This paper aimed to update a woman hand-held case notes tool reflecting WHO 2016 antenatal care (ANC) guidelines in Malawi. In 2022, the authors applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and to redesign the woman’s health passport tool to reflect the changes. The developed tool was endorsed for implementation within Malawi’s healthcare system by the national safe motherhood technical working group in July 2023. Five themes were identified in the analysis that were missed in the previous tool. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date. The authors' efforts reflect a pioneering attempt in Malawi to improve women’s hand-held case notes to enhance quality of care and improve women’s satisfaction with their healthcare system.
Equitable health services
A Case for Integration: A Collection of Lived Experiences of People Living with NCDs and HIV has been published as part of the Non Communicable Disease (NCD) Alliance’s “Our Views, Our Voices” initiative, dedicated to promoting the meaningful involvement of people living with NCDs in the NCD response. Many people living with HIV struggle with mental health, yet most are unaware that their HIV status makes them more vulnerable. A number of people with HIV also reported that their other conditions were not promptly diagnosed by healthcare workers at HIV clinics. The NCD Alliance has developed 15 Transformative Solutions, which are recommendations for contextually appropriate, person-centred information about NCDs and their risk factors for people living with HIV. These include overarching recommendations: that governments – with the support of WHO, UNAIDS, global health donors, and key constituencies, including civil society, communities and people living with HIV and NCDs, and the private sector – must coordinate, fund and drive local context- responsive agendas for HIV-NCD integration to achieve the 90% integrated care target, which emphasises person-centred care and considers the whole care cascade (prevent-find-link-treat- retain). The document proposes that government strategies, national policies, and strategic plans for HIV-NCD integration must: take a phased and context-specific approach to linkages and integration of services and systems; promote the transition to UHC; consider the state of development of different national and local systems for health; and include essential HIV and NCD prevention and care services as key priorities in COVID-19 recovery plans and the ‘building back better’ agenda.
This paper explored the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework. A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen women seeking post-abortion care services were` interviewed using audio recorders; transcribed data was analyzed using thematic analysis. Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as ‘normal pregnancy symptoms’ and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care. Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, the authors argue that there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.
This paper aimed to assess whether people living with HIV (PLWH) were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana. Of the 3981 participants enrolled, 2547 were female, and 1196 were PLWH. PLWH were more likely to report previous screening for diabetes, elevated cholesterol and to have had their weight checked than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake, smoking cessation, weight control, physical activity and alcohol consumption than their HIV-uninfected counterparts. PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.
Since 2017, Niassa and the neighbouring provinces of Cabo Delgado and Nampula in Mozambique have faced mounting attacks by non-state armed groups, with millions of people fleeing their homes in search of safety. This has come alongside repeated climate shocks – from flooding to drought and powerful cyclones – and ensuing public health emergencies such as malaria and cholera outbreaks. The ongoing instability and decimated health facilities have rendered pregnancy and childbirth increasingly life threatening, while conflict and displacement are also putting women and girls at greater risk of gender-based violence and trafficking. UNFPA is distributing contraceptives and raising awareness through mobile teams and clinics across northern Mozambique. In Niassa, health providers from all 16 districts have received training on long-term family planning methods, such as the Pill, implants and intrauterine devices. Through the Lichinga centre, community leaders and volunteers have also spoken to around 2,500 adolescents and young people from the region, discussing cultural barriers to sexual health and the stigma surrounding HIV and AIDS. A collaboration with Rádio Moçambique and Radio Comunitária de Cuamba also produced over 360 broadcasts that discuss sexual and reproductive health services and gender-based violence. Presented in local languages such as Ciyao and Cinyanja and Emakhuwa, the outreach efforts reached around 1.6 million people in Niassa province alone.
This study assessed the contribution of the One Health approach to strengthening health security in Uganda. A process evaluation was done between 25th September and 5th October 2020, using a mixed–methods case study. Funding and implementation status from the National Action Plan for Health Security 2019–2023 launch in August 2019 to October 2020 was assessed with a One Health lens. Full funding was available for 36.5% of activities while 40.6% were partially funded and 22.9% were not funded at all. The majority of the activities were still in progress, whereas 8.6% were fully implemented and 14.2% were not yet done. In workforce development, several multi-sectoral trainings were conducted including the frontline public health fellowship program, the One Health fellowship and residency program, advanced field epidemiology training program, in-service veterinary trainings and 21 district One Health teams’ trainings. Real Time Surveillance was achieved through incorporating animal health events reporting in the electronic integrated disease surveillance and response platform. The national and ten regional veterinary laboratories were assessed for capacity to conduct zoonotic disease diagnostics, two of which were integrated into the national specimen referral and transportation network. Multi-sectoral planning for emergency response and the actual response to prioritized zoonotic disease outbreaks was done jointly. This study demonstrates the contribution of ‘One Health’ implementation in strengthening Uganda’s health security.
Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda had variable COVID-19 responses. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, with learning synthesized across the countries. Surveillance approaches across countries included case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travellers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. The authors recommend investments to enhance surveillance approaches and systems including decentralising surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also noted to be critical.
This study was conducted in 2020 to inform research to define the content and delivery strategies for health check-ups to be performed in young and older adolescents, and to assess whether such services are likely to be acceptable and feasible in Tanzania, using a semi-structured guide with purposively selected stakeholders from government departments, non-governmental and community-based organisations, schools and health facilities. Stakeholders interviewed were supportive of introducing routine health check-ups among adolescents and recommended focusing on non-communicable diseases, physical disabilities, common mental health problems, reproductive health problems, specific communicable diseases, and hygiene-related problems. They also recommended combining counselling and family planning information with these check-ups. Three venues were proposed: schools, community settings, and youth-friendly health facilities. The authors propose further implementation research and cost benefit analysis to help guide policy on this.
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.
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.