integrating STI and MCH / FP services

This operations research brief summarizes research carried out under the Africa OR/TA Project 11 from 1995-1999 including situation analysis of programs to provide STI; HIV/AIDS services and MCH and FP services using an integrated approach and subsequent intervention studies to test ways of improving the existing approaches

Collecte de fonds et mobilisation de ressources pour les programmes de lutte contre le VIH/sida

"Des approches variees de mobilisation de ressources""; ""La planification du travail de mobilisation de ressources pour qu'il soit mieux oriente vers les besoins des ONG/OCB""; ""Le developpement de competences cles""; tels sont les aspects sur lesquels cet ouvrage se focalise. Par la meme occasion; il se propose de developper l'assurance et les competences des ONG/OCB afin de permettre a ces dernieres les possibilites d'une mobilisation de ressources strategique et systematique dans le travail consacre au VIH/sida."