Challenges in Implementing the National Health Response to COVID-19 in Senegal

Health Planning in Times of COVID-19 in Burkina Faso: The Role of Its National Strategic Pandemic Management Committee

CONTEXT

Presenting the COVID-19 crisis as a pandemic misleadingly implies a certain homogeneity between the regions of the Globe in terms of their burden and reactions. However, from the outset of the crisis, countries presented different epidemiological realities and sometimes adopted divergent, even opposing measures. Curiously, the heterogeneity of responses persisted as scientific evidence accumulated about COVID-19 and the strategies for dealing with it.

CASE STUDY

This commentary aims to recount the specific experience of Burkina Faso, and how it reoriented its initial biomedical response into a multisectoral strategy. Burkina Faso set up a committee specifically to examine the effects not only of the pandemic, but also of the control measures. This committee was mandated to decompartmentalize the lens through which the COVID-19 was dealt with. It entered into dialogue with a level of stakeholders often overlooked during national health crisis: communities. As a member of this "National Committee for Crisis Management of the Pandemic", one of the co-authors contributed to its orientations and has witnessed first-hand some of the challenges it faced.

RECOMMENDATIONS

This experience suggests that the project of extricating the field of public health from medicine is advancing in Burkina Faso. In order to manage future crises more effectively and across different sectors, there is an urgent need to establish state structures and to strengthen public health systems. States need coordination units that have the legitimacy, authority and resources required to mobilize a variety of actors at the community, national and international levels.

The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal

BACKGROUND

In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers.

METHODS

This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews.

RESULTS

The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes.

CONCLUSION

Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.

Acceptability of contact management and care of simple cases of COVID-19 at home: a cross-sectional study in Senegal

BACKGROUND

COVID-19 is a major public health problem. In mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The objective of the study was to determine the acceptability of contact and simple case management of COVID-19 at home and its associated factors in Senegal.

METHODS

This was a descriptive and analytical cross-sectional study. We collected data from 11 June to 10 July 2020. We used a marginal quota sampling strategy. A total of 813 individuals took part in the survey. We collected data using a telephone interview.

RESULTS

The care of simple cases of COVID-19 at home was well accepted (78.5%). The use of home contact management was less accepted (51.4%). Knowledge of the modes of transmission of the virus and confidence in institutional information were associated with the acceptability of home care for simple cases. Regularly searching for information on COVID-19 and confidence in the government's control of the epidemic were associated with the acceptability of managing contacts at home.

CONCLUSIONS

Authorities should take these factors into account for better communication to improve the acceptability and confidence in home-based care for COVID-19 and future epidemics.