The Pholela Health Centre - the origins of community-oriented primary health care (COPC)

The health centre practice pioneered by Sidney and Emily Kark and their colleagues at Pholela during the 1940s was a forerunner of and direct contributor to what later emerged as 'the primary health care approach'. This article gives a detailed account of the context, work and methodologies used at the Pholela Health Centre, emphasising the development of concepts that are now well recognised and described as community-oriented primary health care (COPC). COPC remains highly relevant to health service development in South Africa today

California Tax Practitioners Beware: Even the Ninth Circuit\u27s I.R.C. Section 1031 Loophole Has Limits

Section 1031 of the Internal Revenue Code provides tax deferred status for like-kind exchanges of investment property. The Deficit Reduction Act of 1984 amends this section to curb the use of the controversial delayed exchange as a tool to suspend tax assessment for an inordinate period of time. California attorneys should beware the fiture structuring of like-kind exchanges;for the amendment revises the lenient procedures for like-kind qualification sanctioned by the permissive Ninth Circuit

Sonar beamforming based upon monaural localisation techniques

Includes bibliographies.Sonar beamforming is usually accomplished using a multi-element transducer array. To obtain high resolution, such a system is costly and complex. In contrast, many mammals are capable of good angular resolution using only a single active element surrounded by an irregular reflector – the ear. A study of monaural localisation was therefore undertaken, with a view to the development of a novel beamforming system which uses only a single active element. Computer simulations have shown that the direction of a source can be determined by cross –correlating the output signal spectrum with the known spectral responses of the receiving system for all angles

Self-reported health and health care use in an ageing population in the Agincourt sub-district of rural South Africa.

BACKGROUND: South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. OBJECTIVE: To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a rural South African population aged 50 years or older. METHODS: The Study on Global Ageing and Adult Health (SAGE), in collaboration with the INDEPTH Network and the World Health Organization, was implemented in the Agincourt sub-district in rural northeast South Africa where there is a long-standing health and socio-demographic surveillance system. Household-based interviews were conducted in a random sample of people aged 50 years and older. The interview included questions on self-reported health and health care use, and some physical measurements, including blood pressure and anthropometry. RESULTS: Four hundred and twenty-five individuals aged 50 years or older participated in the study. Musculoskeletal pain was the most prevalent self-reported condition (41.7%; 95% Confidence Interval [CI] 37.0-46.6) followed by hypertension (31.2%; 95% CI 26.8-35.9) and diabetes (6.1%; 95% CI 4.1-8.9). All self-reported conditions were significantly associated with low self-reported functionality and quality of life, 57% of participants had hypertension, including 44% of those who reported normal blood pressure. A large waist circumference and current alcohol consumption were associated with high risk of hypertension in men, whereas in women, old age, high waist-hip ratio, and less than 6 years of formal education were associated with high risk of hypertension. Only 45% of all participants reported accessing health care in the last 12 months. Those who reported higher use of the health facilities also reported lower levels of functioning and quality of life. CONCLUSIONS: Self-reported chronic health conditions, especially hypertension, had a high prevalence in this population and were strongly associated with higher levels of health care use. The primary health care system in South Africa will need to provide care for people with non-communicable diseases

Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa

The authors would also like to acknowledge the field staff at the MRC/Wits Agincourt unit, particularly Ms Rirhandzu Debs and Dr Kerstin Edin from the Umeå Centre for Global Health Research, Umeå University, who facilitated data collection and made important contributions to the fieldwork.Peer reviewedPublisher PD

Scaling up antiretroviral therapy in Malawi-implications for managing other chronic diseases in resource-limited countries.

The national scale-up of antiretroviral therapy (ART) in Malawi is based on the public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment, short course) tuberculosis control framework. The key principles include political commitment, free care, and standardized systems for case finding, treatment, recording and reporting, and drug procurement. Scale-up of ART started in June 2004, and by December 2008, 223,437 patients were registered for treatment within a health system that is severely underresourced. The Malawi model for delivering lifelong ART can be adapted and used for managing patients with chronic noncommunicable diseases, the burden of which is already high and continues to grow in low-income and middle-income countries. This article discusses how the principles behind the successful Malawi model of ART delivery can be applied to the management of other chronic diseases in resource-limited settings and how this paradigm can be used for health systems strengthening

Developing district health systems in the rural Transvaal Issues arising from the Tintswalo/Bushbuckridge experience

District health systems are increasingly acknowledged as a foundation for national health services based on primary health care. Initial efforts to institute a demonstration district health system in the Bushbuckridge area of the eastern Transvaal are described. These include efforts to overcome the organisational and administrative fragmentation caused by homeland and provincial boundaries. Close attention needs to be given to districtlevel health management, the complementary roles of district and regional health authorities, working relationships and accountability among professional staff from different disciplines, involvement of the community in a district health authority and the district health system as an element oflocal government