[procaare] HealthLink Bulletin 03-10-2008

["Manju Chatani" <mchatani@4u.com.gh>]

Cross-posted from HealthLink Editor <editor@hst.org.za>

HealthLink Bulletin 03-10-2008
**********


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HealthLink Bulletin 03-10-2008

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A bi-weekly electronic bulletin compiled by the Health Systems Trust
keeping you up to date on public health issues in southern Africa


HIV and AIDS Barometer
---------------------
* US relaxes visa rules for HIV positive travellers
* Zimbabwe: New government gives HIV-positive people hope
* TB breakthrough a challenge to govt

Other stories
-------------
* New health minister has work cut out for her
* WHO bans SA manufactured generics
* Lack of medical workers plagues developing countries
* Policy on TB remains unchanged, says Health

Events
------
* 1st conference on Strengthening Linkages Between Sexual and Reproductive
Health And HIV/AIDS Services
* The 2008 European Scientific Conference on Applied Infectious Disease
Epidemiology
* Ninth International Congress on Drug Therapy in HIV Infection

Courses and Training
--------------------
* Advances in Behaviour Change Communication for HIV & AIDS

Research and Resources
----------------------
* Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise
* Supporting the delivery of cost-effective interventions in primary
health-care systems in low-income and middle-income countries: an overview
of systematic reviews
* Assessing the Impacts of Public Participation: Concepts, Evidence and
Policy Implications

Publications
------------
* South African Demographic and Health Survey (SADHS) - DOH
* International travel and health 2008 - WHO
* Priority interventions - WHO

 Job Opportunities
-----------------
* National Technical Advisor for HIV Care & Treatment, Malawi


HIV and AIDS Barometer
----------------------
US relaxes visa rules for HIV positive travellers
*************************************************
United States immigration officials on Monday announced moves to ease and
speed up visa-processing for HIV-positive visitors to the United States,
months after a 21-year entry ban on people with the virus was lifted.
Under the new rules, US consular offices overseas will have the authority
to grant temporary, non-immigrant visas to HIV-positive applicants who
meet "all of the other normal criteria for the granting of a US visa", the
Department of Homeland Security (DHS) said in a statement.

Previously, people with HIV were banned from entering the United States
unless they obtained a special waiver. "We're also accelerating the
process by providing an additional avenue for temporary admission while
maintaining a high level of security at our borders," Homeland Security
Secretary Michael Chertoff said in the statement. Visas issued under the
new rules will "be subject to certain criteria designed to ensure an
HIV-positive person's activities while in the United States do not present
a risk to the public health," the statement said, without going into
detail.

President George Bush signed legislation in July which removed HIV from a
list of diseases "of public health significance" that effectively barred
any person infected with the virus that causes AIDS from entering the
United States. The ban on HIV-positive foreigners entering the United
States had been in place since 1987.

(Source: IOL - 30 September, 2008)


Zimbabwe: New government gives HIV-positive people hope
*******************************************************
AIDS activists are hoping that the country's new administration will make
good on promises to urgently improve access to affordable HIV/AIDS
treatment and services at state hospitals. The country's three political
parties - ZANU-PF and the two factions of the majority Movement for
Democratic Change (MDC) - signed a power-sharing deal on 15 September,
ending one of the worst periods of inter-party political violence since
Zimbabwe gained independence in 1980. Despite scepticism that the three
parties will be able to work together, the deal has brought hope to many
ordinary Zimbabweans, particularly those living with HIV, who have been
battling to cope in the current harsh economic and political environment.
Of the estimated 320,000 people in need of antiretroviral (ARV) treatment,
only about 100,000 are accessing the medication at public health
facilities. Besides the treatment gap, government hospitals are struggling
to deliver services in the face of shortages of drugs, medical staff and
foreign currency.

Zimbabwe's social welfare minister banned the operations of all
non-governmental organisations (NGOs) during the run-up to the June 27
presidential runoff, compounding the lack of services available from the
public health sector. Included in the ban were about 400 organisations
providing support services to people living with HIV, such as home-based
care, orphan care and ARV treatment. Although the ban was lifted after an
international outcry from human rights activists, in reality, only those
organisations running ARV programmes were allowed to resume their work;
the beneficiaries of other HIV support services, including orphans and
vulnerable children, were left to fend for themselves. NGOs affected by
the ban are now hoping to be allowed to continue their work without undue
interference and restrictions by the government.

High expectations for new government
Bernard Nyathi, president of the Zimbabwe HIV and AIDS Activist Union, who
is living with HIV, told IRIN/PlusNews that under the new administration,
parliament would cease to be the "rubber stamp" it had been for the past
28 years when ZANU-PF dominated. "The welfare of HIV-positive Zimbabweans
has, for too long, been ignored"
"Through appropriate legal frameworks, members of parliament ... could
help improve the lives of us people living with HIV. We have no doubt
about that and we are very optimistic," said Nyathi. "The welfare of
HIV-positive Zimbabweans has, for too long, been ignored." Chairman of the
Zimbabwe National Network of People Living with HIV and AIDS (ZNNP+),
Benjamin Mazhindu, shared Nyathi's optimism. "In previous years there has
been serious under-funding of key ministries, such as health and social
welfare, with ministries such as defence being given priority," he said.

"In an all-inclusive government, budget allocations won't just be the
decision of one party that has a majority in the house, as was the case
before. Our hope, as people living with HIV, rests on the fact that budget
proposals will [now] be heavily debated in parliament." Mazhindu added
that as soon as the new cabinet was sworn in, ZNNP+ would mobilise its
members to start lobbying for urgent action on access to treatment, and
for increasing budget allocations to the health sector. Another challenge
facing the new government will be to improve relations with donors, to
secure more external HIV/AIDS funding. As a result of the political
crisis, many international donors have pulled out of Zimbabwe over the
years, creating a huge funding deficit for HIV/AIDS programmes. But it
will take time for the new government to make meaningful changes and, in
the meantime, life for many of the estimated 1.7 million people living
with HIV in Zimbabwe will continue to be a struggle. With inflation at
more than 11.2 million percent, those on treatment are finding it
increasingly difficult to afford food to take with their drugs. For those
on waiting lists to begin ARV treatment, getting adequate food is also
essential for helping to delay progression of the disease.

(Source: PlusNews - 03 October, 2008)


TB breakthrough a challenge to government
*****************************************
South African researchers have shown that deaths among people co-infected
with HIV and TB could be more than halved by starting antiretroviral
therapy earlier, adding further pressure on government to improve
treatment for both diseases.
If the government adapts its treatment guidelines in line with the
findings -- which were so dramatic that the clinical trial was stopped
early on ethical grounds -- it will mean starting 150 000 people living
with TB on anti-HIV medicine much earlier than has been planned, and
budgeted, for. Professor Salim Abdool Karim, who headed the study, said
the research indicated that up to 10 000 lives a year could be saved if
people with TB were given antiretrovirals at the beginning of the TB
treatment if they had a CD4 count of less than 500. Currently the
guidelines are for HIV-positive people to start ARVs when their CD4 count
drops to 200, or when this is clinically indicated.

Typically the policy has been for people to start ARVs only once they have
completed TB treatment, because of fears of interactions between the two
sets of drugs. One of the key anti-TB drugs, rifampicin, increases the
speed at which one class of ARVs is broken down by the body. The result is
a need to adjust the ARV dosage, with the attendant risks of side effects.
In addition the combination of a total of seven drugs puts a serious
burden on the liver and increases the risk of drug toxicity. Patients
starting ARVs risk developing immune reconstitution inflammatory syndrome
when their immune systems recover sufficiently to attempt to respond to
all the opportunistic infections that have taken hold.

The theory was that curing a patient of TB would reduce the risk of the
inflammation syndrome, which, in extreme cases, can kill. But the Starting
Antiretroviral Therapy in three Points in Tuberculosis Therapy (Sapit)
trial clearly showed that, despite these concerns, starting antiretroviral
therapy at the beginning of TB treatment in people with a CD4 count of
less than 500 could cut mortality dramatically. The trial was run by an
international collaboration -- the Centre for the AIDS Programme of
Research in South Africa (Caprisa), based at the University of
KwaZulu-Natal. Karim said that last year about 353 000 people were
diagnosed with TB, 70% of whom also had HIV.

Experts in both diseases said that the results underscored the need to
integrate treatment for HIV and TB and to allow trained nurses to start
patients on ARVs at TB clinics. Neil Martinson of the Perinatal HIV
Research Unit said that, given the huge overlap between HIV and TB, it is
crucial that treatment of the two diseases is integrated in facilities
that will reduce the risk of patients getting fresh TB infections from one
another. This is particularly important given the rise of drug-resistant
TB. Francois Venter, head of the Southern Africa HIV Clinicians' Society,
said: "Our TB programme needs to be seen as a key recruitment area for
patients who are at high risk of death if they do not get antiretrovirals.
"Previously clinicians thought that antiretrovirals could be delayed in TB
patients, depending on their CD4 count. This study suggests that a lot of
people will die if we continue this policy." The Sapit trial had three
arms. The one, which was halted early, treated patients once they had
completed their TB treatment.

The other two started patients on ARVs while they were undergoing TB
treatment, one giving patients the anti-HIV drugs when they had completed
the first two "intensive phase" months of the TB course and the other
starting patients on ARVs as soon as possible. The latter two arms of the
trial will continue until 2010, when the results should demonstrate
whether it is best to wait at all before starting TB treatment in
HIV-positive patients with CD4 counts of below 500.

(Source: Mail & Guardian - 25 September, 2008)


Other stories
-------------
New health minister has work cut out for her
********************************************
South Africa's newly appointed Health Minister, Barbara Hogan, has
inherited an unenviable to-do list from outgoing minister Manto
Tshabalala-Msimang, but AIDS activists are optimistic that she is up to
the job.Hogan has no background in health, but has been a member of the
ruling African National Congress (ANC) since 1977 and a member of
parliament since 1994. She is known for being outspoken on sensitive
issues, including HIV and AIDS. According to Zackie Achmat, a prominent
AIDS activist and former chairperson of AIDS lobby group, the Treatment
Action Campaign (TAC), Hogan was one of the few members of parliament to
speak out against "AIDS denialism" - the controversial view that HIV is
not the cause of AIDS, allegedly held by former President Thabo Mbeki.

"She was removed as Finance Portfolio Chairperson by Mbeki, in part for
her stand on HIV/AIDS," Achmat said in a statement. "She has a reputation
for being hard-working, competent and principled." Hogan's deputy, Dr
Molefi Seflaro, is a medical doctor with qualifications in tropical
medicine, public health and health service management. The TAC clashed
with Mbeki and Tshabalala-Msimang on numerous occasions during their
nine-year tenure, most notably during a Constitutional Court battle that
eventually compelled the health department to provide antiretroviral (ARV)
drugs to HIV-positive pregnant women to prevent mother-to-child
transmission. Claiming that over two million South Africans died of AIDS
during Mbeki's presidency, Achmat said that "at least 300,000 deaths could
have been avoided had the President merely met the most basic
constitutional requirements".

Many challenges ahead
Among many challenges now facing Hogan, according to Lesley Odendal, a
researcher at the TAC, is to address the bottlenecks hindering the
scale-up of South Africa's public sector ARV treatment programme.
"Although we do have a large number of people on treatment now, we still
have about half a million people who need ARVs," she told IRIN/PlusNews.
"We still have a long way to go." he identified tuberculosis (TB), the
leading cause of natural death in South Africa and a common opportunistic
infection in people living with HIV, as one of Hogan's most urgent
priorities. "We need to address infection control measures in hospitals
and communities," said Odendal. "We need a multi-sectoral approach, but
the department of health needs to provide leadership."

Dr Warren Parker, executive director of the Centre for AIDS Development
Research and Evaluation (CADRE), a non-profit organisation, urged the new
health minister to prioritise HIV prevention strategies beyond condom
promotion and distribution. "The focus on condoms hasn't worked," he told
IRIN/PlusNews. "It's so apparent that people don't understand the real
risks of HIV infection. The campaigns haven't focused on the specifics
enough."

Parker recommended campaigns addressing the HIV risks of concurrent sexual
partnerships and early sexual debut among teenagers. Both Parker and
Odendal agreed on the urgent need for the health department to scale up
prevention of mother-to-child HIV transmission (PMTCT) services. The
strategy of using dual ARV therapy to reduce infections from mother to
child was approved by the health department in January but has yet to
replace less effective mono-therapy in many parts of the country, Odendal
noted.

Hopes for new leadership style
"The sad thing has been so many lives lost as a product of poor strategic
emphasis, including very directly through many thousands of babies
becoming infected," said Parker. "The leadership orientation of the
previous ministry and presidency has been to defer issues rather than
leading on them, and it has cost lives." Parker added that many of the
shortcomings in the current government response to HIV/AIDS could be
"turned around" with more effective leadership. While acknowledging that
more than leadership was needed to address South Africa's AIDS epidemic,
the largest in the world, Odendal agreed that with a widely lauded
National Strategic Framework already in place, there was plenty of room
for hoping that Hogan's appointment could mark the beginning of a more
positive chapter in the country's AIDS fight.

(Source: PlusNews - 26 September, 2008)


WHO bans SA manufactured generics
*********************************
The World Health Organization on Monday warned customers not to buy drugs
made by Swiss pharma giant Novartis's Sandoz generics unit in South Africa
after an inspection revealed more than 40 faults. AFP reported that the
WHO said it had sent an official "Notice of Concern" letter to Sandoz on
September 12 after an inspection of the unit's Kempton Park factory in
South Africa.

That had revealed 41 separate cases classified as "non-compliances and
deviations from the WHO Good Manufacturing Practices." For example, "the
company failed to ensure that where starting and primary packaging
materials and intermediate or bulk products were exposed to the
environment, interior surfaces were not smooth and free from cracks and
open joints, and did not permit easy and effective cleaning and, if
necessary, disinfection," the WHO said in its letter. The inspection was
carried out in May, said the WHO.

Since then however, Sandoz had failed to take sufficient steps to remedy
the situation and thus the WHO has deemed the Kempton Park site to be
"operating not in compliance with WHO GMP." As such, the WHO would
"recommend suspension of procurement of all prequalified products
manufactured at this site, (and) withhold prequalification of all new
products," the letter said. These recommendations would remain in force
"until satisfactory corrective actions have been implemented by the
manufacturer and verified by WHO," it added.

(Source: Health-e - 23 September, 2008)


Lack of medical workers plagues developing countries
****************************************************
When her baby turned blue, Nivetha Biju rushed the child to the emergency
room of an Indian hospital and watched helplessly as the baby lost
consciousness because the nurses on duty had no idea what to do.
Eventually a doctor saved the baby's life, but many patients are not so
lucky in India and in other developing countries where a scarcity of
doctors and trained nurses means there is often no helping hand in times
of need. "Health systems [in developing countries] are on the brink of
collapse due to the lack of skilled personnel," said Ezekiel Nukuro, an
official with the World Health Organization. "In some countries, deaths
from preventable diseases are rising and life expectancy is dropping," he
said.

The health crisis in developing countries is, some experts say, being
exacerbated by the West as countries relax stringent immigration
regulations to attract doctors and nurses from less developed countries to
boost their own flagging health systems while saving money on expensive
training. The consequences of this "brain drain" are grave as it leaves
gaping holes in the healthcare systems of developing countries where
diseases such as HIV/AIDS, tuberculosis and malaria run rampant and
children die daily from diarrhoea. Aid agencies have warned that a
European Union "blue card" scheme to attract highly skilled migrants like
hospital workers, which was given initial backing by ministers this month,
will worsen the already debilitating brain drain. Africa, with a quarter
of the world's disease burden but only 3% of its health care workers, is
the worst affected region. International disease experts called earlier
this year for the poaching of African health workers to be viewed as an
international crime. Across the continent, HIV/AIDS patients are often
left unattended for days in rudimentary clinics staffed by a single
overworked nurse and a few untrained orderlies. Doctors often only visit
once every few weeks.

"There is a clinic run by a nurse who is over 70 years old, and she can
hardly remember what she did with a patient yesterday ... and yet she
still runs the clinic because there is no one willing to work there," said
Dr Pheello Lethola, an HIV/AIDS and TB specialist in the Southern African
country of Lesotho, where almost one-quarter of the population is infected
with HIV. The lack of medical workers in Africa is most pronounced in
regions where HIV/AIDS is rampant as the disease has whittled away the
ranks of health workers. "A nurse taking care of 400 patients is paid $3 a
day in Malawi, not enough even for a bag of maize. So healthcare workers
move overseas or to private companies here," said Moses Massaquoi, a
doctor with Médécins Sans Frontières in Malawi. WHO experts said in a
report in July that international aid to Africa should be used to boost
doctors' salaries and bolster recruitment and training. The report also
said efforts to connect African hospitals with laboratories and experts
abroad through the Internet and phone, known as "telemedicine", might ease
cost pressures in countries that lack skilled personnel.

(Source: Mail & Guardian - 01 October, 2008)

For the full story please see: http://www.hst.org.za/news/20041881


Policy on TB remains unchanged, says Health
******************************************
The Department of Health says its policy on the treatment of Tuberculosis
patients, especially those who have Multi-Drug Resistant TB (MDR-TB) and
Extreme-Drug Resistant (XDR-TB), will not be changed in any way.

The statement follows media reports which said that patients escaping from
the institution felt they were being kept as prisoners.

Health spokesperson Fidel Hadebe said it was the department's policy that
all TB patients were admitted to hospital for treatment, education,
counselling as well as for monitoring of side-effects with a view to
preventing the further spread of infection. When patients abscond, it
defeats the treatment programme as they can not only develop MDR- and
XDR-TB, but risk infecting other members of the public. Mr Hadebe said
this was the main challenge facing the department over the past few months
related to the escape by MDR- and XDR-TB patients in particular from the
facilities. He explained that TB patients' extended stays in facilities
were centred on the clinical care that the department was committed to
providing.

"Some patients may stay longer than the others due to the fact that they
are not converting to becoming negative. "Those patients who convert are
discharged on treatment for follow-up at a local clinic on a daily basis
and at a hospital on a monthly basis until they complete their treatment
and become negative," Mr Hadebe said. He further noted that plans and
programmes aimed at improving the conditions in TB treatment facilities
were currently underway.

In February, former Health Minister Manto Tshabalala-Msimang said the
department would be focusing on the implementation of the five-year
strategic plan this year. This plan outlined that more than 3000 health
workers were to be trained in TB management during the course of the year.
To help ensure patients received the proper health care they deserved. She
said the department was making every effort to ensure these patients were
comfortable while being treated. Patients also qualify for a chronic
disease social grant.

The department urged all TB patients to comply with their treatment and
remain in the facilities and members of the public were requested to
assist in this regard, to avoid the further spread of TB in communities.

A report on Public Hospitals Performance released last month, showed that
prevention of transmission of TB within the public institutions has become
a major concern. The report followed the launch of the "Core Standards for
Health Facilities in South Africa", setting out the expected performance
for hospitals and primary care facilities in April.

The standards and the criteria were formulated to give a comprehensive and
high level statement of expected and acceptable service delivery with a
focus on the basics including patient safety, patient dignity and basic
management practices. Using these criteria, several teams focusing on
different areas assessed 27 public hospitals and four community health
centres from June to August 2008 during one to three-day site visits. The
report showed that the institutions were not taking enough measures in
this regard, especially in relation to the physical measures to reduce
airborne infection. Therefore it been identified as one of the top
priorities in nearly all the facilities that were appraised.

(Source: Gabi Khumalo, BuaNews - 02 October, 2008)


Events
------
1st conference on Strengthening Linkages Between Sexual and Reproductive
Health and HIV/AIDS Services
*********************************************************************
http://www.svconference2008.org/

Date: 29th September
Location: Nairobi, Kenya
Theme: Taking the Lead: Challenges and Emerging Opportunities in
Responding to Sexual Violence in East, Central and Southern Africa'

This conference aims to utilize Sexual Violence as a nexus for
interrogating and strengthening existing response and the inter-linkages
between HIV/AIDS and reproductive Health. It aims to facilitate the
development of synergistic relationships between policy makers,
researchers, activists and practitioners from Government, academia and
civil society in the East, Central and Southern African region through
facilitating information exchange, sharing experiences and innovative
approaches, developing consensus on current gaps and research needs while
strengthening practice/service delivery strategies.

The 2008 European Scientific Conference on Applied Infectious Disease
Epidemiology
********************************************************************
http://www.escaide.eu/

Dates: 19-21 November, 2008
Location: Berliner Congress Center- Berlin, Germany

Objectives
The conference aims at:
1. strengthening and expanding the human network of all involved in
applied infectious disease epidemiology;
2. sharing scientific knowledge and experience in this field in Europe and
internationally;
3. and providing a dedicated platform for EPIET/FETP (field epidemiology
training program) fellows to present their work.

Topics
A wide range of topics related to applied infectious disease epidemiology
will be covered, including: disease outbreaks, surveillance, antimicrobial
resistance, healthcare-associated infections, food- and water-borne
diseases, zoonoses, vector borne diseases, vaccine preventable diseases,
HIV and other STIs, tuberculosis, respiratory diseases, influenza,
modelling and statistics for applied infectious disease epidemiology,
methods for microbial identification and environmental and occupational
health.
Contact
. for logistics: Cecoforma s.a. / rue L. Frédéricq / 4020 Liège / tel:
:+32 4 344 15 62 + escaide@cecoforma.be
. for program contact : escaide.conference@ecdc.europa.eu

Ninth International Congress on Drug Therapy in HIV Infection
*************************************************************
http://www.hiv9.com

Date: 09-13 November 2008
Location: the Scottish Exhibition and Conference Centre (SECC) - Glasgow, UK

Participation in the Congress is open to clinicians and researchers
throughout the world interested in the exchange of information on drug
therapy in HIV infection.

Registration may be made up to and including 20 October 2008 either in
paper form or online. Only fully paid pre-registered delegates will be
allowed to take part in the Congress.

Registration Fees
Full: £510
Non-OECD: £200
Accompanying: £75
Individual registrations
For any enquiries relating to registration please contact:
Tel: +44(0)1625 613222
Email: hiv9registrations@kp360group.com

Group registrations
For enquiries relating to group registrations of 10 or more people
please contact:
Tel: +44(0)01625 669423
Email: hiv9groups@kp360group.com

General enquiries
For all other enquiries please contact:
Ninth International Congress on Drug Therapy in HIV Infection
c/o Mandy Shore, KnowledgePoint 360 Group
Victoria Mill, Windmill Street, Macclesfield SK11 7HQ, UK
Tel: +44(0)1625 664390
Fax: +44(0)1625 664391
E-mail: hiv9@kp360group.com


Courses and Training
--------------------
Advances in Behaviour Change Communication for HIV & AIDS
*********************************************************
http://tiny.cc/Utpq6

Date: 03 November 2008 to 21 November 2008
Location: Kenya (Nairobi)
Language: English
Training Cost: $2,200

Training Description
This course is designed to equip programme managers working in BCC
programmes with skills to design and implement effective behavior change
communication interventions for HIV & AIDS programmes.
Students will:
1) Develope effective behavior change communication approaches for HIV &
AIDS prevention, care and support interventions;
2) Conduct behavior analysis to identify motivators and inhibitors to
behaviour change;
3) Develop and design appropriate messages and materials for HIV & AIDS
prevention care and support interventions.

Training Contact:
Christiane McWest
Email: cmcwest@cafs.org
Telephone: 254202731479


Research and Resources
----------------------
Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise
*********************************************************************
http://tinyurl.com/4nvb9b

The Lancet 2008; 372:917-927
DOI:10.1016/S0140-6736(08)61402-6
Series, Alma-Ata: Rebirth and Revision

Lawn JE, Rohde J, Rifkin S, Were M, Paul VK, Chopra M.
Saving Newborn Lives/Save the Children-US, Cape Town, South Africa.

This paper revisits the revolutionary principles-equity, social justice,
and health for all; community participation; health promotion; appropriate
use of resources; and intersectoral action-raised by the 1978 Alma-Ata
Declaration, a historic event for health and primary health care. Old
health challenges remain and new priorities have emerged (eg, HIV/AIDS,
chronic diseases, and mental health), ensuring that the tenets of Alma-Ata
remain relevant. We examine 30 years of changes in global policy to
identify the lessons learned that are of relevance today, particularly for
accelerated scale-up of primary health-care services necessary to achieve
the Millennium Development Goals, the modern iteration of the "health for
all" goals. Health has moved from under-investment, to single disease
focus, and now to increased funding and multiple new initiatives. For
primary health care, the debate of the past two decades focused on
selective (or vertical) versus comprehensive (horizontal) delivery, but is
now shifting towards combining the strengths of both approaches in health
systems.

Debates of community versus facility-based health care are starting to
shift towards building integrated health systems. Achievement of high and
equitable coverage of integrated primary health-care services requires
consistent political and financial commitment, incremental implementation
based on local epidemiology, use of data to direct priorities and assess
progress, especially at district level, and effective linkages with
communities and non-health sectors. Community participation and
intersectoral engagement seem to be the weakest strands in primary health
care. Burgeoning task lists for primary health-care workers require
long-term human resource planning and better training and supportive
supervision. Essential drugs policies have made an important contribution
to primary health care, but other appropriate technology lags behind.
Revitalisng Alma-Ata and learning from three decades of experience is
crucial to reach the ambitious goal of health for all in all countries,
both rich and poor.

Supporting the delivery of cost-effective interventions in primary
health-care systems in low-income and middle-income countries: an overview
of systematic reviews
*************************************************************************
http://tinyurl.com/5y3td6

The Lancet 2008; 372:928-939
DOI:10.1016/S0140-6736(08)61403-8
Series, Alma-Ata: Rebirth and Revision

S Lewin, JN Lavis, AD Oxman, G Bastías, M Chopra, A Ciapponi, S Flottorp,
SG Martí, T Pantoja, G Rada, N Souza, S Treweek, CS Wiysonge, A Haines

Strengthening health systems is a key challenge to improving the delivery
of cost-effective interventions in primary health care and achieving the
vision of the Alma-Ata Declaration. Effective governance, financial and
delivery arrangements within health systems, and effective implementation
strategies are needed urgently in low-income and middle-income countries.
This overview summarises the evidence from systematic reviews of health
systems arrangements and implementation strategies, with a particular
focus on evidence relevant to primary health care in such settings.
Although evidence is sparse, there are several promising health systems
arrangements and implementation strategies for strengthening primary
health care. However, their introduction must be accompanied by rigorous
evaluations. The evidence base needs urgently to be strengthened,
synthesised, and taken into account in policy and practice, particularly
for the benefit of those who have been excluded from the health care
advances of recent decades.

Assessing the Impacts of Public Participation: Concepts, Evidence and
Policy Implications
**************************************************************************
http://tinyurl.com/4hycpu

Julia Abelson, PhD1, 2. François-Pierre Gauvin, MA, PhD (candidate)1
1- Centre for Health Economics and Policy Analysis, McMaster University
2- Department of Clinical Epidemiology and Biostatistics, McMaster 
University

The Centre for Health Economics and Policy Analysis (CHEPA) Working Paper
Series

The expansion of ordinary citizens' roles in a variety of policy and
decision-making processes has created a pressing need to draw out the
lessons from accumulated work in the field of public engagement to inform
the design and evaluation of new public engagement processes. In
particular, the effects of these roles on decision processes and outcomes,
and on the citizens themselves, warrant scrutiny.

These questions are increasingly relevant to health policy makers and
health system managers working in local, provincial and national or
pan-Canadian settings to find meaningful and effective ways to involve
citizens in their decision-making processes. In this paper, we explore
what is known about the extent to which the goals of public participation
in policy have been met.

The current state of knowledge about the impact of public participation on
policy and civic literacy is reviewed along with the conceptual and
methodological approaches to evaluation and their associated challenges.
The published (English and French) empirical public participation
evaluation literature is also reviewed and reflections from key informant
interviews with policy makers and public participation practitioners are
shared. The limits to evaluation and its uptake are discussed and
strategies for advancing the practice and methods of public participation
evaluation are outlined..'


Publications
------------
South African Demographic and Health Survey (SADHS)
***************************************************
http://www.doh.gov.za/docs/reports-f.html

The 2003 South African demographic Survey is the second national health
survey to be conducted by the Department of Health, following the first in
1998. Compared with the first survey, the new survey has more extensive
questions around sexual behaviour and for the first time included such
questions to a sample of men. Anthropometric measurements were taken on
children under 5 years, and the adult health module has been enhanced with
questions relating to physical activity and micro-nutrient intake,
important risk factors associated with chronic diseases.

Over the past decade, South Africa has initiated several activities to
extend and improve the population-based health and demographic data in the
country. The SADHS makes an important contribution towards these
endeavours. The SADHS is a central element of monitoring coverage of
government programmes and evaluating their outcomes on population health
and forms a part of the national statistical system.

International travel and health 2008
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http://www.who.int/ith/en/

WHO; 2008

This report provides information on the main health risks for travellers.

More than 800 million international journeys were made in 2007. Global
travel exposes many people to changes in altitude, humidity, disease
agents and temperature - all of which can lead to ill-health. Many health
risks can be minimized by precautions taken before, during and after
travel.

This book explains how travellers can stay healthy and provides WHO
guidance on vaccinations, malaria chemoprophylaxis and treatment,
protection against insects and other disease vectors, and safety in
different environmental settings.

International travel and health 2008 covers the main health risks to
travellers, both during their journey and at their destination. It
includes the relevant infectious diseases including causative agents,
modes of transmission, clinical features, geographical distribution, and
prophylactic and preventive measures.

New and revised contents in this edition include:
. new vaccines and schedules
. worldwide maps of infectious diseases
. updates on the global malaria situation
. an updated country list
. deep vein thrombosis related to air travel
. avian influenza
. chikungunya virus
. the new international certificate for vaccination or prophylaxis.

This book is designed for medical and public health professionals who
advise travellers but it is also a standard reference for travel agents,
airlines, shipping companies and travellers themselves.

Priority interventions
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http://www.who.int/hiv/mexico2008/interventions/en/

WHO, August 2008

HIV/AIDS prevention, treatment and care in the health sector produced by
the World Health Organization, Priority interventions: HIV/AIDS
prevention, treatment and care in the health sector is the definitive
'one-stop shop' designed to help countries, donors and other stakeholders
expand and improve their response to one of the greatest health-care
challenges of our time.
It includes everything from how to expand condom programming to the latest
in treatment recommendations, guidelines and standards. Priority
interventions is designed to be a 'living' web-based document that will be
periodically updated with new recommendations based on the
rapidly-evolving experience of health-sector scale up.


Job Opportunities
-----------------
National Technical Advisor for HIV Care & Treatment, Malawi
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http://www.go2itech.org/itech?page=con-00-00

Seeking: An accomplished public health leader and manager with a proven
record of strengthening public-sector health systems to deliver
comprehensive HIV treatment, care, and support services in
resource-limited contexts. The candidate will bring vision, dedication,
inspiration and innovative thinking to work with the MOH and its local and
international partners to consolidate and advance Malawi's pioneering HIV
programme. Drawing upon a command of evidence-based HIV disease
management, the Advisor will uphold effective, equitable approaches to
Malawi's goal of universal ART access.

Responsibilities:
Through technical assistance to counterparts within the MOH, the Advisor
will lead the HIV Care and Treatment section of the MOH HIV and AIDS
Department to extend the national ART programme and strengthen the
continuum of HIV care.  The MOH HIV and AIDS Department also includes
Program Coordination, HIV Testing and Counselling (HTC), Prevention of
Mother-to-Child Transmission (PMTCT), and Sexually Transmitted Infection
sections, and the Advisor will collaborate closely with the local staff
and other expatriate technical assistance providers in each section.

Specifically, the Advisor will:
* Develop and implement HIV/AIDS care, treatment and support programmes,
policies and standards that build toward universal access to paediatric
and adult ART services
* Facilitate improved linkages and synergies between ART, HTC, PMTCT, TB,
STI, reproductive health, and other public health programmes.
* Assure quality of ART services, by reinforcing systems, policies and
standards for monitoring and evaluation
* Develop the capacity of the MOH HIV and AIDS Department to identify a
prioritized operations research plan relevant to HIV care and treatment
programmes in Malawi, and to design, implement, evaluate, write up and
disseminate operations research studies.
* Collaborate with stakeholders to standardize training/mentoring of
providers across clinical disciplines in the care and management of
opportunistic infections, ART delivery, palliative care, home-based care,
and "care for the care-giver".
* Facilitate improved technical support services such as laboratory, drug
security, and drug forecasting and quantification.
* Assist with feasibility assessment of new treatment regimens and HIV
care models, and identify innovative solutions to human resources
constraints.
* Support MOH leadership to effectively work with stakeholders within and
outside MOH and Malawi, to advance HIV programmes and promote Ministry
interests.
* Assist MOH with preparation and broad dissemination of strategic plans,
annual work-plans, quarterly reports and other ad hoc reports on all
aspects of its HIV programme.

Qualifications:
* Medical doctor with extensive knowledge of HIV care, treatment and
support services, ideally in Africa;
* Five or more (5+) years of practical experience working at senior
management level to oversee a large clinical programme in a
resource-limited context, preferably within the public sector in Africa;
* Strong leadership skills, demonstrated diplomacy in working with a wide
array of stakeholders and technical experts;
* Sound knowledge of public health practice and health system issues in
resource-limited settings;
* Professional links with relevant partners and international experts;
* Solid background in operational research and translation of research
into policy and practice;
* Proven success in implementing health services and/or clinical research
studies;
* Familiarity with the scientific literature on HIV treatment, care, and
support;
* Strong written and oral communication skills, ability to work
effectively in a multi-cultural setting.

Application:
This position will be hired through the International Training and
Education Center on HIV (I-TECH), a joint project of the University of
Washington, Seattle, and the University of California, San Francisco, and
is supported by United States PEPFAR funds through the Centers for Disease
Control and Prevention (CDC). Hiring and placement is through the
University of Washington; application may be submitted at:
http://tinyurl.com/7x4l8

This position closes on 20 October 2008. Remuneration package is
competitive and based on qualifications and experience.

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HealthLink Editor
Health Systems Trust
P.O. Box 808
Durban
4000
South Africa
editor@hst.org.za



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