Equitable health services

Healthcare service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa: a caregivers’ perspective
Meyer-Weitz A; Oppong Asante K; Lukobeka B: BMC Medicine 16(163), doi: https://doi.org/10.1186/s12916-018-1153-0, 2018

This study explored refugee caregivers’ perceptions of their children’s access to quality health service delivery to their young children in Durban, South Africa. This study used an explanatory mixed methods design, purposively sampling 120 and 10 participants for the quantitative and qualitative phases, respectively. The majority (89%) of caregivers were women, with over 70% of them aged between 30 and 35 years. Over 74% of caregivers visited public clinics for their children’s healthcare needs. The majority of caregivers (95%) were not satisfied with healthcare services delivery to their children due to the long waiting hours and the negative attitudes and discriminatory behaviours of healthcare workers, particularly in public healthcare facilities. These findings underscore the need to address health professionals’ attitudes when providing healthcare for refugees. The authors suggest that attitudinal change may improve the relationship between service providers and caregivers of refugee children in South Africa, which may improve the health-related outcomes in refugee children.

Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians
Dei V; Sebastian M: International Journal for Equity in Health 17(86)1-12, 2018

This paper aimed to assess whether horizontal and vertical equity were being met in the healthcare utilisation among adults aged 50 years and above. The paper was based on a secondary cross-sectional data from the World Health Organization’s Study on global AGEing and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Horizontal and vertical inequities were found in the use of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services. Whilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The paper reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access.

Contact tracing performance during the Ebola epidemic in Liberia, 2014-2015
Swanson K; Altare C; Wesseh C; et al: PLOS Neglected Tropical Diseases, doi: https://doi.org/10.1371/journal.pntd.0006762, 2018

During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. The authors describe the scope and characteristics of this contact tracing and assess its performance during the 2014–2015 epidemic in six counties. Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during the period covered, with a PPV of 1.4%. Potential cases were more likely to be detected early in the outbreak; to hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness, as compared to contacts who completed monitoring. Contact tracing was identified to be a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, the study data suggest there were limitations to its performance—particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.

Ebola Attacked Congo Again. But Now Congo Seems to Be Winning
McNeil D: New York Times, 2 September 2018

The month-old Ebola outbreak in the Democratic Republic of Congo, which rose quickly to over 100 cases appears to be fading. More than 3,500 contacts of known cases are being followed, more than 4,000 doses of vaccine have been given and officials reported feeling hopeful enough to allow schools in the area — North Kivu Province, on the eastern border with Uganda — to open as usual. Although five experimental treatments for infected patients recently won approval for emergency use, the author reports that so far too few patients have received them to draw conclusions about how well they may work. One reason experts are reluctant to declare the outbreak contained is that some remote towns have not been visited because of armed groups in the area. Ebola experts also said they would not let down their guard because they remembered a brief, deceptive lull in the early days of the 2014 West African outbreak before it reached three capital cities and exploded, killing more than 11,000 people. Medically, the most exciting prospect on the horizon is that, as of Aug. 22, DRC has approved the emergency use of five potential treatments: two antiviral drugs, remdesivir and favipiravir; and three cocktails of antibodies originally found in recovered patients, including ZMapp, mAb114 and Regn3450-3471-3479. Previously, only about half of Ebola patients were saved if they got supportive treatment, including fluid replacement and fever control, in time. Being consistently able to cure most patients is reported to be an important advance.

Health systems readiness for adopting mhealth interventions for addressing non-communicable diseases in low- and middle-income countries: a current debate
Feroz A; Kadir M; Saleem S: Global Health Action 11(1496887) 1-7, 2018

In low-and-middle-income countries (LMICs), epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases (NCDs). NCD mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs, with human and economic costs, increasing treatment costs and losses to productivity. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth. While mHealth offers a promising approach in prevention and control of NCDs, it is unclear how ready health systems are to adopt it for this. The authors raise a number of factors which determine health systems readiness and response for adoption of mHealth technology including preparedness of healthcare institutions, availability of the resources, willingness of healthcare providers and communities. They discuss these factors and suggest that they be dealt up-front through constant effort to improve health systems response for NCDs.

Maternity waiting facilities for improving maternal and neonatal outcome in low- resource countries
van Lonkhuijzen L; Stekelenburg J; van Roosmalen J: University of Groningen, 2011

A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre which provides Emergency Obstetric Care (EmOC). The aim of the MWH is to improve accessibility and thus reduce morbidity and mortality for mother and neonate should complications arise. This study assessed the effects of a maternity waiting facility on maternal and perinatal health. The authors searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), African Journals Online (AJOL) (April 2009), POPLINE (April 2009), Dissertation Abstracts (April 2009) and the National Research Register archive (March 2008) for conducted randomised controlled trials that compared perinatal and maternal outcome in women using a MWH and women who did not. There were no randomised controlled trials or cluster-randomised trials identified from the search. They found from this evidence that there is insufficient evidence to determine the effectiveness of Maternity Waiting Facilities for improving maternal and neonatal outcomes.

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi
Angwenyi V; Aantjes C; Kajumi M; et al: Public Library of Science ONE 13(7) 1-17: 2018

This study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource constrained setting in Malawi. A qualitative study was conducted which involved patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients, 14 in-depth interviews, and four focus-group discussions with patients. Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included ability to acquire appropriate disease knowledge, poverty level, the presence of support from family caregivers and community-based support initiatives, the nature of one’s social relations; and the ability to deal with stressors and stigma. Non-communicable diseases and HIV co-infected people were more disadvantaged in their access to care, as they experienced frequent drug stockouts and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of care challenges. The authors’ findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. They recommended expanding current peer-patient and support group initiatives to patients with non-communicable diseases, and further investments in the decentralization of integrated health services to primary care level in Malawi.

The role of maternity waiting homes as part of a comprehensive maternal mortality reduction strategy in Lesotho
Satti H; McLaughlin M; Seung K: Partners In Health Reports 1(1) 1-24, 2013

Lesotho has one of the highest maternal mortality rates in the world, Partners In Health (PIH) has included maternity waiting homes since 2009 as part of a comprehensive effort to increase facility-based deliveries and reduce maternal mortality. The maternity waiting homes are located at seven PIH-supported health centres in some of the most remote, underserved areas of rural Lesotho. The homes provide food and shelter for women who live far away from the health centre or have risk factors for potential obstetric complications, and are well-regarded by both health centre staff and pregnant women. Since the implementation of the Maternal Mortality Reduction Project, PIH has seen waiting home admissions and the number of monthly deliveries at health centres increase dramatically. The authors suggest that failure of previous studies to demonstrate a positive impact of maternity waiting homes may reflect the failure to successfully implement other supporting components of a larger, comprehensive strategy to increase access to maternal health services.

Why indigenous medicine could play a role in rebuilding health systems
Falisse J; Masino S; Ngenzebuhoro R: The Conversation, June 2018

This study contributes to the health policy debate on medical systems integration by describing and analysing the interactions between health-care users, indigenous healers, and the biomedical public health system, in the so far rarely documented case of post-conflict Burundi. The authors adopted a mixed-methods approach combining (1) data from an existing survey on access to health-care, with 6,690 individuals, and (2) original interviews and focus groups conducted in 2014 with 121 respondents, including indigenous healers, biomedical staff, and health-care users. The findings reveal pluralistic patterns of health-care seeking behaviour, which are not primarily based on economic convenience or level of education. Indigenous healers’ diagnosis is shown to revolve around the concept of ‘enemy’ and the need for protection against it. The authors suggest ways in which this category may intersect with the widespread experience of trauma following the civil conflict. They find that, while biomedical staff display ambivalent attitudes towards healers, cross-referrals occasionally take place between healers and health centres. The authors emphasise healers’ psychological support role in helping communities deal with trauma.

EAC Executive decries high number of East Africans seeking health services in India
East African Community Secretariat: Arusha, Tanzania, June, 2018

The Executive Secretary of the East African Health Research Commission (EAHRC), Professor Gibson Kibiki, has decried the high number of East Africans going to India to seek medical services which can be accessed in hospitals in the region. Prof. Kibiki attributed the huge exodus of patients to India to the lack of information on health services that were available at referral hospitals in the region. He revealed that East Africans may soon be able to access treatment across national borders in addition to enjoying portable health insurance across the region, adding that the Commission would soon undertake research to gauge the feasibility of a regional health insurance scheme before piloting the scheme. He described as counterproductive the tendency by health researchers and medics in the Partner States to work in silos since the region was one and that diseases did not know national borders.