Evidence of high endemicity of leprosy and yaws in the municipality of Balé-Loko in the Central African Republic

The incidence of neglected tropical diseases (NTD) can serve as an indicator for assessing the quality of healthcare systems because these diseases affect the poorest populations, living in areas where healthcare access is most difficult. The Central African Republic Ministry of Health, in collaboration with FAIRMED, decided to conduct the survey reported here in a village named/owned by the Central African Society of Agriculture and Wood Peeling (SCAD). The study took place from June 11-20, 2017. There were 137 clinical diagnoses of yaws, 102 of them positive on laboratory tests. Moreover, 79% were highly contagious forms. The prevalence of yaws in our study is higher than the 11% found in 2012 in the Lobaye region [4]. We also identified 57 cases of leprosy by screening; 68.42% (n= 39) were multibacillary. Among children younger than 15 years, 8 (16.66%) had grade 2 impairments. The screening rate for new cases is 13.333 per 10 000, quite substantially higher than the mean rate of 2.9 per 10 000 for the 121 countries and territories of this WHO region in 2016 [6]. Among the cases screened during the study, 51% (n=29/57) were already known to healthcare facilities. This study demonstrates the extent of the NTDs in Lobaye in the Central African Republic.

Costs and revenue of health care in a rural Zimbabwean district

The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no means exorbitant, albeit unfortunately not yet within reach of many sub-Saharan African countries today.