World Health & Population
From the Editor-in-Chief
This issue of World Health & Population presents three original research papers that should be of great interest to our readers, in addition to a high-quality paper reprinted from the International Journal of Environmental Research and Public Health (IJERPH). The original papers have all been published online by WHP during the last quarter and are selected here as representative of recent outstanding contributions to the journal.
The first paper in this issue, "Reasons for Inconsistent Condom Use among Female Sex Workers: Need for Integrated Reproductive and Prevention Services," reports on an HIV prevention study in Conakry, Guinea. Authors Josephine Aho and colleagues examine the regularity of use of condoms by females sex workers (FSWs), both with paying clients and with their regular non-client sex partners. There was a large discrepancy in condom usage – nearly 100% with commercial clients but only 80% with regular non-client partners. The study identified a desire to have children, not lack of knowledge about HIV transmission, as a primary driver of inconsistent condom use. The authors hypothesize that marriage and children may be seen as means for the FSW to escape sex work. The study recommended that HIV prevention activities with FSWs consider the individual holistically, and not just focus narrowly on prevention behaviours such as condom use. Involvement of FSW's regular, non-client partners was also seen as critical.
In our second paper, Taís Gomes and colleagues examine the relationship between traditional and improved housing and the transmission of Chagas disease in Northeastern Brazil. Using qualitative methods and structured interviews, the authors examine the interplay between humans, their domiciles and the disease vector – triatomine bugs – which are well adapted to the typical mud structures people live in. Notably, the triatomines are responsible not only for Chagas disease but also for widespread food-borne illnesses. A simple answer is better housing. However, beyond the impact of poverty alone, government land policy and traditional housing preferences (e.g., mud huts) continue the link between disease victims, where they live and insect vectors. Even though the cost of improved housing is currently on par with the cost of mud huts, because of the need to buy the necessary wood, cultural, economic, and policy barriers remain. Again, a more holistic approach is needed to address the vicious circle of disease, poverty and counterproductive government policy.
"Resource Allocation in Pakistan's Health Sector: A Critical Appraisal and a Path toward the Millennium Development Goals" is the third paper in this issue. In the context of the Millennium Development Goals (MDGs), Babar Sheikh and colleagues analyze financing mechanisms prevalent in Pakistan's healthcare delivery system. Largely due to persistent poverty and long-standing political turmoil, Pakistan ranks very low among lower- and middle-income countries in government per capita healthcare expenditure. The healthcare delivery infrastructure, however, is equally weak and would be inadequate, at least in the short run, to absorb increased investment and improve health outcomes. Those who can afford care from the private sector obtain it, thus increasing the equity and access gap between the poor and the not-so-poor. The authors present health financing challenges and opportunities in the context of political "devolution" in Pakistan – the return of making policy and financial decisions to the provinces and away from the traditional highly centralized approach in the country. They conclude that although a myriad of factors are holding back progress toward meeting the MDGs in Pakistan, the devolution initiative empowers provinces to develop innovative, locally relevant and feasible approaches, in particular in the healthcare financing arena.
The final paper in this issue is the reprint from IJERPH, "Global Access to Safe Water: Accounting for Water Quality and the Resulting Impact on MDG Progress," by Onda, LoBuglio and Bartram. Onda and his colleagues are at The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. They propose that adequate monitoring of progress toward the MDG drinking water target (MDG 7c) must include measures of water quality and protection, not just counted as "improved" on the basis of construction or installation alone. When adjusted, the measures show a shortfall of 10% in the achievement of the MDG, contradicting the widely heralded achievement of this MDG target.* Measurement issues matter, and the public, policy makers and politicians alike need to be careful not to "declare victory and leave" too soon. As a side note, Figure 1 in this paper, "World population by water contamination status and sanitary risk, 2010," is a particularly illuminating categorization of the status of the world's population in terms of access to safe drinking water.
In conclusion, the world is rapidly approaching the target date of 2015 for achieving the MDGs, and studies are proliferating about progress, lack of progress, and the need for greater progress toward achievement. Although many MDGs appear less and less likely to be realized, in particular in the most needy areas of the world, the attention the MDGs are still receiving is welcome and needed. The work we have to do will be ongoing.
In summary, we hope that you find the papers in this issue interesting and worthwhile, and that you will also consult others recently released online at www.worldhealthandpopulation.com. WHP remains committed to its mission to provide a forum for researchers and policy makers worldwide to publish and disseminate health- and population-related research, and to encourage applied research and policy analysis from diverse global and resource-constrained settings. WHP is indexed on MEDLINE and is accessible through PubMed.
We look forward to continued enthusiastic submission of manuscripts for consideration, peer review and publication. Finally, the editors and publishers of WHP are always interested in any comments or suggestions you might have on the papers or about the journal and our mission. Please feel free to write or e-mail us.
John E. Paul, PhD MSPH
Editor-in-Chief, World Health & Population
About the Author(s)
John E. Paul, PhD MSPH, Editor-in-Chief, World Health & Population
* For example, Wijeseker, S. 2012, March 6. "MDG Drinking Water Target Being Met Is Cause for Celebration." The Guardian (UK) Policy Matters Blog. Retrieved June 5, 2013. < http://www.guardian.co.uk/global-development/poverty-matters/2012/mar/06/mdg-drinking-water-target-met>.
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