The 156th Session of the WHO Executive Board, held in Geneva, witnessed intense deliberations over the financial repercussions of the United States' withdrawal from the organization. Member States engaged in complex negotiations that revealed deep divisions about how to respond to the significant budget shortfall, with proposals ranging from reducing the base budget from USD 5.3 billion to USD 4.9 billion to potentially increasing assessed contributions by 20%. High income countries largely advocated for postponing new resolutions and prioritizing activities, while low income countries strongly resisted such approaches, arguing for the preservation of the organization's comprehensive mandate. The discussions highlighted the underlying vulnerabilities of the WHO's funding model, which heavily relies on voluntary earmarked contributions, and underscored the challenges of maintaining critical global health functions amid financial uncertainty. Diplomatic exchanges were marked by nuanced debates about prioritization, with countries like Russia, China, and India questioning the sudden financial adjustments and calling for more measured, transparent approaches to budgeting and resource allocation. The session ultimately reflected the complex task of balancing organizational sustainability with the diverse health priorities of Member States in an evolving global health landscape.
Governance and participation in health
This systematic review and meta-analysis investigated self-medication prevalence in Uganda through 22 eligible studies encompassing 9,113 participants across different demographics and regions. Analysis revealed that at least one in two Ugandans self-medicate, with antibiotics being the most commonly self-medicated drugs. Key contributing factors included ease of access to medications, perceived cost effectiveness, long hospital waiting times, home storage of drugs, and perceptions of minor illnesses. The high prevalence of antibiotic self-medication is particularly concerning in the context of antimicrobial resistance, indicating an urgent need for awareness campaigns about the dangers of self-medication.
This paper evaluated the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application in addition to standard HIV pre-exposure prophylaxis, and 313 from Tanga who received pre-exposure prophylaxis alone. Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, the authors conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% of participants in the intervention arm and 20.1% in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm. Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.
Dr. Kangaude, a prominent figure in Malawi's reproductive health landscape, shares insights on the strategies Civil Society Organisations (CSOs) are employing to advance reproductive justice in Malawi. He emphasizes the critical role of advocacy in raising awareness, influencing policy, and challenging discriminatory laws. Collaboration between African countries, he argues, is essential to share experiences, strengthen regional networks, and amplify collective voices. Dr. Kangaude also discusses the numerous challenges CSOs face and the Nyale Institute's implementation of innovative strategies to overcome these obstacles. The episode also highlights the success stories and impactful cases championed by Nyale Institute, demonstrating the power of strategic interventions and unwavering commitment to reproductive justice in Africa.
Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children. A descriptive qualitative evaluation was conducted in 2020 across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. There were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the programme. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of and how to take the anti-retroviral treatment. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, health care workers felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility. This study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased anti-retroviral treatment literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation.
The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination. Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research. GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that GHI earmarking and conditions drive funding allocations regardless of countries’ priorities. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers with both positive and negative implications. To maximise returns on GHI support, the authors suggest that there is need to ensure that their approaches are comprehensive as opposed to being selective; to improve GHI country level governance and alignment with countries’ changing epidemiologic profiles; and to strengthen their involvement of civil society.
How can women in vulnerable circumstances move beyond hopelessness, extreme poverty, and the health and livelihood challenges of a global pandemic? What are the best research approaches to make their experiences count in post-pandemic recovery efforts and future preparedness? Ask them. Two research projects in the provinces of Eastern Cape and KwaZulu-Natal, South Africa, are using experiential methodologies to reveal women’s stories, ideas and solutions to their post-pandemic recovery. By taking two different approaches — one ethnographic and the other a workshop series combined with trial cash transfers —, these two projects aimed to understand the multidimensionality of the lives and circumstances of economically disadvantaged women and investigated different ways to amplify their voices using inclusive approaches. Common themes have emerged from the oral histories collected to date. Researchers report that the pandemic disproportionately affected women, many of whom lost their jobs. Workplaces, health centres and other services closed, leaving women disconnected from their social networks. Adult children and spouses moved home, causing even greater strain and leading to increases in domestic violence. Greater numbers of youth pregnancies added to women’s already difficult care burden. Many women reported that debt closed in. High inflation further compounded the problem, leaving women’s households in a continuous cycle of economic deficit. They continue to struggle with food insecurity and an almost universal dependence on social grants for survival. Women reported a new normal: living with stress, mental illness, isolation and substance use.
This study explored the reproductive health and rights’ needs and challenges amongst young refugee women in South Africa. It was carried out in eThekwini in South Africa in 2021 and 2022 through 35 semi-structured, in person interviews with young refugee women 18 and 24 years old living in the city centre. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women.
This study assessed people’s knowledge of the COVID-19 vaccine and the effect of misinformation on vaccine uptake among healthcare workers (HCWs) and the general population in Uganda. This was a cross-sectional quantitative study conducted in 2022, including 311 HCWs and 253 from the general population. The study revealed that the proportion of vaccinated HCWs (77.4%) was significantly higher than that of the vaccinated general population (64.4%). The research revealed that a large proportion of the participants (89.7%) encountered rumours regarding unverified adverse effects of the COVID-19 vaccine that significantly contributed to vaccine hesitancy,. The study showed a negative impact of misinformation on vaccine uptake and could be the most significant contributor to vaccine hesitancy in future vaccine programs.
A special survey module included in the Afrobarometer Round 9 questionnaire explored citizens’ experiences and perceptions of pollution, environmental governance, and natural resource extraction. It showed that a majority of Batswana see pollution as a serious problem in their communities, with inadequate trash disposal as the most serious offender. They believe that ordinary citizens must assume primary responsibility for reducing pollution and keeping their communities clean, but they also expect “much more” from the government to protect the environment – including tighter regulation of natural resource extraction.