Equitable health services

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.

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19
Karamagi CH; Tumusiime P; Titi-Ofei R; et al: BMJ Global Health 6(3) 2021

The move towards universal health coverage is premised on having well-functioning health systems. The authors present an approach to provide countries with information on the functionality of their systems in a manner that will facilitate movement towards universal health coverage. They propose four capacities: access to, quality of, demand for essential services and its resilience to external shocks and provide results for the 47 countries of the WHO African Region based on this. The functionality of health systems in these countries ranged from 34.4 to 75.8 on a 0–100 scale. Access to essential services represents the lowest capacity. Funding levels from public and out-of-pocket sources represented the strongest predictors of system functionality. The authors propose that such assessment on the capacities that define system functionality can help countries to identify where to focus to improve the functioning of the health system.

Investigation of an anthrax outbreak in Makoni District, Zimbabwe
Makurumidze R; Tafara Gombe N;Magure T; Tshimanga M: BMC Public Health 21(298), 1-10, 2021

The authors investigated an anthrax outbreak in Makoni District, Zimbabwe, and assessed the environment, district preparedness and response, and outbreak prevention and control measures. They found that most of the cases were managed according to the national guidelines. Multivariable analysis demonstrated that meat sourced from other villages, skinning, and belonging to religions that permit eating meat from cattle killed due to unknown causes or butchered after unobserved death were associated with contracting anthrax. The poor availability of resources in the district caused a delayed response to the outbreak. Although the outbreak was eventually controlled through cattle vaccination and health education and awareness campaigns, the authors report that the response of the district office was initially delayed and insufficient. They call for strengthened emergency preparedness and response capacity at district level, for revival of zoonotic committees, awareness campaigns and improved surveillance, especially during outbreak seasons.

IWG Fireside Chat: Looking Back, Looking Ahead
International Working Group on Health Systems Strengthening: IWG. February 2021

In December, the IWG hosted an event with health professionals with experience in different fields to better understand leadership in health systems, and consolidated the reflections from the discussions. The discussion raised several key features, including: Investing in gender, racial, and geographic equity among global health leaders and health activists; improving teamwork and multidisciplinary collaborations between individuals and communities of diverse skills, capabilities and backgrounds; networking across health leaders and communities and promoting local ownership and leadership. The session also pointed to the importance for the success of public health interventions and initiatives that those affected and implementing them be at the centre of the design and interactions.

Preparedness of health care systems for Ebola outbreak response in Kasese and Rubirizi districts, Western Uganda
Kibuule M; Sekimpi D; Agaba A; Halage A; et al: BMC Public Health 21(236), 1-16, 2021

This study assessed the preparedness of the health care facilities for the Ebola (EVD) outbreak response in Kasese and Rubirizi districts in western Uganda. It involved interviews with 189 health care workers and visits to 22 health facilities. Twelve out of the 22 of the health facilities did not have a line budget to respond to EVD and the majority of the facilities did not have case definition books, rapid response teams and/or committees, burial teams, and simulation drills. There were no personal protective equipment that could be used within 8 h in case of an EVD outbreak in fourteen of the 22 health facilities. All facilities did not have viral haemorrhagic fever incident management centers, isolation units, guidelines for burial, and one-meter distance between a health care worker and a patient during triage. The authors recommend proactively tracking the level of preparedness to inform strategies for building capacity of health centers in terms of infrastructure, logistics and improving knowledge of health care workers.

Communities, universal health coverage and primary health care
Sacks E; Schleiff, M; Were M; Ahmed Mushtaque Chowdhuryc A; et al: Bulletin of the World Health Organisation 98, 773–780, doi: http://dx.doi.org/10.2471/BLT.20.252445, 2020

With much of the world’s population still lacking access to basic health services, evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care (PHC). Policies and actions to improve PHC must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Metrics used for evaluating PHC and Universal health coverage largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand PHC.

Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model
Kimani R; Maina R; Shumba C; Shaibu S: Human Resources for Health 18(75), 1-5, doi: https://doi.org/10.1186/s12960-020-00518-3, 2020

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The authors outline how the COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. The lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. They argue for a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. The authors propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.

Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois E; Andrew McKenzie A; et al.: Bulletin World Health Organisation 98, 781–791, doi: http://dx.doi.org/10.2471/BLT.20.252742, 2020

In this paper, the primary health-care (PHC) systems in 20 low- and middle-income countries were analysed using a semi-grounded approach. Options for strengthening PHC were identified by thematic content analysis. The authors found that despite the growing burden of non-communicable disease, many low- and middle-income countries lacked funds for preventive services; community health workers were often under-resourced, poorly supported and lacked training; out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in PHC was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of PHC. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. The authors argue for policy-making to be supported by adequate resources for PHC implementation and that government spending on PHC should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of PHC management is also said to be needed.

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