There is enormous evidence that the reduction of exposure to risk factors leads to a decrease in the morbidity and mortality related to chronic diseases. Based on such evidence has lead to many demands for a systems approach to public health which allows the incorporation of many disciplines, communities and strategies with a common goal of reducing disease prevalence. The systems approach is based on the knowledge that disease and health are as a result of factors beyond the biological and individual human behavior. For KS and PCP an appropriate program will involve establishing units in existing healthcare facilities that specialize on the two diseases and other opportunistic diseases. The units will be established through consultation and collaboration with other stakeholders such as organizations representing the rights of homosexuals, the government, health facilities, researchers and the communities. Such partnership should be strengthened and forums for stakeholders established in the said units.
In collaboration with researchers in the field, the units should have a research and development wing aimed at developing accurate, specific and sensitive diagnostic techniques for the two disorders as well as the underlying infective agent. The R&D team should develop commonly accepted diagnostic tools such as the results can be confirmed in a central regional reference lab. The R&D team should also expedite the search for efficacious treatments for the two diseases and the underlying infections causing immunodeficiency such as HIV/AIDS. The units should also integrate comprehensive prevention of KS and PCP, other opportunistic diseases (such as B-immunoblastic sarcoma and B-cell lymphomas) and viral infections that compromise the immunity such as Human T-lymphotropic retrovirus III, cytomegalovirus, HIV and Epstein-Barr virus. The mentioned conditions have been found to coexist in a significant proportion of patients with KS and PCP.
Another important component of a system to address the KS and PCP outbreak is the development of preventive strategies. Primary preventive strategies will be geared towards the reduction or avoidance of personal exposure to the risk factors identified. Such strategies would include educating the patients on the need to use protection during sexual contact, to avoid substance drugs and abuse and to avoid multiple sexual partners. The secondary and tertiary preventive strategies would include early detection and treatment of the two diseases and the underlying and associated infections to prevent progression to late stages that are difficult to treat.
The R&D will also identify more preventive strategies through cost effective research. In addition, there will be community involvement that will involve support groups and awareness campaigns. The last aspect of the system is an effective surveillance and evaluation system that will involve follow-up of patients and effective record keeping and reporting of cases at the regional referral hospital that will host the special unit’s headquarters.
The type of system theory-based strategy that would be effective in the program discussed above is the wellness-based healthcare system that hinges on prevention, intervention and innovation. The said strategy is based on a consensus in various arenas e.g. business, clinical and policy arenas. The strategy does not presume that solutions are with one single stakeholder, but rather encourages innovative approaches to the development of prevention and intervention strategies. That way the different stakeholders regularly meet to formulate and evaluate preventive and intervention strategies. The benefits of the wellness-based initiative include a balance of quality, cost and access to healthcare.
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