Comparing Integrated Management of Child Illnesses at Kawempe Health Center (IV) in Uganda, Vertically Integrated Health System and a Horizontally Integrated Health System at two centers in San Francisco County California USA

Comparing Integrated Management of Child Illnesses at Kawempe Health Center (IV) in Uganda, Vertically Integrated Health System and a Horizontally Integrated Health System at two centers in San Francisco County California USA

Muyunga-Mukasa, T.R.

                       Kawempe National Referral Hospital. Source: Google

                                                 INTRODUCTION

In Uganda, a country in East Africa, collaboration with International teaching Hospitals has helped create opportunities for transfer of knowledge, best-practices and skills that would otherwise not be available at lower level health facilities. The Liverpool-Mulago Collaboration is one such example. This resulted in the integrated management of childhood illnesses where: identifying families with expecting mothers; immunization drives; neonatal care; postnatal care; involving men in caring for expectant mothers; voluntary medical male circumcision; HIV/STIs checking; Partner counselling; and home-based nutrition plans are performed as packaged health services. In USA, the San Francisco Bay Area’s San Francisco County has various health delivery services that are combined as a single package. In this discussion, one will read briefly about Kawempe Health Center (IV),  Kaiser Permanente (KP) and Mercy Housing.

Access is a proxy measure for patient experience around which health delivery is built. Access can be initiated in form of collaboration, vertical integration or horizontal integration. These three strategies make the initiatives provide better health outcomes such as: collaboration, integration and service expansion accessible to the people who need them.  Collaboration creates space for transfer of  health delivery skills, human resource,  capital and logistics (LMP, 2014). Integration is as a result of acquisition, merger, alliance networks and joint ventures. Service integration includes extension of core product or service and this is known as horizontal integration. 

The kind that involves entry into a new type of service along the continuum of care provides diversified services is called vertical integration. Vertical integration provides proximity to different services, specialties, research, clinic trials and availability of different health professionals (Memorial Hermann, 2015).  For the sake of this discussion, access is the ability of a person to obtain health care services when needed (Shi, 2015).

                             Kawempe Health Center (IV), Kampala Uganda

Kawempe Health Centre (IV) is about 5-6 miles away from the National Referral Hospital, Mulago. The health facility is used as a primary health unit that offsets the congestion or referrals at Mulago. This ensured such activities that led to  over 6,000 deliveries per year (LMP, 2014). Funds to pay for resident doctors, a functioning operating theatre, blood transfusion facilities and Uganda government commitment to improve the functionality of Kawempe Health Centre have seen a fresh start there. Currently such services like caesarean sections and Voluntary Medical Male Circumcision are conducted there. This in turn is reducing the number of referrals to Mulago Hospital. Other services include: Mother and Child health services; Youth Friendly Services; HIV and STI counseling services; Laboratory Services;health Management Information Services; primary care;and a Health Centre (III) with a fully functional maternity unit. The long-term volunteers continue to offer support and training to the local midwives in areas such as neonatal resuscitation, patient monitoring and emergency obstetric skills. The form of collaboration has elements of vertical integration and is known for its cost-effective care with quality services to its enrollees. It is a yellow-star awardee providing quality services and access to healthcare services for a wide ranging population in Kawempe Division (a division of Kampala Capital City Authority-KCCA). 

The implications of  collaboration and integration for the management of the organization is that it has brought about facilitation that promotes healthy outcomes for the urban/sub-urban communities.

                        Kaiser Permanente, San Francisco Bay Area California USA

Kaiser Permanente is a vertically integrated health system that links services at different stages in the production process of health care, e.g., organization of primary care, acute care, post acute services and a hospital (Kaiser Permanente. (2014). The vertically integrated health system provides an environment in which an important element of health delivery or provision called access is possible. As one of America’s leading health care providers and not-for-profit health plans, founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of members and the communities. Kaiser Permenente serves more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health (kp.org/share). Kaiser Permenente provides employment, care, coverage, a list of doctors to choose from, get lab tests, and pick up medications all in one place. Under the same arrangement one is able to purchase individual or family health pan; Medicaid/Medical; Medicare; Employer-sponsored plans; as well as explore employment opportunities. Kaiser Permanente health plans ware expended to include breast cancer screenings and early detection (kp.org/healthy). The form of integration exhibited by Kaiser Permenente is known for its cost-effective care with quality services to its enrollees (Shi, 2015). It is a top-notch provider of quality services and it continues to provide access to healthcare services for a wide ranging population in Northern California. 

The implications of integration for the management of the organization is that scattered  entities are under one mutually cooperative arrangement. This has significant influence on patient well being as well as the patient/consumer experience along the continuum of care. Being under one roof the following six features, i.e., safety, effectiveness, patient-centeredness, timeliness, efficiency and equitable services that close the gap for minorities or underserved population groups are achievable.

                    Mercy Housing  San Francisco Bay Area California USA

Mercy Housing is in 41 states of US and is an example of horizontal integration that I chose to share with you. Mercy Housing, a national nonprofit organization, is working to build a more humane world where poverty is alleviated, communities are healthy and all people can develop to their full potential. Affordable housing and supportive programs improve the economic status of residents, revitalize neighborhoods and stabilize lives. Mercy Housing one of the nation’s largest affordable housing organizations participates in the development, preservation, management and/or financing of affordable, program-enriched housing across the country. It serves a variety of populations with housing projects for low-income families, seniors and people with special needs. It acquires and renovates existing housing, as well as develop new affordable rental properties. Mercy Housing created a stable foundation where residents can explore their full potential, supported by practical resident programs such as health classes, financial education, employment initiatives, parenting and after-school programs for children. Residents are supported with the resources they need to be good neighbors and members of a greater community. Mercy Housing begins with housing, but goes far beyond to strengthen the lives of the people who call Mercy Housing home. Whether it's educational support, a financial literacy program or health care education, Mercy Housing is always trying to provide services for local low-income community. Mercy Housing provides Resident Services that fall into four program areas: Economic Development, Education, Community and Health & Wellness. In an effort to assist the millions of people in need of stable affordable housing, Mercy Housing provides a wide range of affordable, low-income apartment rental opportunities across the United States.  The housing services are available for families, seniors and people with special needs, including those with developmental disabilities, HIV/AIDS, formerly homeless individuals and Veterans. 70% of  all residents are families;21% of our residents are seniors; 9% of residents are people with special needs (people with HIV/AIDS, formerly homeless individuals, veterans and people with physical and mental impairments). 

The implications of integration for the management of the organization is that the scattered housing are earmarked to serve different population groups geographically and health-wise. Mercy Housing can also go into mutual cooperative arrangement with other service providers. This has significant influence on resident well being as well as experience. Being that they are grounded in non-discrimination, Mercy Housing provides homes for vulnerable population groups. Other service providers are able to bring care to the home-bound and bed-ridden. Under such an arrangement, minorities or underserved population groups are able to access services that improve of their welfare (Mercy Housing Publications, 2015).

HIV/AIDS care systems and structures can learn from the USA and vice versa. Shared lessons and themes are opportunities for transfer of knowledge, best-practices and skills across health facilities. Diversifying care and prevention norms include the integrated management of childhood illnesses; identifying families with expecting mothers; immunization drives; neonatal care; postnatal care; involving men in caring for expectant mothers; voluntary medical male circumcision; HIV/STIs checking; Partner counselling; and home-based nutrition plans being part  of the comprehensive package of health services. This contributes the strengthened prevention, support and mitigation continuum necessary for ending HIV. 

Source: LMP

Source: LMP

Source: LMP

Source: LMP

REFERENCES:

1). Being the Best Saves Lives: Kaiser Permanente Leads the Nation in 21 Quality Measures. October 22 2015. http://share.kaiserpermanente.org/article/being-the-best-saves-lives-kaiser-permanente-leads-the-nation-in-21-quality-measures. Retrieved on December 22 2015. 

2). Kaiser Permanente. (2014). Kaiser Permanente. Retrieved from http://kp.kaiserpermanente.org. Retrieved on December 22 2015.

3). Mercy Housing Publications. (2015). http://www.mercyhousing.org/Publications. Retrieved on December 22 2015.

4). Memorial Hermann. (2015). Memorial Hermann. Retrieved from http://www.memorialhermann.org. Retrieved on December 22 2015.

5) Liverpool-Mulago Partnership For Women's and Children's Health. 2014. http://lmpcharity.org/index.php/lmpprojects/hciv/kawempehciv. Retrieved on December 23 2015.

6). Shi, L., & Singh, D. A. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.

The "Insurancization" Culture: What America can teach Africa: From a Public Health Perspective

The 2010 Patient Protection and Affordable Care Act (PPACA) and its modifier The 2010 Health Care and Education Reconciliation Act are also called the Affordable Care Act. They are good examples to emulate by African countries engaged in implementing sweeping health care delivery Laws, initiatives and systems if they want to be relevant in this post globalization era. In essence, they enable government to generate and direct funding means for a universal coverage initiative.

The United States of America is increasingly investing in global health. It is imperative that say, African countries, study what has made the US stand at par with older developed countries of Europe. One way to do this is by identifying historical events or circumstances that brought about the need for impacting legislation and examining the positive and/or negative consequences that followed the implementation of the acts.

Health delivery in the US is complex and fragmented into functional components: financing, insurance, delivery and payment.

Health delivery is changing to accommodate concerns of educational and research institutes, medical suppliers, insurers, payers, claims processors, healthcare providers and many integrated networks providing a continuum of care and covering many of the service components. The changes are mainly in response to concerns regarding costs, access and quality (Shi, L. & Singh, D. A., 2015).

How much have African countries empowered their communities to look at health as a commodity of value? 

Health is an outcome of individual behavior, inclination, opportunity to participate in healthy behavior in relation to  family, community, environment and social conventions on a backdrop of systems through which health services can be provided (Turnock, 2016). Three institutions: government (e.g., legislature, judiciary, executive, federal and state); private sector (e.g, foundations, research institutes and lobby groups) and businesses (e.g., military, media, law, finance, manufacturing, industry and non-governmental organizations) influence the delivery of health, allocate values and shape the lives of all Americans (Dye and Ziegler, (2006). US government is distinct from the private sector and business spheres. This was emphasized by many presidents, e.g., President Coolidge Calvin,1923-1929. This distinction is maintained further between Federal and State governments by court rulings too, e.g., the  US Supreme Court ruling of 2012.

The 2010 Patient Protection and Affordable Care Act (PPACA) is a comprehensive measure tying together comprehensive coverage, care and costs in order to deliver health services. PPACA is also tied to other acts such as the Sunshine Act (Sarah Freymann Fontenot, 2013) which mandates that any transaction between a physician (or teaching hospital) and the pharmaceutical or device industries more than $10 in value must be publicly disclosed. The government’s intention is to end what it labels covert activity, unnecessary drug prescription and potential conflicts of interest between physicians and the pharmaceutical and device manufacturing industries. PPACA also calls for comprehensive service provisions addressing the needs of elderly, disabled, women, men, youths, children, refugees, poor, special population groups and the uninsured. Enrollment is on-going. The PPACA has three features: expanded coverage; cost friendliness; and expanded care for different populations payable at different health provision facilities (e.g., local hospitals, dental clinics, and chosen network of Doctors within states and in some cases across states). It is  given different names in different states, e.g., Azcentral for Arizona, MassHealth in Massachusetts or Covered California in California.

PPACA is a summation and culmination of all other piecemeal tried and tested Acts since 1912. To arrive at it, one has to trace it from the beginnings of America. However, according to History of Health Reform in The USA (www.kff.org) concerted effort towards the present PPACA is traced from developments that transpired between 1912 to 1932 when major events such the 1921 Sheppard-Towner Act, 1929 Baylor Hospital Pre-paid Insurance and the National Health Insurance/New Deal; then the outcomes of events between 1933-1953 e.g., Economic Security Commission to address old-age, unemployment, medical care and insurance and  the report on risks to economic  security arising out of illness; the events of 1954-1974 that included: Military medicare and Civil Rights Act; 1975-1940 events that addressed the high inflation, high costs for health care; and 1991-2011 events that saw the appearance of the National Committee on Quality Assurance (NCQA) Forms to accredit managed care health plans and the eventual passing of the 2010 Patient Protection And Affordable Care Act (P.L. 111-148). 

The positive side of PPACA according to the NCBW 100 brochure  are:

Ending arbitrary withdrawals of insurance coverage.

Guarantees right to appeal.

Ends Pre-existing condition exclusion

Keeps young adults covered.

Covers preventive care at no cost to patients.

Ends lifetime limits on coverage

low monthly premium

The negative side of PPCA are:

It was not sold well to scared undocumented immigrants who thought it was a ruse to identify and have them rounded up.

The PPACA has added to the already fragmented systems that are loosely held together. This makes it hard for overall planning, direction and coordination from a central agency. There is a likelihood of inconsistencies and waste. 

PPACA and the Sunshine Act are interpreted as instruments to deter the medical and pharmaceutical world from prescribing large numbers of dangerous, inappropriate or unnecessary drugs allegedly because of industry influences. This depicts these professions as irresponsible which is not the case.

However, the above three can be addressed through continued awareness drives, involving communities in health delivery and engaging in proactive equitable interventions. The take back home lesson for African countries is to consider establishing mechanisms to generate insurance funds, consolidate a health care delivery system and develop policies that ensure financing, insurance, payments and delivery of health. This will be one way of improving on the general welfare of the populations.

REFERENCES:

1. Dye and Ziegler, (2006). Irony of Democracy. Belmont, CA: Thomson Higher Education).

2. History of Health Reform in The USA. https://kaiserfamilyfoundation.files.wordpress.com/2011/03/5-02-13-history-of-health-reform.pdf. Retrieved on December 3rd 2015.

3. NCBW 100. National Coalition of 100 Black Women-San Francisco Chapter 

4. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett

5. Shi, L., & Singh, D. A. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.

6. President Coolidge Calvin (1823-1933): Washington D.C: The White House Historical Association. 

7.Sarah Freymann Fontenot, (2013).Understanding the Affordable Care Act Bit by Bit: Will Transparency and Sunshine Shrink Costs? ACPE.ORG

The Pontiffs and Africa!

Pope Francis you are welcome to Africa,

Everyone in Africa welcomes you,
yes, this is true, everyone,
Even the young one will be told about you,
In Africa the seasons will be named after you,
yes, 'my  child shall be named Francesca if she is a girl.'
'My child shall be named Francis if he is a boy.'
'We had a bumper harvest during the Papal visit.'
Some will say, 'I felt the Spirit of the Lord,'
Others will say 'I was there and saw the pope with my eyes,'
You are a blessing to Africa,
You are a blessing to Kenya,
And so many will say, Uganda is blessed,
We were blessed before time,
Central African Republic is blessed,
You came to many countries in Africa,
Even if you visited 3 countries this time around,
You were on the African continent,
A very promising continent,

Am sure you are aware of this,

The smile you bring to many faces,

The humility and purpose,

The meaning of living in the now,

The reason to bring God in our life,

The effort behind being responsible,

The mortar between humanity and nature,
Many people were brought together by your visit,
By this I don't mean mere getting together in one place,
many people joined in the occasions that made your visit to Uganda successful,
People from different walks of life,
You brought about peace among enemies,
You caused many to revisit their dreams about life,
We saw purpose dressed in clothes,
A child kissed,
A leper hugged,
a young girl welcomes the pope,
adolescents given hope,
You lit a fire in all of us,
A fire of love,
A fire of respect,
A fire of accountability,
A fire of resolve,
A fire of commitment,
Whether in Kenya, Uganda or Central African Republic,
We promise you: we shall keep the fire burning!

Pope Paul XI and Emmanuel Cardinal Nsubuga of Uganda

Pope Francis

Pope Francis going to work in Rome

Pope admirers

Pope in CAR, November 2015

Pope in CAR

Pope in CAR

Emeritus Pope Benedict and Pope Francis

Pope arrives in CAR

Pope Francis and Emeritus Pope Benedict

Pope Francis

Pope In Kenya,November 2015

Pope in Uganda, November 2015

Seeing off the Pope, November, 2015 at Entebbe International Airport Uganda

Pope in Uganda

Pope with Ugandan youth

Pope visiting the sick

The Vatican

Pope Francis

Pope Francis saying Mass

Pope Francis waving to crowds

Rubaga Cathedral, Uganda

Pope in Kenya

ACKNOWLEDGEMENT: All pictures are collected from different sources such as: New Vision, Daily Monitor, Google, Wikipedia and Vatican Archives. Copyright belongs to them. Here they are used for educational purposes. Thanks.

THE UN ON TERRORISM

UN Envoy welcomes Security Council Resolution on ISIL ( A megaphone Article Post)

Baghdad, 21 November 2015 – The Special Representative of the United Nations Secretary-General for Iraq (SRSG), Mr. Ján Kubiš, welcomed the Security Council Resolution on ISIL adopted Friday.

In the Resolution, the Security Council concludes that ISIL constitutes a global and unprecedented threat to international peace and security, notes that it has the capability and intention to carry out further attacks, regards all such acts of terrorism as a threat to peace and security and expresses its determination to combat it by all means.

“The people of Iraq are suffering daily from the terror tactics and ideology of this evil organization and, therefore, this renewed commitment of the international community to fight ISIL and to come to the aid of Iraq, a country in the forefront of the struggle against terrorism, is timely and welcome,” SRSG Kubiš said.

The United Nations Security Council unanimously adopted Resolution 2249 (2015), which, among others, “calls upon Member States that have the capacity to do so to take all necessary measures, in compliance with international law, (……) on the territory under the control of ISIL (……), in Syria and Iraq, to redouble and coordinate their efforts to prevent and suppress terrorist acts committed specifically by ISIL (……) as well as ANF (Al-Nusrah Frot), and all other individuals, groups, undertakings, and entities associated with Al Qaeda, and other terrorist groups, as designated by the United Nations Security Council, (……) and to eradicate the safe haven they have established over significant parts of Iraq and Syria.”

The Resolution also “Urges Member States to intensify their efforts to stem the flow of foreign terrorist fighters to Iraq and Syria and to prevent and suppress the financing of terrorism, and urges all Members states to continue to fully implement the above-mentioned resolutions.”




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For more information, please contact: Mr. Khalid Dahab, Deputy Director of Public Information/Deputy Spokesperson United Nations Assistance Mission for Iraq (UNAMI), Phone: +964 790 194 0146, Email: dahab@un.org or the UNAMI Public Information Office: unami-information@un.org

Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda

Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda    

Muyunga-Mukasa, T.R.                      

                                                     SUMMARY:

Local government officials can present over 25 performance indicators below following the use of USAID funds:

1) focus on the poor; 2) improve engagement of the private-for-profit sector; 3) enhance efficiency; 4) strengthen stakeholder coordination; 5) improve service quality; 6) stimulate consumer-based advocacy for better health;  7) programming in maternal; 8) newborn and child health; 9) immunization; 10) family planning and reproductive health; 11) nutrition; 12) health systems strengthening; 13) water/sanitation/hygiene; 14) malaria; breaking cycle of transmission of HIV; 15) pediatric HIV care and treatment; 16) increase in numbers of women attending at least one antenatal care visit with a health care provider; 17) Opportunities for women to deliver their babies with a skilled attendant present will increase; 18) planning meetings on targeted health themes;  19)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues go; 20) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination; 21) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health;  22) existence of strategic plans at different levels of governance reflecting needs of communities;  23) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization;  24) generating disaggregated statistics giving insight into population demographics and;  25) lists or action plans by Village Health Teams.

A PRIMARY SCHOOL IN A RURAL PART IN UGANDA. DOES THE GIRL CHILD HAVE OPPORTUNITY TO WASH HER HANDS AFTER USING THE WASHROOM?  DOES SHE GET A FAIR CHANGE OF SANITARY PADS?

Local governments in Uganda can design systems that promote the health and life of adolescent girls and young women (5-24 years). A mental, sexual and reproductive health plan targeting adolescent girls and young women, can be effective if it is integrated with other activities. At a three percent (3%) population growth by 2025, a young population and a high total fertility rate, Uganda’s high population rate will continue to drive health expenditures upwards. Local Governments in Uganda are entities that can mobilize for action through planning and partnerships. This is captured in the Health Sub-District concept bringing essential health services-especially basic surgical and obstetric care closer to the communities. The attendant staffing, infrastructure, equipment and operating costs become resources for promotion of health. A  comprehensive WHO review of Uganda’s Health System conducted in 2011, found that whereas significant efforts are being implemented to qualitatively and quantitatively improve health in Uganda, more needs to be done to a) focus on the poor; b) improve engagement of the private-for-profit sector; c) enhance efficiency; d) strengthen stakeholder coordination; e) improve service quality; and f) stimulate consumer-based advocacy for better health. At local government level there are opportunities to conduct local health assessment and devise community health improvement plans. These local government entities are in a better position to tap into, say, the USAID funding if a focus on quality of care, service integration, and equity are to become a reality. The generated mechanisms and resources at an initial phase may be costly but these costs are reimbursed under the inbuilt cost of doing the U.S. government’s PEPFAR Business (CODB). The critical fiscal space thus created is an opportunity to increase government expenditure on health.  This will in turn create a standardized service delivery across all local government regions. Uganda has a Maternal mortality ratio of 435/100,000 live births. By end of 2015, Uganda needs to reduce that figure to 131/100,000. Poor access to quality maternal care services, is a significant barrier to improving maternal mortality in Uganda. “HIV/AIDS, malaria and respiratory infections are the top three causes of overall disease burden in terms of Disability-Adjusted-Life-years (DALYs) lost,” (Fiscal Space For Health In Uganda).

THIS SCHOOL IN A RURAL PART OF UGANDA IS A CO-EDUCATION FACILITY. WILL THE GIRL CHILD THINK ABOUT A SANITARY PAD OR HOW EARLY SHE HAS TO RISE FROM BED IN ORDER TO COMPETE FOR WHERE TO SIT IN THAT OVERCROWDED CLASSROOM?

There are two documents I hope local government planners can use. One is the Country operational plan guidance document provided by USAID, with focus on eradicating HIV/AIDS. It is a comprehensive tool that local council members in Uganda can find useful as they try to utilize PEPFAR funds in a bid to align money in prevention investments. At the local government level, planned and costed investments are called votes, e.g., providing insecticide-treated mosquito nets to a given number of households. In a bottom-up planning, promoted by decentralization, it is possible to harmonize targets for treatment, prevention and anti-discrimination at Local Council I, II, III, IV, V, Town Council, Municipality, Division and district. There are two outcomes that come to mind. One, it will strengthen an existing local public system that ensures health promotion and prevention of diseases. Two, it will critical forces of change at community level with health promotion and prevention of diseases at the planning core.

A CLASSROOM

The second document is the:The Maternal and Child Survival Program (MCSP). MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The Program places greater emphasis on key cross-cutting issues such as innovation, e/mHealth, equity, quality, gender, public-private partnerships, and involvement of civil society, community approaches and behavior change interventions. While maintaining focus on the technical high impact interventions, MCSP works toward sustainable scale up to include strengthening the health systems that deliver these interventions. (http://www.mcsprogram.org/). “It is at the heart of improving maternal-newborn health services globally: ensuring care is patient-focused; integrating programs to better serve the needs of mothers and babies; and extending innovative health services to the poorest and most socially vulnerable mothers and babies,” (Bliss, K. 2015). This USAID funding will help local governments mobilize for action through planning and partnerships where a woman in Uganda can seek appropriate counseling and maternal care services in any facility. There will be an increase in number of women attending at least one antenatal care visit with a health care provider. Opportunities for women to deliver their babies with a skilled attendant present will increase.

DO THESE MEN HAVE A PLAN TO PROVIDE THE ADOLESCENT GIRL WITH COMPREHENSIVE SEXUAL AND REPRODUCTIVE HEALTH COUNSELLING AT SCHOOL? THE PROFESSOR WHO IS ALSO A PRESIDENTIAL CANDIDATE IN UGANDA FOR THE 2016 PRESIDENTIAL ELECTIONS IS STANDING IN THE CENTRE WITH TWO TEACHERS. NB. ALL THESE PICTURES BELONG TO THE PRESIDENTIAL CANDIDATE PROFESSOR VENANSIUS BARYAMUREEBA.

The health sector at the district and sub district level in Uganda is governed by a district health management team (DHMT). The DHMT is led by the District Health Officer (DHO) and consists of managers of various health departments in the district. The heads of health sub districts (HC IV managers) are included on the DHMT. The DHMT oversees implementation of health services in the district, ensuring coherence with national policies. A Health Unit Management Committee (HUMC) composed of health staff, civil society and community leaders is charged with linking health facility governance with community needs (http://gov.ug/ministry/ministry-health).

USAID funding into a local government budget plan will cause: 1) planning meetings on targeted health themes including national and district indicators (UBOS, 2010)  2)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues 3) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination 4) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health 5) existence of strategic plans at different levels of governance reflecting needs of communities 6) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization 7) generating disaggregated statistics giving insight into population demographics and 8) lists or action plans by Village Health Teams as a continuum of response who bridge the gap and increase equity in access to health services ( http://www.pathfinder.org/). With the above it is more likely to have information on: voluntary medical male circumcision (VMMC), Test and treat, Viral load, TB/HIV, virology suppression, children health, pregnant women receiving B+, adults on life-saving anti-retro viral treatment, health needs of groups that are higher risk than total population, identified community resources  that support the public health system in promoting health and improving quality of life. A list of themes would be developed, which in turn could be used to assess community health status and community themes. 

Form a team amongst you and check with the US Embassy to see how your local government entity qualifies. A devolved institutionalized public health service is possible in Uganda. Turnock (2015) in “Essentials of Public Health” lists outcomes of deliberate community health improvement plans. I have chosen some points from the long list that I feel would be further outcomes of using USAID funds at a local government level. These are some of the further outcomes: 1) working with policy-makers, promote partnerships, educate, inform, develop policies and plans that support individual and community health efforts and plans 2) Social-community level activity plans 3) Social marketing and targeted media public 4) joint health education programs with schools, churches, Faith-based Organizations, cultural organizations and other entities 5) undertaking health improvement planning e.g., preventive screening, rehabilitation and support programs 6) building coalitions drawing from a wider range of potential human/material resources to improve community health.

REFERENCES:

1. Bliss Katherine (2015). http://www.smartglobalhealth.org/

2. Fiscal Space For Health in Uganda. World Bank Working Paper No. 186 Africa Human Development Series 

3. Government of Uganda, Ministry of Health. http://gov.ug/ministry/ministry-health

4. National Village Health Teams (VHT) Assessment In Uganda. 2015. http://www.pathfinder.org/

5. Statistical Abstract. Ministry of Health. 2010. http://www.ubos.org/

6. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.

7. USAID (2015). Country Operational Plan Guidance 2016 – Draft

8. USAID (2015). http://www.mcsprogram.org/our-work/ 

21st Century USA From a Public health Perspective

The main role of public health in the 21st Century will be to protect us from various diseases or life threatening conditions deriving from: climate change; emerging diseases; bioterrorism; racism; stigma; prejudice; and political dilemmas. Public health practitioners of the 21st Century must be in position to understand the complexities of cultural diversity, e.g.,different generational, economic, professional, ethnic, religious, linguistic background, gender, gender identity, sexual orientation, stereotypes, prejudices, physical status, conscious bias, unconscious bias, structural bias, enjoyment of access to resources, access to opportunities, access to options, safety from violence,  affordability of housing, civil rights, access to food, access to jobs, opportunities for job trainings, access to recreation and readiness to be  a compassionate provider. Many clients and communities face bias and discrimination when they attempt to access health and social services and , as a result, receive fewer services and services of poorer quality (Berthold, T. 2009). In order to provide public health services, government has concrete plans such as enacting laws, enforce laws, provide financial support and oversight to ensure promotion of health, prevention of diseases and instituting a preparedness mechanism.The most important new or expanded roles for public health occupations in the 21st century will include:

1. Strengthening the public health activities framework that is interlinked by a network of federal, state and local public health agencies with emphasis on referral mechanisms and oversight processes.

2. Ensure a reporting mechanism that dovetails into the overarching design where: the contribution of USA to international health-related interventions continues; the legal foundation gives gives primacy for health concerns to states; allows the federal government to promote consistency and minimum standards across the 50 diverse states; and a practical foundation of LHDs serving as the point of contact between communities and the three-tiered government.

3. Shifting mobilization tasks to advocacy entities at community level as a means of having a pulse on changing needs, resource needs and meeting public expectations.

4. Investing in early warning mechanisms for threats from fires to bio-terrorism. There will be need to have a contingency for fire hazards now that the globe is getting warmer. This will mean wildfire-prone geographical zones like Mid-Western and California will have more established fire departments. The quarantine points at border entry points, airports and ports need to be strengthened now that there is more likelihood for bioterrorism, hostility and acts of sabotage against the U.S. or any other nation by terrorists and enemies (www.nytimes.com). 

5. Public health practitioners reaching out to the indigent or marginalized. This will rely on the work of local health agencies. These will in turn report to second tier government levels and different organizations that form the backbone through which the power to protect the public’s health is possible.

6. Providing training and promoting competencies for public health professionals in the 21st century mostly in these areas: conducting essential public health services; legislation; regulation; policies; and the ability to negotiate,  justify public funding for many public health initiatives. For public health to be perceived, such essential services as are relevant: monitoring the health status of the population; diagnosing and investigating problems deemed hazardous to the public’s health; educating the population on health issues; mobilizing communities to act on their own health issues; developing policies; enforcing laws and regulations that protect the public; linking people to health services; ensuring a competent health care workforce; evaluating the effectiveness, access and quality of health services and researching to continue progress and innovation in healthcare (Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett).

7. Use of Technology, which will enable complex research to be translated into action in a faster and flexible way. Technology can be used in many other forms as well. One way is establishing a centralized health management information templates that can be used to report for instance compliances to the Healthy 2020 vision and mission. Events in which equity and equality are addressed can be captured at local, state, regional and federal levels. Racial biases are shown to be a part of the social structure of medical practices at both macro and micro levels (Centre for excellence in health care journalism). Use of web-based platforms to share information can help improve on coverage of what works and who is served. Public health will be a means for America to deal with the hot topics that focus on: race, culture, ethnicity, lifestyle, health status and health care in America. This might be the great quest of technology as well. Through technology it will be possible to level the health care playing field. Socioeconomics, individual racism, and institutional racism that represent the three predominant pathways to differential treatment for diseases will be targeted and redress provided. Reporting mechanisms will provide common indicators used to gauge quality of life for women and men irrespective of their gender, sexuality, race and social status.  Compiling reports into a format that can be disseminated to all concerned is another good use of  print technology and the world-wide web. In this format the media can be relied upon to make information available or the applicability of the information by society in form of case reports/studies or any format that is reliable for dissemination. However, newsprint, radio and TV tend to tap into our anxieties focusing on trivia. “The CDC has had to contend with bogus reports of imported banana carrying flesh-eating bacteria, drug addicts placing HIV-infected needles in pay coin-return boxes, virus soaked sponges arriving with the mail,” (Drexler, M. 2010). 

8. Understanding the need for post trauma stress counseling and care arising from the link between terrorism, massacres and resultant traumas, e.g., counseling after separation from loved ones, death and shock,  care after post traumatic stress disease (PTSD), homelessness following destruction of homes or infrastructure and other needs. A global nightmare envelopes the world every time wars, genocides and terrorist attacks occur anywhere in the world. The rallying call that brings together nations ready to do rescue activities is to profess solidarity with the suffering nations. Rescue efforts are made by nations. This was seen after September 11, 2001, in UK, in Uganda, in Tanzania, in Kenya and most recently in the 10th district of Paris where the most recent attacks have occurred. The San Francisco editorial has this to say, “France’s loss is our loss. Its grief is our grief. And its fight to counter the forces of inhumanity is our fight”  (San Francisco Chronicle, Editorial, November 14th, 2015). 

9. The effects of political pronouncements such as the recent debate on mass deportations sends trauma shocks to those who are  not documented yet they many have lived in USA all their life and some are employed. These people may end up not attending social services for fear of being hounded and put on hot lists.

10.  Establishing a structure of international partnership to deal with climate change, neglect, poverty and famine  at a global level which in turn make humans and in some cases livestock vulnerable to influenza, Legionnaires’ disease, Lyme disease, toxic shock syndrome, E. Coli 0157:H7, STDs, Ebola virus, AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza (Drexler, M. 2010). 

11. Understanding the increasing relation of chronic low-level inflammation, wide range of common debilitating disorders, stealth infections, deadly sepsis, how to balance use of antibiotics and inflammatory-quashing steroids. Research findings recommend Mediterranean style diet for those suffering from inflammatory disorders (Sachs J.S., 2007).

In the 21st Century, stigma discrimination, bias and prejudice will be the issues that need addressing. This in turn will clear the way for addressing neglect, poverty and famine. In situations where equality, respect and dignity are promoted, proper protection of life and ensuring individual well-being will be achievable.

REFERENCES:

1. Berthold, T. 2009. Foundations For Community Health Workers. San Francisco, MA: Jossey-Bass.

Centre For Excellence in Health Care Journalism. 2006.

2. Drexler M., 2010. Emerging Epidemics: The Menace of New Infections: H1N1 Flu, SARS, Anthrax, E.Coli.Penguin Books.

3.http://www.nytimes.com/2015/11/15/world/europe/strategy-shift-for-isis-inflicting-terror-in-distant-lands.html?emc=edit_th_20151115&nl=todaysheadlines&nlid=60949333&_r=0

4. Sachs, J.S. 2007. Good germs,Bad Germs: Health and Survival in a Bacterial World. New York, NY: Hill and Wang.

5. SFChronicle.com

6. Turnock, B. J. 2016. Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett. 

Applying Country Based Health Metrics From a Public Health Perspective; Case of USA and One African Country ( Uganda)

All countries have a Public Health Provision Model that combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. The countries promote population-based activities, monitor health status, investigate health problems and hazards, inform and educate people about health issues, mobilize communities, develop policies and plans, enforce laws and regulations for the wellness of their citizens.

To promote public health practice, medical health practice and long term care practice that in turn ensure quality life, these countries invest money of different amounts. They commit resources which cause health outcomes. However, the social-ecological factors in these countries make it a unique framework within which to provide public health and medical health services. Biologic, environment, behavioral, social, cultural and health services available in a given country in turn affect the well-being of the citizens.  These in turn affect the impact of the strategies or interventions. 

The US has a population total of 320,051,000. Its total expenditure on health as a percentage of GDP for the year 2013 was $ 17.1, a total expenditure on health per capita for 2013 at $ 9,146 and life expectancy of males at 76 and females at 81 (www.who.int/countries/en/).  It has committed over 15 million workers in the Public Health workforce and $ 3.0 trillion in resources. The public health needs presently facing the US include: slowing population growth rate, and older population, increasing diversity of population, changes in the family structure, a persistent lack of access to needed health services for many Americans and relative prevalence of particular diseases (Turnock, B. J. 2016).

On the other hand, Uganda has a population total of about 37, 579,00, its total expenditure on health as a percentage of GDP for the year 2013 was $ 9.8 a total expenditure on health per capita for 2013 at $ 146 and life expectancy of males at 57 and females at 61 (www.who.int/countries/en/). faced with lukewarm commitment in funding the health sector. The funds keep vacillating below or above $294,117, 000 as in the case of 2011. This amount is far below what the international ceiling ( e.g., Abuja Declaration) calls for.  Uganda still battles parasite infestation e.g., malaria-causing mosquitoes.  Plans to commit to eradicate malaria are half hearted pronouncements made at electoral campaigns most of the time. “The Government also committed itself towards developing and implementing a comprehensive strategy to eradicate malaria and strengthen its prevention, diagnosis and treatment. It also committed itself to reduce morbidity and mortality from the major causes of ill health and premature death,” (www.newvision.co.ug).

In order for public health to be a collective effort that promotes quality health outcomes, countries need to back public health initiatives with a funding commitment and not just lip service. Public Health Provision can be effective if it combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. 

REFERENCES:

1. http://www.newvision.co.ug/news

2. http://www.who.int/countries/en/

3. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.