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Friday, August 12, 2022
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Latest Trends and Advancements in Health Care
Role of Technology

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Till date finding gaps in care is a tedious task and many providers face challenges in identifying them. Clinical data analysis has helped providers plan carefully, set benchmarks and monitor their performance. A study revealed that the use of data analytics could help save more than $300 billion in U.S. healthcare, apart from making information flow transparent and creating a value chain in healthcare.

Lately, there have been several developments in technologies such as artificial intelligence, virtual reality, and wearable technologies that have not only been disruptive but also have the potential to change the face of healthcare in 2017 and transform the vision of population health management. Healthcare veterans believe that the road to population health is an unpaved but a long one, and is bigger than anything else. It needs:

– Coordination among Healthcare teams,

– Transition to Value,

– Disruptive Technology changing the way Healthcare Organizations deliver care.

Countries with Improved Healthcare System in Africa 2020
Countries with Improved Healthcare System in Africa 2020-Nigeria

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Top 10 Countries with Improved Healthcare System in Africa 2020

African countries lose millions of US Dollars yearly in medical tourism.

Top 10 Countries with Improved Healthcare System in Africa 2020



Health Systems in India
India

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Health systems in India


Background

Report on the Health Survey and Development Committee, commonly referred to as the Bhore Committee Report, 1946, has been a landmark report for India, from which the current health policy and systems have evolved.1 The recommendation for three-tiered health-care system to provide preventive and curative health care in rural and urban areas placing health workers on government payrolls and limiting the need for private practitioners became the principles on which the current public health-care systems were founded. This was done to ensure that access to primary care is independent of individual socioeconomic conditions. However, lack of capacity of public health systems to provide access to quality care resulted in a simultaneous evolution of the private health-care systems with a constant and gradual expansion of private health-care services.2

Although the first national population program was announced in 1951, the first National Health Policy of India (NHP) got formulated only in 1983 with its main focus on provision of primary health care to all by 2000.3 It prioritized setting up a network of primary health-care services using health volunteers and simple technologies establishing well-functioning referral systems and an integrated network of specialty facilities. NHP 2002 further built on NHP 1983, with an objective of provision of health services to the general public through decentralization, use of private sector and increasing public expenditure on health care overall.4 It also emphasized on increasing the use of non-allopathic form of medicines such as ayurveda, unani and siddha, and a need for strengthening decision-making processes at decentralized state level.

Due to the India's federalized system of government, the areas of governance and operations of health system in India have been divided between the union and the state governments. The Union Ministry of Health & Family Welfare is responsible for implementation of various programs on a national scale (National AIDS Control Program, Revised National Tuberculosis Program, to name a few) in the areas of health and family welfare, prevention and control of major communicable diseases, and promotion of traditional and indigenous systems of medicines and setting standards and guidelines, which state governments can adapt. In addition, the Ministry assists states in preventing and controlling the spread of seasonal disease outbreaks and epidemics through technical assistance.5 On the other hand, the areas of public health, hospitals, sanitation and so on come under the purview of the state, making health a state subject. However, areas having wider ramification at the national level, such as family welfare and population control, medical education, prevention of food adulteration, quality control in manufacture of drugs, are governed jointly by the union and the state government.

Public health-care infrastructure in India

India has a mixed health-care system, inclusive of public and private health-care service providers.6 However, most of the private health-care providers are concentrated in urban India, providing secondary and tertiary care health-care services. The public health-care infrastructure in rural areas has been developed as a three-tier system based on the population norms and described below.7 The urban health system is discussed in the article on Urban Newborn.

Sub-centers

A sub-center (SC) is established in a plain area with a population of 5000 people and in hilly/difficult to reach/tribal areas with a population of 3000, and it is the most peripheral and first contact point between the primary health-care system and the community. Each SC is required to be staffed by at least one auxiliary nurse midwife (ANM)/female health worker and one male health worker (for details see recommended staffing structure under the Indian Public Health Standards (IPHS)). Under National Rural Health Mission (NRHM), there is a provision for one additional ANM on a contract basis.

SCs are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programs. The Ministry of Health & Family Welfare is providing 100% central assistance to all the SCs in the country since April 2002 in the form of salaries, rent and contingencies in addition to drugs and equipment.

Primary health centers

A primary health center (PHC) is established in a plain area with a population of 30 000 people and in hilly/difficult to reach/tribal areas with a population of 20 000, and is the first contact point between the village community and the medical officer. PHCs were envisaged to provide integrated curative and preventive health care to the rural population with emphasis on the preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Program (MNP)/Basic Minimum Services (BMS) Program. As per minimum requirement, a PHC is to be staffed by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on a contract basis. It acts as a referral unit for 5-6 SCs and has 4-6 beds for in-patients. The activities of PHCs involve health-care promotion and curative services.

Community health centers

Community health centers (CHCs) are established and maintained by the State Government under the MNP/BMS program in an area with a population of 120 000 people and in hilly/difficult to reach/tribal areas with a population of 80 000. As per minimum norms, a CHC is required to be staffed by four medical specialists, that is, surgeon, physician, gynecologist/obstetrician and pediatrician supported by 21 paramedical and other staff. It has 30 beds with an operating theater, X-ray, labor room and laboratory facilities. It serves as a referral center for PHCs within the block and also provides facilities for obstetric care and specialist consultations.

First referral units

An existing facility (district hospital, sub-divisional hospital, CHC) can be declared a fully operational first referral unit (FRU) only if it is equipped to provide round-the-clock services for emergency obstetric and newborn care, in addition to all emergencies that any hospital is required to provide. It should be noted that there are three critical determinants of a facility being declared as a FRU: (i) emergency obstetric care including surgical interventions such as caesarean sections; (ii) care for small and sick newborns; and (iii) blood storage facility on a 24-h basis.

Schematic diagram of the Indian Public Health Standard (IPHS) norms, which decides the distribution of health-care infrastructure as well the resources needed at each level of care is shown in Figure 1.

An external file that holds a picture, illustration, etc. Object name is jp2016184f1.jpg

Indian Public Health System. Reprinted with permission from National Rural Health Mission, Ministry of Health and Family Welfare, Government of India.21

On the basis of the distributional pyramid, currently there are 722 district hospitals, 4833 CHCs, 24  049 PHCs and 148 366 SCs in the country.

National rural health mission: strengthening of rural public health system

NRHM, launched in 2005, was a watershed for the health sector in India. With its core focus to reduce maternal and child mortality, it aimed at increased public expenditure on health care, decreased inequity, decentralization and community participation in operationalization of health-care facilities based on IPHS norms. It was also an articulation of the commitment of the government to raise public spending on health from 0.9% to 2-3% of GDP.8

Seeking to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary health care, NRHM (2005-2012) aimed to provide effective health care to the rural population throughout the country with special focus on 18 states having weak public health indicators and/or weak infrastructure. Within the mission there are high-focused and low-focused states and districts based on the status of infant and maternal mortality rates, and these states are provided additional support, both financially and technically. Gradually it has emerged as a major financing and health sector reform strategy to strengthen the state health systems.

Major initiatives have been undertaken under NRHM for architectural correction of the rural health system—in terms of availability of human resources, program management, physical infrastructure, community participation, financing health care and use of information technology. Some of these activities are tabulated below (Table 1).

Table 1

Glimpse of activities under the National Rural Health Mission (2005–2013)
Human resources (new providers)931 239 Accredited social health activists
 27 421 Doctors at PHCs, 4078 specialists at CHCs*
 40 119 Staff nurses
 72 984 ANM
Human resources (program management)618 District Program Managers and 633 District Accounts Managers deployed
AmbulanceMore than 30 000 ambulances deployed nation wide
Community participation structure499 210 Village level Health Sanitation and Nutrition Committees (VHSNCs) created
 29 063 Patient Welfare Committees created at public facilities
Web-based mother and child tracking systemTracking 105 million mother–baby dyads
Finances providedA total of 21 billion USD invested (2005–2015) by the central government
OtherBetween 2009 and 2013, graduate medical capacity increased by 54% and post graduate medical seats by 74%

Abbreviations: ANM, auxiliary nurse midwives; CHC, community health centers; PHC, primary health center.

Source: Adapted from Quarterly NRHM MIS reports: National Executive Summary9 and Rural Health Statistics*.10

The mission emphasized on increasing health-care delivery points as well as facilities available at the health-care delivery points. It not only focused on increasing the number of physicians, specialists, staff nurses, as well as ANMs, but also gave importance to increasing the production capacity of medical colleges at graduate and post graduate levels. Physical infrastructure was enhanced by creating more health centers, newborn care units and renovating existing centers, which increased the capacity of health systems to treat more mothers and children. Special efforts were made to strengthen community participation through the formation of health committees at the village level and patient welfare committees at public health-care facilities. Information technology was used to track delivery of services to the mother and child. And all this has been an outcome of increased financial assistance by the central government and increased rates of utilization. During the period 2005-2013, the total investment by the central government equalled nearly 17 billion USD.


National programs and initiatives for newborn health

In India, major policies and national programs are planned and implemented during the 5-year planning phase. Despite the fact that no explicit programs on newborn care have been designed in the past, various programs and the 5-year plans in the country had focused on provision of services for mothers and children.111213141516171819 The launch of the CSSM program in 1992, for the first time included an essential newborn care component, and specifically integrated newborn care in the maternal and child health program. Thereafter, newborn care started receiving more attention and resources in the subsequent programs and initiatives.

Under NRHM, newborn health received unprecedented attention and resources with the launch of several new initiatives aimed at reducing the burden of maternal and newborn mortality and morbidity.

In February 2013, the government launched the strategic approach, reproductive, maternal, newborn, child and adolescent health (RMNCH+A),20 to accelerate actions for equity, harmonization and improved coverage of services. Although the RMNCH+A approach recognized that newborn health and survival is inextricably linked to women's health, across all life stages, it also clearly emphasized interlinkages between each of the five life stages with adolescent health as a distinct life stage, and connected community, outreach- and facility-based services. On the basis of this approach, the central government has taken vital policy decisions to combat major causes of newborn death, providing special attention to sick newborns, babies born too soon (premature) and too small (small for gestational age).

Specific interventions for the newborn included under the RMNCH+A strategy include:

  1. Delivery of antenatal care package and tracking of high-risk pregnancies;

  2. Skilled care at birth, emergency obstetric care and postpartum care for mother;

  3. Home-based newborn care and prompt referral;

  4. Facility-based care of the sick newborn;

  5. Integrated management of common childhood illnesses (diarrhea, pneumonia and malaria)

The strategy identifies the roles to be played at each level of care and the service provision and health systems requirement in terms of manpower and commodities for each of them. (Figure 1)212223 SCs and PHCs are designated as delivery points; CHCs (which are the FRUs) and district hospitals have been made functional 24 × 7 to provide basic and comprehensive obstetric and newborn-care services. Only those health facilities are designated as FRUs that have the facilities and manpower to conduct a caesarean section. Moreover, the strategic document identifies the required capacity building efforts for which NRHM has produced manuals. So far out of 116 capacity building manuals, 10 are dedicated to newborns. The document also has the guidance for reaching remote inaccessible areas to ensure maternal and child Health care.

One of the key aspects of the document and one that certainly contributes to its comprehensive nature is the involvement of various stakeholders in its development. Apart from the core drafting team of the Ministry of Health and Family Welfare, the technical support team is represented by the development partners, academic partners, practitioners, nationally and internationally. This has proved to be an important step for wider adaptation of processes and is crucial for implementation success.


Conclusion

India has been focussing on providing comprehensive care to mother and child. It has framed policies that allow the design and implementation of programs on newborn care in an inclusive manner. However, looking at the pace of achievements of the targets so far and future targets, it needs to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward newborn care, identifying areas through operational research, which can enhance quantity and quality of care for newborn care in India. The path is set and we need to operationalize and move forward.

Third Coronavirus Wave Fueled by Delta variant Sweeps Across South Africa
President Warns of Resurgence Infections Coronavirus – latest updates See all our coronavirus coverage

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Two healthcare workers dressed in PPE.
Healthcare workers in Johannesburg prepare to test people for Covid-19. Photograph: Denis Farrell/AP
Sun 4 Jul 2021 09.30 BST

The health system in Johannesburg, South Africa’s biggest city, is being overwhelmed by a massive wave of infections driven by the Delta variant, the winter in the southern hemisphere and a faltering vaccine campaign.

The new variant is now dominant in Africa’s most developed country, where the official death toll is now more than 60,000, though excess mortality statistics suggest more than 170,000 may have died from Covid.

Across Africa, the Delta variant is fuelling an aggressive third wave of infections, with case numbers climbing faster than all earlier peaks, according to the World Health Organization.

WHO experts warned last week that infections across Africa have increased for six consecutive weeks, up by 25% last week, reaching 202,000 positive cases. South Africa accounted for more than half of Africa’s cases last week, although it is one of the few countries where testing is extensive. On 1 July alone more than 21,000 cases were registered.

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Authorities in South Africa have been unable to stem the spread of the new variant, only moving to impose new restrictions after a massive wave of infections ravaged the country’s economic heartland.

President Cyril Ramaphosa said last week that the country’s health system was “buckling” as he imposed a two-week ban on all gatherings, indoors and outdoors, along with the sale of alcohol and travel to or from the worst hit areas of the country, such as Gauteng, its most populous and economically productive province. An extended curfew was also imposed, and schools shut early for holidays.

“We have overcome two decisive waves but now we have a new hill to climb, a great challenge, a massive resurgence of infections… a devastating wave,” he said.

Anger and frustration have grown after repeated promises to accelerate the faltering vaccination campaign have been broken. Only three million jabs have been delivered to a population of 60 million. Acting health minister Mmamoloko Kubayi-Ngubane said that delivery of vaccines would gather pace in coming weeks, with all those over 50, as well as police, teachers and soldiers, being targeted.

Cyril Ramaphosa
Cyril Ramaphosa imposed a ban on gatherings, travel and the sale of alcohol last week. Photograph: Elmond Jiyane/GCIS/EPA

However, a series of corruption scandals involving Covid spending has undermined trust in the government. The health minister has been suspended pending an investigation into corruption allegations.

The surge in infections has laid bare the weakness of the public health services, with hospitals overflowing and shortages of oxygen, but above all a lack of trained personnel. The much-publicised arrival of military doctors has been described by health practitioners as “a very late drop in a very big ocean”.

Last Thursday the South African Medical Association threatened to take the government to court because scores of new junior doctors cannot find placements despite staff shortages.

The vaccine drive has been halted over weekends and public holidays to rest health workers but also because there is no budget for overtime, officials have admitted.

In many parts of the country volunteer organisations are filling gaps. Some patients in Johannesburg who have failed to find a bed on a public ward are being cared for at a makeshift Covid ward set up by a Muslim charity in the city.

“We don’t see dead people. The funeral services see dead people. We see death. That’s the difference. We see death happening. We try to get to patients on time but unfortunately we can’t always do that,” said Anees Kara, a volunteer doctor.

Studies of blood donors released on Friday have revealed that almost half of the population may have already been infected by the virus, though the third wave appears set to be the worst yet.

The WHO has said the speed and scale of Africa’s third wave is unprecedented.

“The rampant spread of more contagious variants pushes the threat to Africa up to a whole new level. More transmission means more serious illness and more deaths, so everyone must act now and boost prevention measures to stop an emergency becoming a tragedy,” said Dr Matshidiso Moeti, WHO’s regional director for Africa.

Eight vaccines have been approved for the WHO emergency-use listing, but shipments to Africa have, in effect, dried up. “While supply challenges grind on, dose-sharing can help plug the gap. We are grateful for the pledges made by our international partners, but we need urgent action on allocations. Africa must not be left languishing in the throes of its worst wave yet,” said Moeti.

Only 15 million people – 1.2% of the African population – are fully vaccinated.

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Heart Attack: Avoid These Three Foods
Heart Attack

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HEART attack risk is often directly related to one's diet. What you eat will always impact your overall health and if your diet is rich in these types of food, your risk will increase. What should you eat and what should you avoid?
A heart attack is a medical emergency whereby the supply of blood to the heart is suddenly blocked, usually by a blood clot. It is vital to heed the warning signs as soon as they arise to reduce the damage inflicted on the heart muscle. It is also vital to ensure your diet is heart-healthy and try to avoid these types of food which may increase your risk.
Red meat
Eating too much beef, lamb, and pork may raise your odds for heart disease and diabetes.
The cause for this may be because red meat is high in saturated fat, which can boost cholesterol.
Numerous studies point to how gut bacteria process a part of the meat called L-carnitine.
If you have to have a diet with red meat try to limit your portions.
Also, look for lean cuts like round, sirloin, and extra-lean ground beef.
Baked goods
Cookies, cakes, and muffins should be rare treats as they tend to be loaded with added sugar, which leads to weight gain.
They’re also linked to higher triglyceride levels, and that can lead to heart disease.
Baked goods' main ingredient is usually white flour, which may spike your blood sugar and make a person hungrier.
Try swapping in whole-wheat flour, trim the sugar, and use liquid plant oils instead of butter or shortening.
Bacon
More than half of bacon’s calories come from saturated fat, which can raise your low-density lipoprotein (LDL), or bad cholesterol, and boost your chance of a heart attack or stroke, said WebMD. The health site added: “It’s full of salt, which bumps up your blood pressure and makes your heart work harder.
“High amounts of sodium (the main part of salt) can lead to stroke, heart disease, and heart failure.
“Bacon’s added preservatives are linked to these issues as well.”
For a happy heart, limit your intake of saturated fat and avoid trans-fat (found in hydrogenated oils) completely.
Saturated fat should make up no more than six percent of your total daily caloric intake.
To manage blood pressure, limit your daily sodium intake to 1,500 mg or less.
Ask your healthcare professional if caffeinated beverages, like coffee and tea, are appropriate for your heart.
Enjoy these drinks in moderation without added cream, milk, or sugar.

Foods to help keep your heart healthy include:
Lots of fruits and vegetables
Lean meats
Skinless poultry
Nuts, beans, and legumes
Fish
Whole grains
Plant-based oils, such as olive oil
Low-fat dairy products
Eggs (up to six per week is recommended 

Higher stress levels raise blood pressure, risk of heart attack and stroke, study finds,
By Sandee LaMotte

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(CNN)Is that stress pumping steadily through your veins? Even if your blood pressure is normal right now, high stress levels may put you at risk of developing hypertension within the next decade or so, a new study found.

When the stress hormone cortisol continues to increase over time, you may also be at higher risk of having a stroke, heart attack or heart disease, according to the research published Monday in Circulation, the journal of the American Heart Association.
It's yet another study illustrating the link between the mind and a person's heart health, said cardiologist Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine in Houston who was not involved in the study.
"Stress, depression, frustration, anger and a negative outlook on life not only make us unhappy people but negatively impact our health and longevity," said Levine, who chaired the AHA's scientific statement on the connection between mental well-being and heart disease.
When developing the AHA statement, "we looked at all the data we could find and we concluded that negative psychological health factors such as stress were clearly associated with many cardiovascular risk factors," Levine said.
Higher levels of stress hormones are linked to hypertension and an increased risk of heart attack and stroke in people with normal blood pressure, a study revealed.
The good news, Levine said, is that because the mind, heart and body are interconnected and interdependent, a person can also improve their cardiovascular health by striving for a positive psychological outlook.
"You can decide to change your mindset about that stressful situation or set boundaries -- just by being aware you can keep that stress from becoming toxic to you," said stress management expert Dr. Cynthia Ackrill, an editor for Contentment magazine, produced by the American Institute of Stress.
"We shouldn't discount our ability to have a role in our well-being," said Ackrill, who was not involved in the study.

1 in 500 US residents has died of Covid-19 Madeline Holcombe
By Madeline Holcombe

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'It's bad to the bone': Unvaccinated man describes Covid-19 fight 04:06

(CNN)The United States has reached another grim milestone in its fight against the devastating Covid-19 pandemic: 1 in 500 Americans have died from coronavirus since the nation's first reported infection.

As of Tuesday night, 663,913 people in the US have died of Covid-19, according to Johns Hopkins University data. According to the US Census Bureau, the US population as of April 2020 was 331.4 million.
It's a sobering toll that comes as hospitals in the US are struggling to keep up with the volume of patients and more children are grappling with the virus. In hopes of managing the spread and preventing more unnecessary deaths, officials are implementing mandates for vaccinations in workplaces and masking in schools.
They are fighting against a sharp upward trend in cases and deaths: The US is reporting a more than 30% increase in average daily cases and a near tripling of average daily deaths over the past month, according to data from the US Centers for Disease Control and Prevention.
But with only 54% of the population fully vaccinated, the rate of people initiating vaccinations each day has declined over the past month.
Health experts have hailed vaccinations as the best source of protection against the virus, noting that the majority of people hospitalized with and killed by Covid-19 are unvaccinated. In Pennsylvania, from January 1 to September 7, 97% of the state's Covid-19 deaths were among unvaccinated people, Pennsylvania's acting secretary of health said Tuesday.
Another layer of strong protection, experts say, is masking.
The CDC recommends people -- even those fully vaccinated -- wear masks indoors in areas with substantial or high community transmission. More than 99% of the population lives in a county with one of those designations.
In Ohio, where children's hospitals are overwhelmed with Covid-19 and respiratory cases, Gov. Mike DeWine is encouraging schools to issue mask mandates since the state legislature has told him it would overturn any mandate he issued.
"Reasonable people may disagree about a lot, but we can all agree that we must keep our children in the classroom so they don't fall behind and so their parents can go to work and not take time off to watch their kids at home," DeWine said.
The combination of masks and vaccinations is the way to keep children in school, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN Tuesday.
"If you surround the kids with vaccinated people and you have everybody wear a mask, you can get a situation where the children will be relatively safe in school," Fauci told CNN's Jake Tapper.
A memorial for people who have died as a result of of Covid-19 is seen on the National Mall on September 22, 2020 in Washington, DC.

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