International Festival of Public Health

LT 3 - Global Health

Betsi-Quthing Health Partnership: A Global Project with a Local Heart

Presenter: Aaron Pritchard (Betsi Cadwaladr University Health Board)

Other Author(s):

Abstract Text:

The Betsi-Quthing International Health Partnership is a small and evolving health link between the University Health Board in North Wales and Quthing health district in Lesotho, Southern Africa. Guided by the Tropical Health and Education Trust's (THET) Principles of Partnership and those outlined by the International Council of Voluntary Agencies (ICVA, 2007) the partnership focuses on the co-development of bespoke training which addresses self-identified priority areas among our health colleagues in Quthing. Through a public health lens and with a system wide perspective, our partnership facilitates visits in both directions and through which health professionals share learning with each other. Recent and ongoing work includes the delivery of a bespoke programme of clinical skills refreshers for health workers across all rural health centres in Quthing as well as supporting nurses working in remote and resource limited settings to care for people with mental health needs using the World Health Organisation (WHO) mental health GAP framework. The partnership has also integrated support with local health service leadership and management, reflective of the system approach to healthcare provision embedded in our work. Underpinning all our work is a commitment to enabling sustainability and doing so with recognition of the centrality of being needs-led and adaptable to context. A key component of this sustainability involves exploring more innovative ways to support our partners using low-cost and accessible communication technology. Crucially, the partnership is founded on friendship and respect and this currency, we assert, is the most sustainable of all.

The potential contribution of Community Health Workers in prevention and control of non-communicable diseases in Uganda: a case study of Wakiso district

Presenter: David Musoke (Makerere University School of Public Health)

Other Author(s): Edwinah Atusingwize, Sarah Nalinya, Rawlance Ndejjo, Charles Ssemugabo, Damilola Oyewole, Gibson Linda

Abstract Text:

Background: The increasing burden of non-communicable diseases (NCDs) poses a major challenge to Uganda’s health system which is already overstretched by communicable diseases. The involvement of community health workers (CHWs) in the prevention and control of NCDs in Uganda is minimal, and it is not clear what their specific roles could be. This study therefore assessed the potential contribution of CHWs in the prevention and control of NCDs in Wakiso district, Uganda.

Methods: This was a cross-sectional mixed methods study conducted among 485 CHWs in Wakiso district. In addition, 6 key informant interviews (KIIs) and 4 focus group discussions (FGDs) were held. The KIIs were conducted among officials from Wakiso district health office, Ministry of Health, as well as health practitioners, while FGDs were held among CHW parish coordinators. Quantitative data was analyzed in STATA 12, and thematic content analysis was used for qualitative data.

Results: Besides a few misconceptions, CHWs were generally knowledgeable about NCDs (75.3%), with hypertension (77.1%) and cancer (63.0%) being the most commonly known. Many CHWs knew the common risk factors for NCDs including poor diet (60.1%), smoking (31.9%) and physical inactivity (27.9%). The majority of CHWs said NCDs were preventable (71.8), treatable (89.9%), and that they had a potential role in their prevention and control (94.4%). From the FGDs, CHWs were frequently consulted on NCDs by community members. However, only 63.1% reported having ever been involved in NCD prevention or control. Potential roles of CHWs in prevention and control of NCDs were community mobilisation and sensitization, screening, case referrals, and support for adherence to treatment. However, there were concerns about potential challenges to their involvement in NCDs prevention and control related to inadequate knowledge, negative community perceptions, and lack of support from health workers. In addition, it emerged that the success of CHWs involvement in prevention and control of NCDs would require critical attention to the needs of training and supervision to enhance their performance.

Conclusion: CHWs were generally knowledgeable about NCDs, but their involvement in the prevention and control of these diseases was limited despite being regularly consulted by community members. With adequate support systems such as training and supervision, CHWs can contribute to the prevention and control of NCDs in Uganda.

Primary Health Care implementation in Ghana: The influence of International NGOs

Presenter: Nana Nimo Appiah-Agyekum (University of Ghana)

Other Author(s): Anita Anima Daniels, Richard Osei-Boateng

Abstract Text:

Purpose: In Ghana, international charities and foundations have always played a key part in implementing global health initiatives in general and PHC in particular (Delisle et al., 2005). Yet, a paucity of evidence exists on the issue especially considering current trends of over-reliance on external funding for local health interventions. This study therefore explores the essence and challenges faced by international NGOs with respect to PHC implementation in Ghana to fill the knowledge gap.

Participants and methods: 15 top and middle level PHC implementers across Ghana were purposely selected and interviewed. The interviews was recorded, transcribed and analysed thematically using the framework analysis.

Results: Consensus among respondents was that donors and international organizations maintained a stranglehold on PHC interventions which resulted in a diminished role of the community and the GHS. Aside reinforcing a culture of dependence on external stakeholders for PHC sustenance, PHC was determined by donor preferences and priorities than by local needs. In relation, a common view was that the external control and management of PHC interventions and resources challenged PHC implementation especially when the external stakeholders understood neither the peculiar socio-cultural environment nor the local variations in health conditions and needs. The challenge was even worse in donor-led initiatives that did not allow modification and variation of interventions to suit peculiar local areas.

Conclusion: Generally approaches to PHC especially in the developing world are more of a function of external stakeholder needs and preferences than socio-economic circumstances, political ideologies, geographical and demographic features of the country. In spite of the numerous contributions to PHC, external stakeholders, based on findings, appear to have usurped the power and responsibilities of local governments to implement PHC and provide health services in general for their people. Especially in countries implementing the SPHC, external donors have deepened the medicalization and inequities in health outcomes by focusing on specific medical interventions and target populations (Magnussen et al., 2004). Their stranglehold on all aspects of PHC also appears to be a major cause of disempowerment of local communities from partaking in decisions and actions affecting their health in Ghana.

Religion as partner in improving global health

Presenter: Omololu Fagunwa (University of Huddersfield)

Other Author(s): Mary Olaniyan

Abstract Text:

Global health, concept of placing priority on improving health and achieving equity in health for all people worldwide has begun to gain attention of governments and health professionals, with the World Health Organisation at the frontline. The WHO recognised dimensions of health are physical, social, mental and spiritual health. Religious beliefs and practices may have both positive and adverse impact on health and disease. Not until recent time has the positive influence of religion on health attract attention in the academic space. Here we present the influence of religious practices and beliefs and its organised body on health outcomes. Literatures were reviewed for the association between religious rituals and infections. Major world religions – Judaism, Christianity, Islam and Hinduism have rituals that can potentially cause infections. On a positive note, the influence of religion and its organised body on health outcomes – Immunization and Access to Medicine is highlighted. Religion is both a social determinant of health and key driver to achieving improved global health. Religion needs to be given the necessary considerations in all global health discourses, strategies and implementations.