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Hasan MZ, Neill R, Das P, Venugopal V, Arora D, Bishai D, Jain N, Gupta S. Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2021-005667. [PMID: 34135071 PMCID: PMC8210663 DOI: 10.1136/bmjgh-2021-005667] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Integrated health service delivery (IHSD) is a promising approach to improve health system resilience. However, there is a lack of evidence specific to the low/lower-middle-income country (L-LMIC) health systems on how IHSD is used during disease outbreaks. This scoping review aimed to synthesise the emerging evidence on IHSD approaches adopted in L-LMIC during the COVID-19 pandemic and systematically collate their operational features. METHODS A systematic scoping review of peer-reviewed literature, published in English between 1 December 2019 and 12 June 2020, from seven electronic databases was conducted to explore the evidence of IHSD implemented in L-LMICs during the COVID-19 pandemic. Data were systematically charted, and key features of IHSD systems were presented according to the postulated research questions of the review. RESULTS The literature search retrieved 1487 published articles from which 18 articles met the inclusion criteria and included in this review. Service delivery, health workforce, medicine and technologies were the three most frequently integrated health system building blocks during the COVID-19 pandemic. While responding to COVID-19, the L-LMICs principally implemented the IHSD system via systematic horizontal integration, led by specific policy measures. The government's stewardship, along with the decentralised decision-making capacity of local institutions and multisectoral collaboration, was the critical facilitator for IHSD. Simultaneously, fragmented service delivery structures, fragile supply chain, inadequate diagnostic capacity and insufficient workforce were key barriers towards integration. CONCLUSION A wide array of context-specific IHSD approaches were operationalised in L-LMICs during the early phase of the COVID-19 pandemic. Emerging recommendations emphasise the importance of coordination and integration across building blocks and levels of the health system, supported by a responsive governance structure and stakeholder engagement strategies. Future reviews can revisit this emerging evidence base at subsequent phases of COVID-19 response and recovery in L-LMICs to understand how the approaches highlighted here evolve.
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Affiliation(s)
- Md Zabir Hasan
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada .,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Priyanka Das
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vasuki Venugopal
- Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India
| | - Dinesh Arora
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nishant Jain
- Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH India Office, New Delhi, India
| | - Shivam Gupta
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mutabazi JC, Gray C, Muhwava L, Trottier H, Ware LJ, Norris S, Murphy K, Levitt N, Zarowsky C. Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study. BMC Health Serv Res 2020; 20:582. [PMID: 32586318 PMCID: PMC7318762 DOI: 10.1186/s12913-020-05381-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods A total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.
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Affiliation(s)
- Jean Claude Mutabazi
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada. .,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Lorrein Muhwava
- Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, J Floor, Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, Western Cape, South Africa
| | - Helen Trottier
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada
| | - Lisa Jayne Ware
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Shane Norris
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Katherine Murphy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Naomi Levitt
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Christina Zarowsky
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada.,School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville 7535, Cape Town, Western Cape, South Africa
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Mundell JP, Visser MJ, Makin JD, Forsyth BW, Sikkema KJ. Support group processes: Perspectives from HIV-infected women in South Africa. QUALITATIVE RESEARCH IN PSYCHOLOGY 2012; 9:173-187. [PMID: 22514790 DOI: 10.1080/14780887.2010.500350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the experiences and perceived benefits of support group participation among HIV-infected women in South Africa. From a qualitative analysis of responses, key psychological processes through which support groups are potentially beneficial were identified. These processes included: identification; modeling; acceptance; and empowerment. The participants' consequent life changes were explored in order to associate these processes with the positive outcomes of support group participation. Through understanding the relationship between the psychological processes within a support group setting and the potential benefits, and by targeting these processes in the development and implementation of future support group interventions, a framework is provided for achieving positive outcomes associated with support group participation.
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Affiliation(s)
- J P Mundell
- The University of Pretoria, MRC Unit, Serithi Project
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Mundell JP, Visser MJ, Makin JD, Kershaw TS, Forsyth BWC, Jeffery B, Sikkema KJ. The impact of structured support groups for pregnant South African women recently diagnosed HIV positive. Women Health 2012; 51:546-65. [PMID: 21973110 DOI: 10.1080/03630242.2011.606356] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The authors of this study evaluated a structured 10-session psychosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p<0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t=2.68, p<0.05) and lower levels of avoidant coping (t=-2.02, p<0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t=2.11, p<0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one's HIV status, but may not have sustainable benefits over time.
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Affiliation(s)
- Jonathan P Mundell
- MRC Unit for Maternal and Infant Health Care Strategies, Department of Psychology, University of Pretoria, Pretoria, South Africa.
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Visser M, Mundell J, de Villiers A, Sikkema K, Jeffery B. Development of structured support groups for HIV-positive women in South Africa. SAHARA J 2005; 2:333-43. [PMID: 17600975 PMCID: PMC11132678 DOI: 10.1080/17290376.2005.9724858] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Women living with HIV in a stigmatising community need support to cope with their HIV status. In a process of action research, a structured support group programme was designed to meet the needs of women to cope with their diagnosis and interpersonal relationships. The emphasis was on identifying their needs and developing programme material to address those needs through group participation and interaction. The programme was pilot-tested at two sites located in two townships in Tshwane, South Africa. Feedback after each session made it possible to adjust the programme to the needs of the participants. In a formative evaluation, audio-taped sessions, process notes of facilitators, and experiences of the participants were used to identify therapeutic elements, the value of the groups and the problems in the implementation process. Women reported benefit from participation in the support groups. A 10-session structured programme to be used in support groups addressing the most important needs of HIV-positive women was developed.
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Affiliation(s)
- Maretha Visser
- Department of Psychology, University of Pretoria, Brooklyn, Pretoria 0002, South Africa.
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