Geneva Health Forum Archive

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Prevention, Organization System Strengthening, AIDS, Care and Treatment: Nigeria

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Author(s): Rashidat Mamudu1, Charity Obiakalusi1, Omorogbe Eloghosa1
Affiliation(s): 1Management Sciences for Health, Lokoja, Nigeria
1st country of focus: Nigeria
Relevant to the conference theme: Chronic Communicable diseases
Summary: Prevention, Organization strengthening, AIDS Care and Treatment (Pro-ACT), is a USAID funded Management sciences for health project and supports the government of Kogi state to provide HIV care and treatment for people living with HIV (PLHIV) in four secondary health facilities since January, 2008. At the end of September, 2011, 4,148 HIV+ individuals were identified and enrolled in care at the 4 treatment sites.
What challenges does your project address and why is it of importance?: Living well with HIV requires lifelong care and support. In many treatment centers in Nigeria, retention in care is a major challenge for care providers and treatment programs.  Many patients find it difficult to come to terms with a chronic health condition especially one like HIV, which is still heavily stigmatized. Misleading information abounds in the communities as cultural and religious beliefs play a major role in the lives of Nigerians and are used as a means to confuse many PLHIV. Many spiritual leaders claim to cure the virus and use the mass media being to advertize their claim. This has led to many patients abandoning their treatment or refusing medical care despite improved treatment access. This makes it important to devise workable strategies to communicate with them to ensure treatment adherence.
How have you addressed these challenges? Do you see a solution?: In order to improve treatment adherence, reduce default and failure to follow up, appointment diaries and defaulters registers were introduced. In collaboration with the clinic staff, patients doing well and willing to volunteer were identified from the support groups and clinics. The volunteers had their capacity built on counseling, peer education, community home visits and support by Pro-ACT and deployed to the clinics to serve as role models, provide peer education and track defaulting and failure to follow up patients. A look at six months data, October, 2010 to March, 2011 activities after engaging the peers illustrated a reduction in default rate and higher return to care of those tracked.
How do you know whether you have made a difference?: A total of 124 (16m, 39f) defaulting and lost to follow up patients were identified> All of them were tracked by the community peer counselors, 104 (36m, 68f) 83.87% of them returned to care, 9 (4m, 5f) 7.26% were reported dead by family members of the patients while 11 (3m, 8f) 8.87% who promised to come back are still being followed up. This showed a marked difference when compared to a six months outcome before peer counselors were introduced. The results showed a total of 223(99m, 124f) defaulters and failure to follow up patients identified, the tracking report showed 25(10m, 15f) 11.2% returned to care, 24(9m, 15f) were reported dead by family members of patients while 174 (80m, 94f) were classified as promised to return or untraceable.
Have you or the project mobilized others and if so, who, why and how?: The project worked with people living HIV through seven established support groups linked to the 4 Pro-ACT supported clinics. Part of the sustainability plan is to support them in registering as Community based organizations to improve their legal backing, which helps to improve their access to resources to support their members. Pro-ACT is also funding capacity building to improve their ability to 1) manage and run the organizations and 2) identify resources to implement programs and document the process. The volunteers are also actively involved in these groups with some of them supported to serve as role models in the community by working to present the benefit of remaining in care and pass on the right information from the patient's perspective through talks in religious homes and mass media. Also, at a state level, religious leaders are being educated and mobilized on the importance of conveying the right message to the public. In Lokoja, one of the communities where we work, one of the most influential religious leaders now preach the importance of medical care especially for PLHIV while assuring them that visiting the hospital is not a lack of faith in God.
When your donor funding runs out how will your idea continue to live?: All our activities are in collaboration with the government of Kogi state. Pro-ACT is actively involved with the state through the ministries and State Agency for the control of AIDS to ensure the program continues when donor support ends. Capacity building on leadership is one strategy we use. The result of one of the leadership seminars we had was the establishment of 3 fully owned government care and treatment programs in 3 under-served communities in the state with Pro-ACT providing technical guidance. At the beginning of the year, Pro-ACT supported the state in developing a 5 year operational plan to support continuous care and support after donor funding ends.

Ongoing Clinical Audit as an Effective Tool for Identifying Gender Gaps in HIV Service Delivery in Rural Clinics In North East Nigeria

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First: Nwokedi
Last: Ndulue
Name your project or intiative: Ongoing Clinical Audit as an Effective Tool for Identifying Gender Gaps in HIV Service Delivery in Rural Clinics in North East Nigeria.
1st country of focus: Nigeria
Relevant to the conference theme: Gender
Summary: Gender inequalities such as socioeconomic disparities, domestic violence, and cultural expectations make women more vulnerable to HIV infection. Gender differences in society affect communication and decision-making in the home which are necessary for prevention of HIV and STIs. Successful Abstinence Be Faithful programs depend on man-woman mutual agreement on a code of behavior that must be adhered to consistently.  MSH ProACT project recognizes gender as a critical factor in the transmission, prevention, care and mitigation of HIV/AIDS. ProACT work in this area focuses on increasing gender equity in HIV/AIDS programs, significantly increasing male participation in all aspects of HIV prevention, care and treatment and empowering women sufficiently to access HIV services as well as resources in their households and community.
What challenges does your project address and why is it of importance?: Since 2008, USAID funded ProACT project of Management Sciences of Health (MSH) supports HIV care and treatment services in 5 rural hospitals in Adamawa State, North East Nigeria. MSH ProACT work in this area focuses on increasing gender equity in HIV/AIDS programs. We are aware that the challenges to accessing clinical care for HIV infection are further exacerbated for women, further increasing their vulnerability.  As part of an ongoing initiative to ensure quality improvement, a file audit was conducted in five hospitals in March 2010. A critical evaluation of gender differences of the clinical services delivered to patients was integrated into this audit. All clinical services evaluated were sub-stratified to measure gender differences. A total of 509 patients’ files were reviewed. 70% of enrolled patients were females and 30% were males. 89% of enrolled males and 62% of enrolled females received baseline CD4 testing. Of all the patients who did not receive a repeat CD4 testing, 83% were females. Among all patients who received baseline TB screening, 68% were males, and 32% were females. Females comprised 79.2% of all patients presenting with advanced HIV disease (WHO stages 3 and 4). Among patients who were documented as lost to follow up, 62 % were females.
How have you addressed these challenges? Do you see a solution?: To address these challenges we instituted the following interventions: • daily running of CD4 test in high volume sites and at least 3 days in low volume sites• Task shifting to the Triage and ART nurse to screen for TB and generate CD4 lab request forms before 12 noon to ensure clients samples are collected on same day as they are enrolled.• We ensured all appointment dates are recorded in the Appointment Diary for clients not able to do CD4 on the same day. • Ensured immediate tracking of patients missing clinic appointments.
How do you know whether you have made a difference?: We analyzed data post intervention covering a one year period. A total of 1560 clients were enrolled during this period; 68% were females while 32% were males. Of the 1317 clients screened for TB at baseline, 68% of them were females while 32% were males. 84% of enrolled females and 85% of enrolled males were screened at baseline for TB. 68 %( 1065) of enrolled clients had baseline CD4 count of which 66 %( 705) were females and 34% (360) were males.66% of enrolled females had repeat CD4 count while 72% of enrolled males had a repeat CD4 count. A total of 140 clients were LTFU and tracked back during the period; 58 %( 81) were females while 42 %( 59) were males.7.6% of enrolled females were LTFU while 11.9% of enrolled males were LTFU. The results demonstrate over >50% increase in the number of female clients who had baseline TB screening as well as repeat CD4 evaluation. In addition there was an improved tracking outcome for female clients. Based on these findings, we therefore recommend that efforts to identify gender disparities in access to clinical care should be integrated into ongoing quality improvement initiatives.
Have you or the project mobilized others and if so, who, why and how?: I. Communities and their leaders: The project is mobilizing and building the capacity of CSOs working in target communities to begin to address identified gender disparities. Emphasis is being placed on practical skills-building sessions for men and women leaders, youth groups, FBOs to perform gender analyses of their everyday life practices, appreciate the risks and benefits gender stereotypes have on HIV transmission and family health outcomes, personalize HIV infection and make long-term commitments and shared visions for their families.  II. Identifying Male Mentors: The project through the Male Mentor Program (MIP) is using a peer to peer counselling strategy as a model for reaching out to men in target communities and for improving male involvement in HIV care and treatment of PLHIVs
When your donor funding runs out how will your idea continue to live?: A training of trainers (TOT) on mainstreaming gender into HIV/AIDS services was conducted in Feb 2010. Participants were drawn from ProACT technical staff, key desk officers from the State ministries of women affairs and social development, SACA, SMOH and the ministry of education to ensure they provide direction and promote gender mainstreaming in future state programs. The training modules addressed issues such as social norms like early marriages for females, inequitable access to health, education and resources, parenting, adolescence and growing up, the girl-child, effective communication in marriage, peer pressure and influence.   Working with facility teams the project has continued to ensure that the facility M&E system captures data on gender differences in access to and utilization of HIV/AIDS services. ProACT continues to provide ongoing capacity building of facility multidisciplinary teams to follow up on gender issues raised by the quality of clinical care audit. The project has continued to ensure that the state M&E system captures data on gender differences in access to and utilization of HIV/AIDS services.  The Institutional capacity of MSH ProACT supported CBOs have been built in proposal development to be able to independently access funds - Gashaka Charity foundation based in Taraba state has received a $10,000 grant from the TY Danjuma foundation to expand its community based programs that address OVC and gender issues. .  MSH ProACT project is providing technical assistance on proposal writing to PLHIV Peer Support Groups to enable them access the World Bank FADAMA III project $100,000 grant (USD ). Living with Hope Support Group based in Adamawa has secured N450,000 ($300) grant for agriculture related Income Generating Activities(IGA) that will benefit mostly women living with HIV. In addition, the ProACT project has continued to support CBOs, state teams to actively participate in national, state and USG-supported gender specific forum/working teams in the country where they share experiences, harmonize strategies and approaches to gender programming.  Following the Leadership Development Program (LDP) training in January 2009, the Kogi SMoH LDP team received approval and a budget line of N30m ($200,000) from the State Executive Council to set-up three state-operated HIV comprehensive care and treatment sites in underserved areas of Kogi State. Three sets of automated lab platforms for CD4,Chemistry and Haematology analysis were procured by the state and these sites were activated to provide comprehensive HIV care and treatment services in July 2011.These sites provide better access to women and their children.

Youth Friendly Health Services: A Chibombo District Experience

First: Victor
Last: Silumbwe
1st country of focus: Zambia
Relevant to the conference theme: Vulnerable groups
Summary: Chilbombo Child Development Agency is implementing the integrated HIV/AIDS project with a focus on Youth Friendly Health Services. youth friendly services meets young peoples sexual and reproductive health needs, regardless of their sex, religion, ethnicity,religion as well as cultural diversity. This was achieved through capacity building and sensitization meeting on the importance of making health services more youth user friendly
What challenges does your project address and why is it of importance?: low utilisation of health services among youths in three rural health posts of  Chibombo District , central province Zambia, due to judgemental tendancies by health staff, long waiting queues as well as lack of privacy
How have you addressed these challenges? Do you see a solution?: 1. Capacity building training to health staff, community health care providers and youths  in Youth Friendly health services Management 2. Construction of 3 youth friendly corners 3. Community sensitization meetings through participatory mass media 4. monitoring and evaluation
How do you know whether you have made a difference?: There has been a drastic increase in the number of youth accessing health services in rural health centres from 10% to 60% as of June, 2011. Chibombo District Health Office Report
Have you or the project mobilized others and if so, who, why and how?: yes the project has mobilised other relevant stakeholders in Chibombo District, to support youth friendly health services advocacy efforts through district stakeholders meetings
When your donor funding runs out how will your idea continue to live?: youth friendly health services will be integrated into the activities that Chibombo Child development agency is implemeting. Peer counsellors will continue providing the service at the local rural health centres.i

Partnering Strategically with Faith Based Organisations: The Case of Moravian Diploma Nursing School in Mbozi, Tanzania

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Author(s): Alexander Bischoff1, Sunoor Verma1
Affiliation(s): 1Division of International and Humanitarian Medicine, Geneva University Hospital, Geneva, Switerland
1st country of focus: Tanzania
Additional countries of focus: Switzerland
Relevant to the conference theme: Communicable chronic diseases
Summary: To address chronic conditions effectively, investments need to be made training nurses with additional and new skills. This is even more relevant in the rural low-income setting where the trained workforce has a high turnover due to economic migration.  In this presentation we will use the partnership between the University Hospitals of Geneva, "Solidarité internationale" and the Moravian Church of Tanzania which has led to the establishment of the Moravian Diploma Nursing School (MDNS) as a case study. We look at the potential and challenges of partnering with a faith-based organisation especially in the broader context of the global chronic conditions epidemic and the human resources in health crisis.
What challenges does your project address and why is it of importance?: The global epidemic of chronic conditions leads to an acute shortage of health workers. The workforce crisis is particularly serious in low-income countries in sub-Saharan Africa, compounded by the fact that the few health workers that are trained in these countries often migrate to the richer countries in the North. Two main strategies exist to address the human resources crisis: either to put into place retention policies in rural areas or to invest in new capacity building. In Tanzania the projections given by the Ministry of Health and Social Welfare (MOHSW) show the need of nursing officers is 20,008 but only 3,280 are in the market. The gap is therefore 16,728.To fill this gap, 18 new schools would need to be built. In Tanzania, the MOHSW is expanding the health services infrastructure in order to ensure universal access to quality health care. The MOHSW has to increase the training capacity in order to train an adequate number of skilled and competent human resources to provide the much needed health services. Currently, there is a huge discrepancy between available infrastructure and available trained health personnel, in particular nurses. While Tanzania is used as an illustration, this scenario is valid to many other low and middle income countries around the world.
How have you addressed these challenges? Do you see a solution?: The need for more nurses is such, that more nurse training institutions are urgently needed. Therefore, the MOHSW is encouraging private institutions, in particular faith-based organizations (FBO) to start or increase their respective nurse training capacities. It is against this background that the Mbozi Diploma Nursing School project was launched.  The Tanzanian Human Resources for Health strategic plan foresees and encourages Private Public Partnerships and FBO driven initiatives to address the shortfall in health workforce:  In Tanzania, 83 hospitals are run by churches (FBO). Overall FBOs provide more than 50% of the health care services in the country.  The MDNS project is constructed as a PPP between the FBO, i.e. the Mbozi Mission Hospital of MCT-SWP, HUG, Solidarité and the MOHSW. It should be mentioned that the FBO is adhering to all policy and clinical guidelines regarding health care in general and HIV/AIDS in particular, issued by Government and WHO. Also, MDNS nurse graduates will receive governmental (MOHSW) certificates and will be free to seek employment wherever they want (they are in no way bound to stay at the MMH or at another FBO health facility).  This project attempts to address the human resources for health shortage by providing diploma nursing education in a rural area where there are few training opportunities. It is an initiative by the Moravian Church of Tanzania South-West Province (MCT-SWP), via its own Mbozi Mission Hospital (MMH) and the Swiss-based partner organization DIHM in Geneva. The DIHM (Division of International and Humanitarian Medicine) is part of HUG (Hôpitaux Universitaires de Genève, Switzerland).  The establishment of an institutional partnership between the MMH Nursing School and the SMIH/HUG will ensure the provision of clinical, educational, management and evaluation support by a different HUG services. The donor is SSI, “Service de solidarité international”, a governmental (cantonal) international development organization.
How do you know whether you have made a difference?: The project is in the first phase of implementation hence it is premature to gauge impact. However if the community participation can be an indicator to how well a need is being addressed, then this project is certainly making a difference. The community has been enthusiastic in its support of the infrastructure development phase of the project. There is increasing pressure from the community to increase the number of enrolments in the school. The overall goal of the project is: to improve access to quality primary health services for the population in Mbeya Region by training nurses in a new Nursing School, attached to Mbozi Mission Hospital. These are the 6 objectives: (A) Decrease nurse shortage, (B) Improve quality training (nursing skills), (C) Improve quality of care /services,  (D) Balance between Human Resources (HR) and infrastructure, (E) Influence health policy (on Human resources), (F) Guarantee sustainability. A detailed project monitoring plan that lists the deliverables (progress indicators) at 6 points in time, i.e. every six months in the 3-year-duration-project shall measure whether the present project makes a difference.
Have you or the project mobilized others and if so, who, why and how?: The present project has been able to mobilize a number of actors in the region. We obtained support and/or go-aheads by different federal governmental officials at district level by district council authorities, the MCT-SWP (church central level). Also, we obtained agreement for nursing student internships at the following health facilities: Vwawa Hospital, Tunduma Health Centre, Mbeya Referral Hospital, Mbeya Regional Hospital.
When your donor funding runs out how will your idea continue to live?: This is an initiative that addresses well articulated needs and wants of the community in which it is embedded. Partnership arrangements are such that they ensure that once the training facility and program is established, it will be integrated into the national chain of such schools.  With up-to-date infrastructure as well as the investment in HRH in the health sector, the project will have a sustained impact, also beyond the project duration. Accommodation facilities that are well-built, well-run and well-kept, will be seen as a well organized school. FBO programmes have been generally acknowledged for their long-term commitment and sustainability as they are well rooted in the community and the community members have a direct stake and control over the direction of the initiatives. The project setting is unique at this moment because the MOSHW is actively encouraging PPPs and has been a reliable partner in international funding and is seeking pilot-projects which can be replicated elsewhere. There is therefore a pronounced interest by the MOSHW that this project works and is sustainable. In the future, the nursing school will be able to generate funds thanks to the student tuition fees.

Mental Health and Young People: International Perspectives on Growing Challenges

http://youtu.be/xLCtIV0x6Gg

Author(s): Anne Meynard1, Dagmar Haller1, Daliborka Pejic2, Suzanne Ehrensberger3, Patana Mulisanze3, Saskia von Overbeck4
Affiliation(s): 1Hôpitaux universitaires Genève, Departement de l’enfant et de l’adolescent et Dpt de médecine communautaire, de premier recours et des urgences, 2Fondacija fami, Doboj, Bosnia & Herzegovina, 3Association Santé Mentale: Suisse Rwanda, 4Service de psychiatrie de l’enfant et de l’adolescentDepartement de l’enfant et de l’adolescent Hôpitaux Universitaires de Genève
1st country of focus: Bosnia and Herzegovina, Switzerland, Australia
Relevant to the conference theme: Vulnerable groups
Summary (max 100 words): There is urgent need of innovative and multisectoral interventions to address mental health issues in young people. Lack of trained professionals or adapted services, impact of socioeconomic factors on mental health are some of the challenges faced by many countries around the world. Interprofessional collaboration, community programs, International partnerships and web-based interventions can maximize the use and exchange of expertise among professionals, young people and their families.
What challenges does your project address and why is it of importance?: The presentation will present short aspects of two collaboration projects (Rwanda and Bosnia and Herzegovina) and experience in Geneva with vulnerable youth, questioning innovative ways of addressing mental health issues with young people and international collaboration. About Bosnia &Herzegovina: Great societal changes and turmoil, such as postwar trauma, unemployment and poverty, have undoubtedly negative effects on the occurrence of risk behavior and health of youth in BiH. About 50% of the young people have lost some family member or a close relative, and around 16% of people suffer from PTSD. UNPFA data show that around 50% of young people in Sarajevo and around 60% in Banja Luka do not use condom during sexual intercourses. Around 30% of young people are regular smokers, 21% frequently consume alcohol; 5.8% of boys and 6,8 of girls have experienced drugs. UNFPA data show that around 50% of young people in Sarajevo, i.e. around 60% in Banja Luka, do not use condom during sexual intercourses. In spite of significant achievements (psychiatric services and community mental health), existing mental health services are still unable to respond to the multiple and growing needs of the population, and in particular young people. Social stigma, segregation and isolation of people with mental health problems, are main barriers to treatment and reintegration of the people with mental health problems. About Rwanda: In the aftermath of the genocide, a significant number of the Rwandan population is traumatised and needs help. The country has very few psychiatrists to take care of the patients and the task is not easy for them because they have to face a huge demand. Moreover, physicians in general have practically no training in mental health. In view of the current state of affairs that is high demand of patients to take care of alongside scarce human and logistical resources, group therapy is deemed to be a very good way to treat people. This form of care can be used in different age ranges from children to adults. Since there is a shortage of skilled and trained people in psychiatry, it is of paramount importance to train the available health workers in this kind of care. This year we start to teach our colleagues with the Child Psychiatry, again this was very useful.
How have you addressed these challenges? Do you see a solution?: About Bosnia &Herzegovina: An established network of family medicine teams is serving as the base to support the development of new activities in various fields, including mental health. According to the BiH Strategic Health Care Reform plan, Family Medicine has been assigned as the primary health care provider also for adolescents. The projects focus has been, therefore, on strengthening family medicine activities in the field of working with youth. Training provided FM teams with the basic knowledge on developmental issues, epidemiological data, communication skills with young people and their families, use of screening tools (HEADSSS), confidentiality and youth-friendly principles. Improvement of multidisciplinary and multi-sectoral collaboration started by including the participants from other departments/institutions/organizations in the training, thus initiating the creation of a network of health and non-health service providers in the municipality (CBR professionals, youth-friendly center staff, social workers, school pedagogues, young people, NGOs, VCCT center. etc.). The network is to be strengthened through implementation of practical tasks, development of procedure/protocols and actions plans, network meeting, etc. Promotional activities, such as round table public discussion and distribution of network leaflets, aim to better inform the community and young people, about the available help. Development of practical tools, such as translation of the WHO Adolescent Job Aids, will be of valuable assistance in everyday work with youth.

About Rwanda: One way to address these challenges is to train the Rwandan colleagues in these methods of treatment. We have been working with them since 1996 and they are currently becoming little by little familiar with the basic notions of psychiatry. After years of collaboration, we can now start to introduce them to different aspects of this specialization. A few weeks ago the Minister of Health talked about launching the training phase of colleagues assisted with partners. We hope to participate to this coming form of collaboration. As long as we do not foresee in the near future any university training in psychiatry, I do not think we there will be any tangible solution to these challenges.
How do you know whether you have made a difference?: About Bosnia &Herzegovina: The training itself showed how important it was for the participants to have the opportunity to “hear each other”, learn more about already available services in the community and together start improving work with and for youth and develop specific services for young people adapted to the local context of each municipality.

About Rwanda:We examined the first sessions we conducted with health workers and noticed that they have started to integrate or internalize some theoretical aspects. In addition, these health workers are more receptive to new concepts. We also observed that our colleagues are becoming more skilled and comfortable in their work. They also are more interested in the training, we have new demands.
Have you or the project mobilized others and if so, who, why and how?: About Rwanda: Since the HUG has stopped their funding, we only have the membership fee from our joint mental health Association (Association Santé Mentale: Suisse Rwanda). The Association “Saturnales 2010” gave us some funds to run and conduct a training in group therapy. As a result, there is a positive feedback from Rwanda and we have begun the process of sensitizing the importance of this project and calling for partners in different kinds of forum such as this congress
When your donor funding runs out how will your idea continue to live?: About Bosnia &Herzegovina: By relying on existing standards and strategies, formalizing mutual collaboration and work with youth with protocols and procedures, improving knowledge and skills with training and practical assistance in their implementation, building a pool of local youth health experts, and creating a network of youth service providers, there are reasonable chances that the changes made will continue to live and grow.

About Rwanda: Since we are training doctors, nurses in the country, our goal is that the latter will take over the work we have started and train others when we complete our training activities.

AIDS Knowledge Among High School Students in a District of South India

Project/Initiative Outline:

First Jegan
Last Rupa Subramanian
Name your project or intiative AIDS knowledge among high school students in a district of South India
1st country of focus India
Relevant to the conference theme Communicable chronic diseases; Vulnerable groups
Summary This study was conducted in school children to analyze the degree of knowledge about HIV/AIDS. By this study we conclude that both girls and boys did not aware fully about HIV/AIDS.
Background India is the 2nd largest HIV/AIDS infected country in the world. According to report, 35% of AIDS cases reported are below 25 years of age and 50% of new infections are between 14 to 24 years old. This is mainly due to insufficient knowledge about HIV/AIDS among the children and youths.
Objectives The aim of the study was to assess the knowledge about HIV /AIDS among  school children aged 14-18 years old.
Methodology
This study was carried out among 3872 students of five high schools in a district of South India to analyze the degree of knowledge about HIV/AIDS prevention, transmission, sign and symptoms. A structured, multiple choice questionnaire was administered.
Results Among 3872, 59% were boys and 41% were girls. All were in the age group of 14-18years. Regarding prevention, 88% of boys and 64% of girls referred condom is the only way of prevention, 75% of both girls and boys inform that have to wash their genital after sexual relation. Regarding transmission, all students inform that sexual intercourse is the main way and 63% informed that it also transmitted through unsafe blood transfusion. Nearly 73% of boy and 42% of girls did not aware about the sign and symptoms of HIV/AIDS. 38% of boys and 55% of girls known the testing method against HIV/AIDS(ELISA). 37% students believed AIDS is a communicable disease and 18% informed it can’t be preventable, 15% students affirmed AIDS is curable. Only 5% of students were aware about the exact mechanism of HIV/AIDS infection, and no students aware about the future co-infection of the disease.
Conclusion Our study concludes that, both girls and boys were not fully aware of the mode of transmissions and prevention of  HIV/AIDS. It is concluded that health education on HIV/AIDS education, without hindering the information, should be incorporated in school syllabus.

GHF2006 – Interview with Mary Robinson

September 3, 2006

Submitted by: Viola Krebs (ICVolunteers); Contributors: Jean-Pierre Joly (ICVolunteers)

"With the human rights as a framework... the objective of 'access to health for all' will certainly have made some progress through the conference." Image: Viola Krebs, ICVolunteers.org

Mary Robinson, the first woman President of Ireland (1990-1997) and more recently United Nations High Commissioner for Human Rights (1997-2002) shared with the conference team some of the main challenges at hand when it comes to access to health for all: accountability, financing, the brain drain and the responsibility of those who have the means to make a difference, such as the private sector. She pointed out that the high turnout at the Forum was an indicator of the need for it and the urgency of discussing access to health. Access for all is the concern of all.

Q: Accountability of politicians for decisions affecting human health and dignity is a key issue. If everybody agrees on the principle, the question remains of how to assess their achievements and how to enforce accountability?

I speak more and more about accountability including accountability in the social context. Human rights help greatly. We know what the legal commitments mean for countries. The UN Committee on Economic, Social and Cultural Rights has provided guidance to governments and standards against which they can be held accountable. We have more and more ways to measure their ability to fulfill the right to health. Some of the core obligations such as ensuring that no one is discriminated against in terms of access to basic treatment are to be fulfilled regardless of available resources. The increasing sophistication of civil society groups also enhances social accountability. The Treatment Action Campaign case in South Africa proved that governments can be required to implement comprehensive and coordinated programmes in order to realize the right of access to medical treatment. On 4th September, I will be in London to help Paul Hunt, the UN Special Rapporteur on the Right to Health, to defend his ideas on this matter with the UK Government. It is an important move because we need to keep accountable rich as well as poor countries.

Q: Requesting from developing countries that they finance themselves the access to health for all at a national level seems unrealistic. On the other hand it appears that financing provided by the developed countries for the South has short term effects. Is there a methodology that could be followed to obtain long-term sustainable results?

The current situation is actually shocking. Public health systems in poor countries are broken, in particular in rural areas where many problems surface. We need absolutely to change the approach. It is being recognized that the local parameters have to be far more taken into account. Many errors have been made by the IMF and the World Bank, which actually weakened the ability of countries to take local action. The new trend amongst donors to privilege general budget support since the Paris declaration on aid will put more responsibility on the countries' decision makers. Health ministers will have to be very skilled managers which is not necessarily always the case currently. In quite a number of countries corruption also remains a major issue. Everything should be done to support health ministers and their ministries in order to allow them to manage funding from the GAVI (Global Alliance for Vaccines and Immunization), NGOs, foundations and other donors and to enable them to meet, amongst other things, the Abuja declaration which targets that 15% of national budgets would go to their health systems.

Q: When one thinks of resources, a major one is the human resource. Developing countries suffer from an ongoing brain drain affecting deeply their health systems. How to stop and even reverse this trend?

It is of utmost importance to stop the brain drain. Mid-level workers need to be trained. These middle-skilled personnel are undervalued and invisible. Yet, these health personnel show more sustainability while not being tempted by migration like highly trained health professionals. A good example of this is the use of Tanzania's paramedical personnel to dispense anti-retroviral medication. On 12 September, we will have a high level meeting in New York on migration. The aim is to stimulate more bilateral agreements between countries to avoid permanent migration and to enhance shared training efforts. All countries should share responsibility in this field. In this respect, the pull factor is of importance, meaning that the rich may agree to train more. In the US, where I am currently living, 500,000 nurses and 200,000 doctors are needed by the year 2015. Nurses are being imported. The fact of acquiring them cheaply by not having to educate them is unacceptable. There are many ideas to think about.

Q: The pharmaceutical industry is often criticized. Do you think there is evolution to provide medicine at lower costs? Is there a will within those companies to become socially responsible beyond just a superficial marketing move?

We regard the private sector as an important player either providing good resources or a negative influence. We are keen to see them fully responsible and specific companies have taken this direction. Paul Hunt, the UN Special Rapporteur on Health, is developing guidelines related to the human right to health. The subject is vast and goes from intellectual property to pricing. It is evident that we need a structure and guidelines and pharmaceutical companies, as well as all other stakeholders, have to buy into this.

Q: What are your expectations from the debates during the present Forum and in what way can they influence decision makers?

The Forum comes at the right time. This is proven by the fact that the attendance overshot all expectations. I am convinced that we can initiate change in most of the fields which are on the agenda. The dynamics exist to accelerate a breakthrough in areas such as safer food and water supply, improving educational levels and other social determinants. The Millennium Development Goals have set a 0.7% of GDP level for the aid to be provided by the North to the South. The US Administration is today more willing to commit itself as well. All of this needs to be thought through. The errors of the past often found their origin in the non-coordinated approach of health issues and systems. This Forum gives the opportunity to encompass government representatives, healthcare specialists, donors and NGOs, to strengthen sustainable long-term health systems and to develop common views. With the human rights as a framework it seems that the objective of access to health for all will certainly have made some progress through the conference.

Q: A few weeks ago you attended the World Conference on AIDS in Toronto. What was your overall impression and what conclusions could be drawn from the debates?

My impression was quite similar to the one that prevailed during the previous conference two years ago in Bangkok. A lot of emphasis was put on the progress to be expected from fundamental scientific work. Subjects such as the status of development of microbicides were at the centre point of the majority of the debates, but the use of female condoms got little mention in the context of sub-Saharan Africa. The ability of women and girls to protect themselves from contracting the virus is as important as the process to prepare effective microbicides. The issue of the identification of risk groups did not seem to draw a lot of attention. It appeared as if there was a tendency not to want to address real problems. In a sense it was quite disappointing. Community groups know what they are doing and what they need, but they did not always get enough attention. The focus was more on well known guests than on rallies on women's issues and rights. A number of key issues were not addressed. The planning for the next conference in Mexico needs to put the priorities right.

More Information

For more information about Mary Robinson's current activities and work with Realizing Rights, see http://www.realizingrights.org.

GHF2006 – Interview with Dr. Julio Frenk, Minister of Health of Mexico

Improvement of health systems and poverty reduction go hand in hand. Image: Viola Krebs, ICVolunteers.org

September 2, 2006

Submitted by: Viola Krebs (ICVolunteers); Contributors: Jean-Pierre Joly (ICVolunteers)

Health reform is badly needed in many countries in the developing world in order to stop the burden of catastrophic healthcare costs remaining on the shoulders of individual families. We talked to Dr. Frenk, Minister of Health for Mexico, where an important healthcare system reform was launched in 2003. The reform implemented, among other things, a 7-year plan to finance "el seguro popular" or popular insurance.

Q: How do you see the development of a global health policy? What are the major issues?

Let me give you the example of Mexico to illustrate my views. It is about a real life experience regarding the deep transformation undertaken by my country in the field of developing and managing a health system. It has been a process of shared learning and innovation, inspired by other countries, including European nations. It is our aim to share our experience with others and make it available to them.

Many barriers have to be overcome when putting in place a coherent health system which provides equal access to health for all. Barriers are geographical, cultural and organizational. For example, bureaucracy will generate long queues and alter quality. In addition, a major stumbling block to enhancing health programmes is their financing. We, in Mexico, have understood that we need to demolish the financial barriers to make progress. Financing is of course not just an issue for Mexico. Indeed, nearly everywhere in the world, financing of health systems has not kept up with existing and forecasted needs. However, developing countries have to bear a double burden. Not only do they have to face health problems due to epidemic diseases but, at the same time, they have to build their infrastructure.

Hence, many low and medium income countries have been unable to adapt their health systems. But the changing environment requires them to do so. Several factors can provide pressure to trigger change. Today, we have to face new epidemic diseases such as AIDS which did not exist 25 years ago. Another factor is brought by technological evolution: there are new drugs available that can save lives. And then there is the growing pressure and awareness of populations that health is a fundamental right. Good pressures can help adjust health systems in order for them to respond better to needs.

Q: So, how did you go about bringing change to the health system in Mexico?

We decided to tackle the issue on several fronts, in particular the social, the financial and the cultural ones. What we have done is not perfect but it has produced good evidence. First, one has to understand the reality and become aware of the unacceptable paradox that the lack of financing healthcare in a country can itself create poverty. Next, you can transfer experience from elsewhere to adapt and improve the existing or non-existing system, taking into account the social, financial and cultural characteristics or limitations of the country. Once you have been able to produce good results of the interdependence between improvement of health systems and poverty reduction a new global dynamic appears.

In the Mexican case we took the decision to invest heavily in research to guarantee quality in the long run. Finally, it seems of utmost importance to me to articulate a clear ethical framework in which you can reflect the challenges of your people. Another element is the use of the ethical (universal human right) argument, to obtain the necessary political support in order to have your projects accepted.

Mexico has created a social protection scheme which is social insurance similar to what exists in several European countries and which allows poor people access to health care. This system of protection, also called popular insurance or "seguro popular" avoids that people are excluded from basic healthcare.

As I mentioned before, it is important to implement these new policies gradually in order to keep the finances of the country in balance. The Ministry of Finance only supported the changes on the basis of a sound financial plan. We adopted a 7-year horizon for the reform. A strict follow-up on the expenditure side increases credibility among parliamentarians and increases the chances of funding being continued in the future. Thanks to the support of the whole government we could create 2700 new facilities. It is true that in our case we started from a very low level and had a huge shortage, which explains why there were so many health facilities needed and created, in particular in the poorest parts of Mexico.

Our programmes also include education and training of medical staff. Another significant effort has been produced on the drug supply side. In this context, measures are taken that drugs are only obtained through prescriptions in order to have better control. And everything is done to spend the money in an efficient way.

We also are constantly assessing our policy, the state of the technology in place. A number of challenges need to be addressed. There are still existing geographical discrepancies, bureaucracy treating people without dignity, organizational and cultural barriers. 10% of the Mexican population is indigenous and more than 50 languages are spoken in the country. Health care in the patient's language is needed. Monitoring tools are being put in place and the reports are made public. The results of the present system are needed to convince members of parliament and taxpayers to continue their investment in the new social contract for health.

Q: Just some words about your candidacy to the World Health Organization (WHO) and what your plans are?

I very much value the legacy of Dr. Lee. We had the honour of working together under Dr. Bruntland. We were colleagues. Later, I followed his work being on the Mexican delegation to the World Health Assembly. Also, Mexico hosted the conference on health research for development in November of 2005, which was an opportunity to welcome Dr. Lee to Mexico. Unfortunately, his term was cut short by his sudden death. I would like to continue many of the reforms that were started under him. I was very much in line and agreed with Dr. Lee's approach, in particular his focus on Africa, AIDS treatment, partnerships and financing mechanism in those partnerships. The focus on the internal management being more accountable will also be one of my priorities. The improvements initiated by Dr. Lee must continue.