Key Questions to Consider:
Field Note: Successful Sodium Regulation in South Africa
Records have shown a 100% increase in the prevalence of hypertension in men and 50% in women since 1998. Hypertension has become a worldwide health concern as a precursor to stroke and cardiovascular disease. In South Africa, the prevalence translates to 75,000 strokes a year—adding a major financial strain to a fragile healthcare system. In 2007, 350,000 people were stroke patients, and 35% had moderate to severe disability which requiring rehabilitation.
Some factors contributing to hypertension include: 1) genetic sensitivity to sodium; and 2) the food environment (increased sodium in food). In 2013, the South African National Department of Health (NDOH) took action by passing a new mandatory regulation that limits the quantity of sodium used in processed foods. The NDOH understood the need for intersectoral collaboration and called on the government, academics, and industry to achieve a pragmatic policy plan that responded to the concerns voiced by all sides. Context-specific evidence served as a crucial guide to understanding hypertension in the South Africa. Joint meetings for 14 months included many sectors as well as sodium experts such as the Heart and Stroke Foundation of South Africa and Professor Graham MacGregor from World Action on Salt and Health (WASH).
Local research showed about 25-40% of an average South African's daily intake of sodium comes from bread. For this reason, the target of change was the baking industry due to the role of bread as a staple food for most of the South African population. The Department of Health collaborated with researchers as they suggested the intended outcome of their regulation and its feasibility. South Africa is the first country in the world to regulate sodium at the manufacturing level. This legislation is to be implemented in two phases, by 2016, and even lower sodium content by 2019. The food industry is not to retain salty taste with chemical substitutes. The new regulation also specifies methods of testing for sodium levels to check for compliance from industries through chemical analysis via atomic absorption spectrometry. Fines and penalties with respect to non-compliance with the regulations are included in the legislation.
[Source: WHO (South Africa), WHO African Regional Office, South African National Department of Health, World Action on Salt and Health (WASH)]
Field Note: Using Microfinance to Promote Intersectoral Action for Health in Ghana
Microfinance institutions (MFIs) play a role in improving health through increasing opportunities for women's social and economic positions, health literacy, and service uptake. Garmeen Ghana was initiated in 2003. Using MFI funds, Gharmeen Ghana added the Mobile Technology for Community Health (MOTECH) as a means to enhance communication between health services and local women. This strategy aimed to embed health within microfinance for women in an effort to empower low-income women: 1) financially; 2) increase health literacy; and 3) assure social mobilisation. This project is aimed to address gender inequalities in economics, social wellbeing, and health.
Garmeen Ghana added MOTECH as a means to bring the health sector into a more direct relationship with the women and enable them to improve health outcomes for mothers and their newborns. This program launched in the Upper East region (2010) as a partnership between Ghana Health Service, Garmeen Foundation, and Columbia University's Mailman School of Public Health. It uses mobile phones to increase the quantity and quality of prenatal and neonatal care in rural Ghana with a goal of improving health outcomes for mothers and their newborns.
Mobile phones provide opportunities for both receiving information and assure the tracking of services delivered. This program provides two interrelated mobile health services: Mobile Midwife—a phone application than enables pregnant women and their families to receive SMSs and voice messages that provide time-specific information about their pregnancy each week, in their own language. This includes reminders of services and advice on accessing resources such as birthing kits in an effort to reduce cost of transportation to health services when service can be provided over the phone. The second application helps community health workers record, monitor, and track the care delivery to women and newborns in their target areas. Furthermore, community health workers assure that women visit healthcare providers when necessary, and assure that new mothers receive training on how to take care of their newborns. MOTECH is an innovative way of taking action and assuring that women have the needed cost-effective care.
[Source: WHO (Ghana), WHO African Regional Office, Gharmeen Ghana]
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