Ebola’s Message: Public health and medicine in the twenty-first century (basic bioethics)
Evans, Nicholas G, Tara C. Smith, and Maimuna S. Majumder (editors). Cambridge, MA: The MIT Press, 2016.
The 2013-2015 Ebola outbreak was a public health disaster that killed over 11,000 people and devastated Guinea, Liberia, and Sierra Leone. Thanks to its mismanaged international response and sensational media coverage, it was used by politicians to justify poor policy. However, it also featured promising developments on clinical treatments and the recognition of the need for global public health systems to deal with epidemics that cross national borders. This book offers a range of perspectives on the lessons learned from the science, politics, and ethics of the Ebola outbreak. It also discusses the management of Ebola in both rich and poor nations, the spread of the disease, racist perceptions of West Africa, media responses to the outbreak, and the ethical concerns of running clinical trials of experimental treatment during an outbreak.
A new routine health information systems (RHIS) curriculum from MEASURE Evaluation aims to improve capacity to conceptualize, design, develop, govern, and manage an RHIS, and use the information the system generates to improve public health practice and service delivery.
The curriculum was developed by leaders in the field of RHIS—the USAID-funded MEASURE Evaluation project; the World Health Organization; the Free University of Brussels/European Agency for Development and Health (AEDES); the University of Oslo, Norway; the National Institute of Public Health (INSP) in Mexico; and the University of Queensland, Australia. Strong HIS that produce reliable, timely, and good-quality data help health program managers to monitor, evaluate, and improve health system performance and make evidence-informed decision.
Achieving improvements in global health isn’t done alone—it takes a system. Read about five ways MEASURE Evaluation helps to change the world.
Experts at MEASURE Evaluation develop approaches and conduct research for health information systems strengthening and improved public health outcomes in low- and middle-income countries across the globe. We gather the best of their thinking, results of rigorous evaluations, and innovations grounded in best practice—here delivered in small sound packages to advance understanding and best practice.
Structural interventions aim to improve health outcomes by altering the social, economic, and legal-political environment in which health processes and outcomes are embedded (Blankenship, et al., 2006; Parkhurst, 2013). By targeting structural factors such as poverty and education, structural interventions aim to influence the underlying context of HIV risk (Blankenship, et al., 2006). Investment in structural interventions and their evaluations has lagged behind that in behavioral and biomedical interventions for HIV prevention. Additionally, methodological challenges in evaluating structural interventions have contributed to the relative dearth of evidence about their effectiveness (Gupta, et al., 2008; Heise & Watts, 2013). In addition to showing that a structural intervention works in a particular context, it is important to provide evidence for why, under what circumstances, for whom, and at what cost the intervention is effective (Heise & Watts, 2013).
The process of evaluating structural interventions is much the same as that of evaluating other interventions. However, in this guidance we highlight strategies and considerations that are uniquely important in the former.
Although numerous challenges exist in evaluating structural interventions, current evidence indicates their promise for HIV prevention. By planning for evaluations early, working with stakeholders, determining a theory of change, carefully selecting research questions, and selecting the most appropriate research design, those in the HIV-prevention field can continue to determine which interventions are most effective.
MomConnect is an mHealth initiative giving pregnant women information via SMS. We report on an analysis of the compliments and especially complaints component of the feedback. We scrutinised the electronic databases containing information on the first seventeen months of operation of MomConnect. During this time, 583,929 pregnant women were registered on MomConnect, representing approximately 46 per cent of pregnant women booking their pregnancy in the public sector in South Africa. These women gave feedback on services received: 4173 compliments and 690 complaints. Nearly three quarters (74 per cent) of all complaints were resolved. The complaints were classified into those related to health services (29 per cent), staff (22 per cent), health systems (42 per cent) and other (6 per cent). These complaints were fed back to managers in the health facilities. This has resulted in improvements in the quality of services, e.g. decreased drug stock-outs and change of behaviour of some health workers.
The delivery of health-related services via information and communications technologies (ICT) is referred to as eHealth. The South African mHealth strategy (2015–2019) defines mobile health—or mHealth—as a subset of eHealth, which involves the use of mobile computing, medical sensors, or other communication technology in the delivery of health services. mHealth has the potential to empower clients with information to inform their healthcare decisions and link them to health services.
Many types of mHealth projects and applications can compromise client privacy or confidentiality. For example, an application may store sensitive client data without any controls on who is allowed to access it. Or clients may be negatively affected by incorrect medical advice from information applications, or misdiagnosed through remote conversations with health providers. To avoid these and other negative scenarios, it is essential that regulations to protect clients be in place and enforced.
Although mHealth regulations currently in place in South Africa have a number of gaps, regulatory bodies will be able to address many of them in the medium to long term. People involved in the design and implementation of mHealth projects should keep abreast of regulatory developments to ensure they are in compliance.