Cape Town Water Crisis: Surrounded by two oceans, is desalination the solution?

Level four water restrictions are now a reality for the City of Cape Town as dams are effectively seeping towards the unusable 10% mark, yet a viable solution exists through desalination.

Every single person in Cape Town and surrounds is being urged to keep water consumption to less than 100 litres per person per day.

The City says key to reaching this level is ensuring that showers do not run for more than two minutes per person, toilets are flushed only when absolutely necessary and with grey water, and all internal plumbing and plumbing fixtures are checked for leaks, according to the city…..more

Taking Trachoma Elimination Online: MOOC Draws Thousands

Building on the success of the first-ever massive online course (MOOC) on trachoma elimination, The Task Force’s International Trachoma Initiative (ITI) and partners are now providing another opportunity for public health professionals to learn about strategies for eliminating the bacterial disease.

Nearly 2,800 public health professionals in 64 countries took part in the first MOOC “Eliminating Trachoma” last October. The course opened again in April to connect even more public health professionals with the latest resources.

The course offers a solution to a major obstacle in the effort to eliminate trachoma – keeping planners and implementers across multiple countries up-to-date on policy and best practices in a rapidly changing environment…..more

A nearly all-white diversity panel? When will universities start taking race seriously

Last week, the Higher Education Funding Council for England (Hefce) announced its equality and diversity advisory panel membership. I was taken aback to find that the panel of eight consisted of seven white members. It feels at odds with its stated focus on dealing transparently with issues of equity in the Research Excellence Framework funding allocations.

On its website in March 2017, Hefce noted that the previous equality and diversity panel had “expressed disappointment” that limited progress had been made since the 2008 Research Assessment Exercise towards increasing diversity in the membership of the Ref panel, which judges the ratings that research submissions are awarded. Hefce added that “enhancing panel representativeness” will be one of the issues the new equality and diversity panel will address. But three years on this appears not to be the case….more

The bigotry underlying the notion of state capture in South Africa

The notion of state capture is currently very topical in South Africa, in both popular and academic circles. According to the popular view, President Jacob Zuma, along with a number of senior civil servants, has been captured and is doing the bidding of a well-heeled expatriate Indian family, the Guptas. A more plausible explanation of the nature of this relationship is required.

During the past year, political debate in South Africa has been dominated by the notion of state capture. More specifically, debate has been dominated by speculation on the nature of the relationship between President Zuma, members of his extended family and influential Indian family, the Guptas. According to popular lore, not to mention several academic treatises, the Gupta family has somehow managed to capture President Zuma and other senior civil servants and been able to manipulate them into awarding them a number of lucrative public contracts. This has enabled the Gupta family to become fabulously wealthy.

For a number of reasons, the assertion that the most powerful person in the country has somehow been captured is unconvincing. Indeed, the very proposition that a democratically-elected president of a sovereign nation of 55 million citizens can somehow manage to get ensnared in the schemes of a single family, no matter how influential, simply beggars belief. Far more plausible in one’s view that President Zuma and his coterie of advisors and assorted hangers-on have captured the Guptas by deliberately seeking them out and cajoling them into becoming a convenient conduit for their ill-gotten gains whilst bearing public blame for corruption and all that is wrong in South Africa. ….more

Measuring quality of health-care services: what is known and where are the gaps?

The United Nations sustainable development goal (SDG) 3 seeks “to ensure healthy lives and promote well-being for all and at all ages”.1 To build healthcare systems that were able to progress towards the millennium development goals, many countries had to extend delivery systems to increase coverage. They also greatly improved measurement of people’s contacts with the health system. However, with the reduction in disease burden due to specific infectious diseases and childhood illnesses, people tend to live longer, have multiple noncommunicable diseases and require more complex services. The focus on measuring access is not sufficient to capture whether people receive effective care; hence this month’s papers on measurement of quality of care in low- and middle-income countries….more

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9TH ANNUAL PAIN SYMPOSIUM – Saturday, 3 June 2017 UP

9TH ANNUAL PAIN SYMPOSIUM Saturday, 3 June 2017 hosted by the Department of Family Medicine in the Sanlam Auditorium at the University of Pretoria (Accredited for 6 + 2 Ethics CPD points)

Dear All,

Thank you very much for your overwhelming support for the 9th Annual Pain Symposium. We are now fully subscribed with ±300 registrations and had to close registrations on Monday. All trade space has also been taken – please interact with the exhibitors.

If you still want to register, you must send an email to Janice at Velocity Vision so that you can come onto the cancellation list – it is possible that a few delegates may cancel during the week.

Janice Candlish (Administrator / Conference Organiser)

Contact details: Tel: 011 894 1278 | Fax: 086 724 9360 | jan@velocityvision.co.za

Enquiries: Prof Helgard Meyer: 012 373 1096 (Doris)

Please come early and enjoy a cup of coffee with your friends and to avoid traffic congestion – this is very important!

Also remember to print your parking voucher for access to the University.

Regards

Prof Helgard Meyer

Department of Family Medicine

University of Pretoria

The potential of task-shifting in scaling up services for prevention of mother-to-child transmission of HIV: a time and motion study in Dar es Salaam, Tanzania

Abstract

Background

In many African countries, prevention of mother-to-child transmission of HIV (PMTCT) services are predominantly delivered by nurses. Although task-shifting is not yet well established, community health workers (CHWs) are often informally used as part of PMTCT delivery. According to the 2008 World Health Organization (WHO) Task-shifting Guidelines, many PMTCT tasks can be shifted from nurses to CHWs.

Methods

The aim of this time and motion study in Dar es Salaam, Tanzania, was to estimate the potential of task-shifting in PMTCT service delivery to reduce nurses’ workload and health system costs. The time used by nurses to accomplish PMTCT activities during antenatal care (ANC) and postnatal care (PNC) visits was measured. These data were then used to estimate the costs that could be saved by shifting tasks from nurses to CHWs in the Tanzanian public-sector health system.

Results

A total of 1121 PMTCT-related tasks carried out by nurses involving 179 patients at ANC and PNC visits were observed at 26 health facilities. The average time of the first ANC visit was the longest, 54 (95% confidence interval (CI) 42–65) min, followed by the first PNC visit which took 29 (95% CI 26–32) minutes on average. ANC and PNC follow-up visits were substantially shorter, 15 (95% CI 14–17) and 13 (95% CI 11–16) minutes, respectively. During both the first and the follow-up ANC visits, 94% of nurses’ time could be shifted to CHWs, while 84% spent on the first PNC visit and 100% of the time spent on the follow-up PNC visit could be task-shifted. Depending on CHW salary estimates, the cost savings due to task-shifting in PMTCT ranged from US$ 1.3 to 2.0 (first ANC visit), US$ 0.4 to 0.6 (ANC follow-up visit), US$ 0.7 to 1.0 (first PNC visit), and US$ 0.4 to 0.5 (PNC follow-up visit).

Conclusions

Nurses working in PMTCT spend large proportions of their time on tasks that could be shifted to CHWs. Such task-shifting could allow nurses to spend more time on specialized PMTCT tasks and can substantially reduce the average cost per PMTCT patient.

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Healthcare Analytics are the Problem. Applied AI is the Solution

aaeaaqaaaaaaaavoaaaajgmzotvinmzmlty2ntqtndfjzs1hzgm1lwu2nmvkogi1ztfhzaThe combination of electronic medical records, financial data, clinical data, and advanced analytics promised to revolutionize healthcare.

It hasn’t happened.

The common excuse is that healthcare wasn’t really prepared for the enormity and complexity of the data challenge and that, over time, with the next EMR implementation, that healthcare will be positioned to reap the benefits. Unfortunately, the next generation of EMR, or the one after that, isn’t going to solve the problem.

They problem is on the analytics side.

Healthcare analytics are still driven by a question-first approach. The start of our analytics journey still begins with the question. The challenge is which question? The more data we have at our disposal, the more potential questions there are and the lower the likelihood that we will ask the one that generates new value for the patient, the provider, or the payer. Even when we are successful in asking the right question, we have engaged in a confirmatory process – we have confirmed something we already knew.

Some will suggest that predictive analytics solves the problem, but it too is hypothesis driven – just in a different way. With predictive analytics, the set of variables selected, the choice of algorithms are, in effect, guesses as to what will produce the best outcome.

Ultimately, both approaches are flawed.

We need a new approach that surfaces trends we humans haven’t even considered, and that delivers a host of meaningful insights to clinicians before they even ask any questions. We need technology solutions that combine the best qualities of human intelligence (artificial intelligence) with the best computing capabilities that exceed human ability (machine learning). When these technologies are operationalized systematically across an enterprise, it’s called Applied AI. Applied AI is here to replace healthcare analytics, and we all stand to benefit.

Five Keys to Applied AI….more

Humble aspirin helping solve one-in-20 pregnancy threat

For most women, the first pregnancy is a joyous time that they will remember with tenderness for the rest of their lives. But for 5 % of all pregnant women around the world, the journey towards childbirth takes an unexpected turn for the worse. The culprit is a disorder that many young women expecting their first child have never heard of, a disease that kills 59 000 and affects approximately 800 000 women every year globally. Pre-eclampsia can go undetected until it’s too late, leading to complications of the liver and lungs or even to convulsion and stroke. It is characterised by high blood pressure and protein in urine, and the only known treatment is the delivery of the baby and the placenta. ‘If the disease occurs early in the pregnancy, the baby is born prematurely with various complications of low birth weight, incomplete organ maturation, blindness and motor and cognitive complications,’ said Hamutal Meiri, from the EU-backed project ASPRE with the company Hylabs Diagnostics, in Rehovot, Israel.

The multinational ASPRE team has paved the way for the roll-out of a preventive treatment targeting women at risk of developing pre-eclampsia early in the pregnancy, known as ‘pre-term pre-eclampsia’, when its occurrence is more dangerous and the prognosis mostly dire. The treatment is based on one simple ingredient, aspirin…..more

Zuma’s Dubai exit plan

0ecba19dd8594020baadf6a40dc59b36An email trail between the controversial Gupta family and their employees has blown the lid off how they have managed to do business with government, ingratiate themselves with senior officials, and go so far as to help move President Jacob Zuma and his family to Dubai.

The emails, obtained by City Press this week, also reveal how the Guptas seduced many senior government role players in their bid to capture departments and state-owned entities.

One of the most astonishing emails is from Gupta-owned Sahara Computers’ chief executive officer (CEO), Ashu Chawla, to Zuma’s son Duduzane. It contains a draft letter from the president to Abu Dhabi Crown Prince General Sheikh Mohammed bin Zayed Al Nahyan, and shows how close Zuma is to the Guptas…..more

A new film empowering girls and women with knowledge about processes that occur during puberty

Sunday the 28th May is Menstrual Hygiene Day, to mark this ​day ​we are ​excited to be ​launching a new film ​”Understanding your period”. The film provides an overview of menstruation and aims to empower girls and women with knowledge about ​the changes that occur during puberty, ​basic biology and hygiene practice.

The film was shot on location in Kenya alongside Carolina for Kibera, an international NGO that uses sports to teach healthy life choices. To find out more and watch the film click on the image below…..more

Timor Leste – Newborn care training programmes

World Health Assembly elects Dr Tedros Adhanom Ghebreyesus as new WHO Director-General

Today the Member States of WHO elected Dr Tedros Adhanom Ghebreyesus as the new Director-General of WHO.

Dr Tedros Adhanom Ghebreyesus was nominated by the Government of Ethiopia, and will begin his five-year term on 1 July 2017.

Prior to his election as WHO’s next Director-General, Dr Tedros Adhanom Ghebreyesus served as Minister of Foreign Affairs, Ethiopia from 2012–2016 and as Minister of Health, Ethiopia from 2005–2012. He has also served as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria; as chair of the Roll Back Malaria (RBM) Partnership Board; and as co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.

As Minister of Health, Ethiopia, Dr Tedros Adhanom Ghebreyesus led a comprehensive reform effort of the country’s health system, including the expansion of the country’s health infrastructure, creating 3500 health centres and 16 000 health posts; expanded the health workforce by 38 000 health extension workers; and initiated financing mechanisms to expand health insurance coverage. As Minister of Foreign Affairs, he led the effort to negotiate the Addis Ababa Action Agenda, in which 193 countries committed to the financing necessary to achieve the Sustainable Development Goals.

As Chair of the Global Fund and of RBM, Dr Tedros Adhanom Ghebreyesus secured record funding for the two organizations and created the Global Malaria Action Plan, which expanded RBM’s reach beyond Africa to Asia and Latin America.

Dr Tedros Adhanom Ghebreyesus will succeed Dr Margaret Chan, who has been WHO’s Director-General since 1 January 2007.


The WHO’s new African leader could be a shot in the arm for poorer countries

The article below was published online by the Conversation. The article was written by Professor David Sanders a founding and Steering Committe member and of People’s Health Movement -South Africa and the current Co-Chair of the People’s Health Movement Global. 

Dr Tedros Ghebreyesus is the first African to be elected as the Director-General of the World Health Organisation (WHO) in its 70 year history. The WHO is the United Nations body that directs its member states on international health issues. David Sanders explains to The Conversation Africa some of the main challenges Ghebreyesus will face in his five-year term.

What is the significance of this appointment?

This is the first time the entire 194-strong WHO assembly voted for the position. Votes were cast by secret ballot. Previously the organisation’s Executive Board selected the DG. The massive margin for Tedros – 133 votes vs 50 for the UK candidate David Nabarro – suggests that the entire Global South voted for him. The size of the landslide had not been expected.

The vote almost certainly represents a vote against big power domination and machinations in the WHO which often appears to ignore the main challenges and aspirations of low and middle income countries.

What does he bring to the table?

As Ethiopia’s former Minister of Health Ghebreyesus spearheaded major reforms to their health system. This included a massive expansion of primary health care infrastructure and a dramatic increase in health human resources at all levels. He oversaw a rapid increase in the training of doctors, shifted the responsibility for key interventions such as caesarean sections to mid-level workers, and the introduction of community-level workers (Health Extension Agents).

All contributed to impressive improvements in health outcomes – especially in child health.

This track record is certainly behind his election. But he’ll have his work cut out for him. The WHO is experiencing its greatest crisis since its founding in 1948. It’s biggest challenges are finance-related.

The organisation is facing a financial crisis with a US$ 456 million deficit this year. This is bound to mean that there will have to be a major cuts to some programmes. Some might even have to be closed. Retrenchments are also on the cards.

For the past few decades the organisation has increasingly relied on donor funds because member states – particularly richer ones – have been reducing their contributions. A full 80% of the organisation’s funding is now from sources other than member states. Donors such as the Bill and Melinda Gates Foundation are making major contributions.

This means that the priorities of donors tend to dominate, thus making it difficult for the WHO to carry out the policies identified by its member states. In addition, intergovernmental bodies such as the World Bank have weakened the WHO’s role.

And some key programmes have had their budgets significantly reduced. One example is the programme to control non-communicable diseases. They are now the top cause of morbidity and mortality globally, and in low and middle-income countries.

Some vital programmes central to the WHO’s mandate remain underfunded. Sometimes this is due to the fact that they conflict with the interests of rich countries and big donors, particularly those with links to industry. For example, governments have consistently opposed putting in place food regulations to address the rise in consumption of unhealthy food. This is presumably because they would affect big corporations that are prominent investors in those countries.

The result has been that the WHO’s leadership role in global health has been undermined.

Another big challenge is strengthening health systems. The Ebola epidemic in West Africa in 2014 showed up weaknesses in the WHO as well as in the health systems of low and middle income countries.

Finally, health systems, particularly in Africa and Asia, face drastic resource shortages. Huge investments are required in human resources, the most expensive and important component. Africa in particular has an extreme shortage of health workers. Their numbers are further threatened by inadequate training programmes and external migration (‘brain drain’) to rich countries. A WHO Voluntary Code of Practice on International Recruitment of Health Personnel has failed to impact positively on such losses. The clear challenge remains for health human resource shortages to be urgently and effectively addressed.

What does he need to do to deal with these challenges?

Ghebreyesus needs to use his strong mandate – notably from the Global South – to truly reform the WHO and its operations in favour of the world’s poor majority.

To do this, he needs to push strongly for member states to honour their commitments to the WHO and to rapidly and significantly increase their financial contributions.

He also needs to ensure that the influence of the food, beverage, alcohol and tobacco industries to control non communicable diseases is resisted. This will be difficult given that a framework has been passed that allows non-state actors to participate in WHO policy-making processes.

On top of this Ghebreyesus must ensure that the health systems of low and middle income countries are strengthened so that health emergencies such as infectious disease outbreaks can be contained.

The current investments in building surveillance capacity for infectious diseases are welcomed. But these efforts will remain inadequate without sustained investment in health systems.

This will ensure that agenda for health security isn’t focused on securing the health of rich country populations against contagion from the poor but on protecting all, particularly the most vulnerable.

What will be interesting to watch over the next five years is whether the evident solidarity between low and middle income countries in voting in Ghebreyesus as their candidate is maintained during the debates and decisions about world health. Until now, rich countries have been dominant in WHO meetings.

Gauteng’s negligent medical ‘professionals’ get off scot-free

Gauteng Health has paid out over R1bn since January 2015 to settle medical negligence, yet not a single disciplinary actionhas been taken against any of the staff involved, reports City Press. Total potential liability claims  stand at R13.5bn.

More than R1bn has been coughed up for medical negligent payouts since January 2015, but no action has been taken against Gauteng Health Department professionals. City Press reports that this is according to DA Gauteng spokesperson for health, Jack Bloom who was quoting a written response by Gauteng Health MEC Gwen Ramokgopa to questions from the DA. The response showed that the provincial health department paid more than R1.017bn since January 2015, to settle 185 medical negligence claims…..more

Why the NHI may take softer approach

Cabinet subcommittee to vote on revised health insurance plan, which Health Minister Aaron Motsoaledi says will initially let private plans continue.  Health Minister Aaron Motsoaledi says he will present a revised version of the National Health Insurance (NHI) white paper to a cabinet subcommittee on Tuesday. If the subcommittee approves the blueprint, it will then be considered by the Cabinet. If the Cabinet approves the plans, the legislative process to enact the policy will begin. A key aspect that will be scrutinised is the future role of SA’s medical schemes and administrators. The paper proposes mandatory membership of NHI and a reduced role for medical schemes to providing only “complementary services”….more

Public health is in critical condition, and the NHI cannot save it

Aaron Motsoaledi deflects attack by Cosatu on national health scheme

Health Minister Aaron Motsoaledi moved on Tuesday to defend his position on National Health Insurance (NHI) after Cosatu accused him of betraying voters by offering medical schemes a lifeline. The NHI white paper released in 2015 says a single NHI fund should be established to pay for services and relegates medical schemes to providing “complementary” services. Health director-general Precious Matsoso and Motsoaledi have recently signalled a potentially softer approach, in which medical schemes would continue to exist…..more

No matter what, Motsoaledi determined to win NHI ‘war’

No matter what the opposition from the private health sector, SA‘s National Health Insurance plan will be implemented, said Dr Aaron Motsoaledi, Minister of Health, and Naledi Pandor, Minister of Science and Technology. Both ministers formed part of the ANC national executive committee subcommittee on health, education, and science and technology, reports IOL. Earlier, in Pretoria, Motsoaledi said that the government had a constitutional responsibility to provide affordable healthcare to all citizens, irrespective of their economic status.

He said the World Health Organisation recommended that countries spend 5% of its gross domestic product on healthcare, but that South Africa spends more than the recommended amount, and in a disproportionate manner. “South Africa currently spends 8.5% of GDP on health.” “The private sector spends 4.4% of GDP on health but only provides care to 16% of the population.” “The public sector spends 4.1% of GDP on health but has to provide care to 84% of the population,” he said. “So this current financing system is unjust and needs to be reorganised so we can pool public and private sector funds to provide quality and affordable healthcare to all South Africans,” he argued…..more