Equitable health services

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.

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.