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.
Equitable health services
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.
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.
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.
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.
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.
Adolescents in sub-Saharan Africa have the highest rate of unplanned pregnancies, almost half (46%) of which end in abortion. Mobile health interventions using mobile phones or devices are argued to have become popular in addressing health issues and were assessed for their role in improving adolescents’ uptake of sexual and reproductive health services. The results showed that mobile health interventions were effective. They improved adolescents’ uptake of sexual and reproductive health services across a wide range of services, particularly contraceptive use. The findings suggest that mobile health interventions promoting prevention or ante-retroviral treatment adherence are acceptable to adolescents and feasible to deliver in sub-Saharan Africa. The authors conclude that there is a need to develop mobile health interventions by and for young people.
Th authors report how financial and non-monetary incentives provided for 6 months to mothers, health workers and boda–boda (motorbike) riders improved the community-based referral process and deliveries in the rural community of Busoga region in Uganda. The incentives included training, training allowances, refreshments during the training, transport fares payable by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group, provision of bonus airtime to all registered Closed Caller User Group participants and rewards to best performers. The study used a mixed methods design. The proportion of mothers who delivered from health centres and used boda–boda transport were 71% in the intervention arm compared to 51% in the control arm. Of the mothers who delivered from the health centres, majority (69%) were transported by trained boda–boda riders while only 31% were transported by untrained boda–boda riders. Of the mothers transported by the boda boda riders, 21% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4% before the intervention, while in the control arm there was limited change. The authors suggest that such incentives and partnerships for different stakeholders along the maternal health chain are key for effective referral processes.
Health Systems Global (HSG) and Health Policy and Planning (HPP), with the support of the International Development Research Centre (IDRC), announce the publication of a Special Supplement – Reimagining health systems for better health and social justice. This Supplement distills and spotlights some of the debates and discussions that took place during the Sixth Global Symposium on Health Systems Research (HSR2020) – Re-imagining health systems for better health and social justice. Articles in the supplement include the editorial Reimagining Health Systems: Reflections from the 6th Global Symposium on Health Systems Research and original manuscripts on equity in public health spending in Ethiopia, universal health coverage in Ghana, organizational structure and human agency within the South African health system and social accountability in Malawi.
The COVID-19 pandemic exposed the wide gaps in South Africa's formal social safety net, with the country's high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and its ensuing epidemiological and social challenges. This article describes and explains the organising principles that inform this community response, and reflects on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.