Equitable health services

Incentives for mothers, health workers and “boda–boda” riders to improve community-based referral process and deliveries in the rural community: a case of Busoga Region in Uganda
Muluya K M; Mugisha J F; Kithuka P; et al: Reproductive Health 19(24), 1-9, 2022

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.

New Special Supplement: Reimagining Health Systems for Better Health and Social Justice
Health Systems Global: HSG, 2021

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.

What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa
van Ryneveld M; Whyle E; Brady L: International Journal of Health Policy and Management, 11, 5-8, 2022

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.

Analysis of the management of the tenth Ebola virus disease outbreak in the Democratic Republic of Congo: developing a multidisciplinary response model to strengthen the healthcare system during disease outbreaks
Vivalya B M; Ayodeji O K; Bafwa Y T; et al.: Globalization and Health 17:121, 1-7, 2021

The declaration of any public health emergency in the Democratic Republic of Congo (DRC) is usually followed by the provision of technical and organizational support from international organizations, which build a parallel and short-time healthcare emergency response centred on preventing risks spreading, including to other countries. The authors propose a contrasting model of strengthening of preparedness and response structures to public health emergencies vis-à-vis the existing health systems in DRC. This is argued to be important to reduce tensions between local recruitment, the impact on the quality of wider healthcare in regions affected by EVD on one hand, and the involvement of international recruitment and its impact on social trust in the emergency response on the other. The authors propose providing a local healthcare workforce skilled to treat infectious diseases, the compulsory implementation of training programs focused on the emergency response in countries commonly affected by EVD outbreaks including the DRC. These innovations are proposed to reduce the burden of the range of health problems prior to and in the aftermath of any public health emergency in DRC as well as early recognition and treatment of EVD.

COVID-19: Comparison of the Response in Rwanda, South Africa and Zimbabwe
Dzinamarira T; Mapingure M; Rwibasira G; et al.: MEDICC Review 23:3-4, 15-20, 2021

African countries have mounted different response strategies to COVID-19, eliciting varied outcomes. In this paper the authors compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources, while Zimbabwe has an effective point-of-entry approach that utilizes strategic information. The authors propose meetings between countries to share experiences and lessons learned during the COVD-19 pandemic.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical cancer prevention and control strategy (2016–2020)
Tapera O; Nyakabau A M; Simango N; et al: BMC Public Health 21(1478), 1-13, 2021

This analysis identified the gaps and opportunities for cervical cancer prevention, diagnosis, treatment, and care to inform the next cervical cancer strategy in Zimbabwe. A mixed methods approach was used. This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. There was no national data on the proportion of women who ever tested for cervical cancer, or to quantify the level of awareness and advocacy for cervical cancer prevention which existed nationally. Some health facilities were inappropriately screening women above 50 years old using VIAC. Gaps were identified in pathology services, in data on investigations at the national level, in limited funding, personnel, equipment, and commodities as well as lack of leadership at the national level to coordinate the various components of the cervical cancer programme. Numerous opportunities were identified to build upon the successes realized to date, with the findings emphasising the importance of effective and holistic planning and public investment in cervical cancer screening.

Limits of neoliberalism: HIV, COVID-19, and the importance of healthcare systems in Malawi
Zhou A: Global Public Health 16(8-9), doi: https://doi.org/10.1080/17441692.2021.1940237, 2021

How have prior experiences with managing HIV prepared African countries for COVID-19? Drawing on qualitative methods, this article examines the impact of HIV interventions on the healthcare system in Malawi and its implications for addressing COVID-19. The author argues that the historical and continued influence of neoliberalism in global health manifests in the structures and routines of clinical practice. In Malawi’s health centres, a parallel NGO system of care has become grafted onto state healthcare, with NGOs managing HIV commodities and providing care to HIV patients. While HIV NGOs do support the work of government providers, it is limited to tasks that align with their programmatic goals. Outside of external funder priorities, the conditions of public healthcare are said to be lagging, and government providers struggle with shortages of staff, medical resources, and basic infrastructure, all of which has been compounded by COVID-19.

A critical discourse analysis of adolescent fertility in Zambia: a postcolonial perspective
Munakampe M; Michelo; C and Zulu J: Reproductive Health 18(75), 1-12, 2021

This study explored competing discourses that shape adolescent fertility control in Zambia, through individual interviews and 9 focus group discussions with adolescents and other key-informants. Adolescent fertility discussions were influenced by marital norms and Christian beliefs, as well as health and rights values. While early marriage or child-bearing was discouraged, married adolescents and adolescents who had given birth before faced fewer challenges when accessing Sexual and Reproductive Health information and services compared to their unmarried or nulli-parous counterparts. Parents, teachers and health workers were conflicted about how to package Sexual and Reproductive Health information to young people, due to their roles in the community. The authors assert that the competing moral worlds, correct in their own right, viewed within the historical and social context unearth significant barriers to the success of interventions targeted towards adolescents’ fertility control in Zambia, propagating the growing problem of high adolescent fertility, and suggest proactive consideration of these discourses when designing and implementing adolescent fertility interventions.

China, Africa and the Fast-Changing Geopolitics of Vaccines
Olander E: The China Africa Project, 2021

Most African countries expected to receive tens of millions of doses manufactured by Indian companies. But now that New Delhi has halted all exports, African officials have no other choice but to look elsewhere — and in many cases, that’s leading them to Chinese and Russian suppliers. So far, Covax’s vaccine distribution has failed to meet the needs of developing countries with just 43.4 million doses spread thinly across 119 countries. According to the USAID fact sheets on the US COVID-19 response, the United States has not provided any aid or relief to African countries so far this year. While Washington is refusing to ship vaccines overseas, Chinese vaccine manufacturing output is steadily rising. Both Sinopharm and Sinovac producers now say they are capable of producing at least 2 billion doses in 2021 alone. The author notes that it is entirely possible that the Chinese will be positioned to fill the supply gap in 2021 for a number of low income countries.

Domestic violence in Mozambique: from policy to practice
Jethá E; Keygnaert I; Martins E; Sidat M; et al: BMC Public Health 21(772) 1-13, 2021

The authors identified gaps in Mozambique in the implementation of existing national policies and laws for domestic violence in the services providing care for domestic violence survivors, through content analysis of guidelines and protocols and interviews with institutional gender focal points. While the guidelines were seen to be relevant, many respondents identified gaps in their implementation, due to weaknesses in penalties for offenders, the scarcity of care providers with appropriate training and socio-cultural factors.

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