Equitable health services

Non-communicable disease burden among inpatients at a rural district hospital in Malawi
Olds P, Kachimanga C, Talama G,et al: Global Health Research and Policy 8:4;1-10, 2023

The authors sought to understand the burden of non communicable diseases (NCDs) among inpatients in a rural district hospital in Malawi between 2017 and 2018. The definition of NCDs was broadened beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. A retrospective chart review was conducted of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. Of 2239 total visits at the hospital, 28% were patients with NCDs, making up 40% of total hospital time. Two distinct populations of NCD patients were identified. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. High rates of NCDs in the younger population were noted.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021
Pillay Y; Museriri H; Barron P; et al: South African Medical Journal 13:1;17-23. 2023

In this article the authors explore the extent to which the third and fourth waves of the COVID-19 pandemic in South Africa affected routine public sector services, drawing on 2019, 2020, and 2021 DHIS data. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. Impact indicators of maternal and neonatal mortality continued to worsen in 2021. The authors note that if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goal targets.

South African Health Review 2021
Health Systems Trust, South Africa, 2022

When it comes to service delivery and access in both the public and private health sectors, COVID-19 has put everything to the test. It has demonstrated how central public health security is to health and livelihoods, and how pandemic health emergencies expose the weaknesses and vulnerabilities of health systems, costing lives and causing immeasurable damage to economies. This edition of the South African Health Review considers the government's and broader health sector's response to COVID-19, explores the current challenges facing the health system at this unprecedented time, and reflects on lessons learnt for future for public health emergencies. The chapters offer information on the challenges of balancing lives with livelihoods, and the impact of COVID-19 on different healthcare workers, especially Community Health Workers who found themselves at the forefront of the COVID-19 response. Other areas covered include the impact of COVID-19 on vulnerable populations.

Trends in inequality in maternal and child health and health care in Uganda: Analysis of the Uganda demographic and health surveys
Kakama A K; Basaza R: BMC Health Services Research 22(1269), 1-12, 2022

This study analyses data from Demographic and Health Surveys conducted in 2006, 2011, and 2016 in Uganda, to assess trends in inequality for a variety of mother and child health and health care indicators. The indicators included infant and child mortality, underweight status, stunting, and prevalence of diarrhoea. Antenatal care, skilled birth attendance, delivery in health facilities, contraception prevalence, full immunization coverage, and medical treatment for child diarrhoea and Acute Respiratory tract infections were health care indicators. Two metrics of inequity were used: the quintile ratio, which evaluates discrepancies between the wealthiest and poorest quintiles, and the concentration index, which utilizes data from all five quintiles. The study found universal improvement in population averages in most of the indices, ranging from the poorest to the wealthiest groups, between rural and urban areas. However, significant socioeconomic and rural-urban disparities persist. Under-five mortality, malnutrition in children, the prevalence of anaemia, mothers with low Body Mass Index, and the prevalence of acute respiratory tract infections were found to have worsening inequities. Healthcare utilization measures such as skilled birth attendants, facility delivery, contraceptive prevalence rate, child immunization, and Insecticide Treated Mosquito Net usage were found to show significantly lower disparity levels. Three healthcare utilization indicators, namely medical treatment for diarrhoea, for acute respiratory tract infections, and for fever, demonstrated perfect equity. Increased use of health services among poor and rural populations was found to leads to improved health status and the elimination of income and residential disparities.

Childhood immunization services accessibility and utilization during the COVID-19 pandemic in Africa
Dzinamarira T; Moyo E; Moyo P; et al: Journal of Infection, doi: https://doi.org/10.1016/j.jinf.2022.07.020, 2022

The authors present findings of a synthesis of available evidence on the accessibility and utilization of child immunization services (CIS) in Africa during the COVID-19 pandemic period. Data were independently extracted from eligible studies from online journals. The review revealed that CIS was disrupted in some countries and that uptake fell in most sub-Saharan African countries during the pandemic. In some CIS completely ceased during the lockdowns, yet in others, there were no significant changes. The authors propose strengthened monitoring of childhood immunization during pandemics to plan early catch-up vaccination activities.

Determinants of COVID-19 vaccine behaviour intentions among the youth in Kenya: a cross-sectional study
Osur J O; Chengo R; Muinga E; et al: Archives of Public Health 80(159), 1-13, 2022

This study assessed COVID-19 vaccine youth behaviour intentions and their determinants in Kenya using a cross-sectional survey and focus group discussions across 47 urban, peri-urban ad rural counties. The findings indicated that only 42% of the youth were ready to be vaccinated, with 52% adopting a wait and see approach to what happens to those who had received the vaccine and 6% totally unwilling to be vaccinated. Hesitancy was higher among females, some religious groups and those with post-secondary education. Lack of information and concerns around vaccine safety and effectiveness were main cause of vaccine hesitancy. Social media was the major information source in hesitancy. Other contributors to hesitancy included low trust in the health ministry, and belief that mass vaccination is not helpful. The authors raise that these causes of vaccine hesitancy are modifiable and suggest that health systems engage with young people to reduce vaccine hesitancy.

There is nowhere to take the child: a qualitative study of community members’ views on managing early childhood substance use in Mbale, Uganda
Skylstad V; Engebretsen I M S; Nalugya S J; et al: BMC Public Health 22(1192), 1-13, 2022

This study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in in Mbale District, Uganda. this area. Three main themes were identified: ‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights. ‘There is nowhere to take the child’: Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child. ‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act. Despite concern about childhood alcohol and substance use, the complexity and magnitude of the problem left community members feeling incapacitated in responding. The authors propose measures that address leadership, service, and legal deficits and that support collective agency to act on the issue in communities.

Transforming Africa's health system in wake of COVID-19 pandemic
World Health Organization (AFRO): WHO, Lome 24 August 2022

As Africa strives to recover from the impact of the COVID-19 pandemic, health authorities and experts gathered in end August for the Seventy-second session of the World Health Organization (WHO) Regional Committee for Africa launched a new drive to find ways of revamping the region's health systems. At a special event on Rethinking and rebuilding resilient health systems in Africa during the 22 – 26 August Regional Committee meeting in Lomé, Togo, delegates examined the measures that have worked in achieving universal access to health care as well as the shortfalls. They also explored ways to maintain essential services during outbreaks and the investments and actions needed to ensure equitable access to quality medical products and health technologies. The special event launched at the Regional Committee kicks off a collective process to support African countries as they ramp up efforts to recover from the pandemic-triggered disruptions and work to rebuild better their health systems. A series of consultations and actions will follow to support countries in achieving universal health coverage and health security.

Challenging the Illusion: Health Equity Amidst New Variants
Essar MY; Lal A; Ahmad S; et al: International Journal of Public Health 67:1604896, doi: 10.3389/ijph.2022.1604896, 2022

Low- and middle-income countries (LMICs) with limited capacities and infrastructures have experienced striking and disproportionate public health and economic losses during the COVID-19 pandemic—particularly due to imposed lockdowns and restrictions. The pandemic’s emerging variants are identified in this paper as a manifestation of unequal and unjust distribution of COVID-19 vaccination—unmasking “health equity” as an illusion. The authors state that firm actions have been taken by High income countries and powerful actors, who could be playing a leading role in offering solutions rather than privileging self-defeating interests. They urge that the ongoing COVID-19 response and future efforts for pandemic preparedness should ensure health equity is made an urgent, core priority—rather than an afterthought.

Improving vaccination equity in rural Uganda
Clinton Health Access Initiative: Uganda, March 2022

From November 2020, Clinton Health Access Initiative (CHAI) Uganda’s vaccines team and Uganda government addressed challenges with routine immunisation service delivery to improve equity across 14 districts representing around 11 percent of the country’s children under five. An assessment in December 2018 found that in the 14 focus districts there was limited interaction between health facilities and the communities they serve. In addition, health facilities were unable to systematically identify underserved communities within their catchment to use their limited resources in an optimal way, leading to a significant number of children un or under-immunised. To address this, health workers were trained on how to identify underserved villages proactively and systematically within their catchment areas and potential barriers to vaccination in these communities. The team piloted an intervention that monitors geographic variations in care-seeking trends in high-volume health facilities, detecting villages with the highest number of unimmunized (zero-dose) children within their catchment areas. Once these underserved villages are identified, health facilities hold meetings with community leaders and influencers to understand the barriers to immunisation and develop targeted mitigation strategies. This work is reported to have led to increased vaccination rates in underserved villages and to have improved the effectiveness of outreach sessions by targeting the underserved communities with high numbers of un- or under-vaccinated children.