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Fejfar D, Andom AT, Msuya M, Jeune MA, Lambert W, Varney PF, Aron MB, Connolly E, Juárez A, Aranda Z, Niyigena A, Cubaka VK, Boima F, Reed V, Law MR, Grépin KA, Mugunga JC, Hedt-Gauthier B, Fulcher I. The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries. Glob Health Action 2023; 16:2178604. [PMID: 36880985 PMCID: PMC10013493 DOI: 10.1080/16549716.2023.2178604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.
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Affiliation(s)
| | - Afom T Andom
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Meba Msuya
- Clinical Services, Partners In Health, Maseru, Lesotho
| | - Marc Antoine Jeune
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Wesler Lambert
- Department of Strategic Planning and Information Systems, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Prince F Varney
- Strategic Health Information Systems, Partners In Health, Monrovia, Liberia
| | - Moses Banda Aron
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Emilia Connolly
- Monitoring, Evaluation, and Information, Partners In Health, Neno, Malawi
| | - Ameyalli Juárez
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Zeus Aranda
- Partners In Health/Compañeros en Salud, Jaltenango de la Paz, Mexico
| | - Anne Niyigena
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Vincent K Cubaka
- Department of Research and Training, Partners In Health, Kigali, Rwanda
| | - Foday Boima
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Vicky Reed
- Strategic Health Informations Systems, Partners In Health, Koidu City, Kono District, Sierra Leone
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Karen A Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Ndayizigiye M, Allan-Blitz LT, Dally E, Abebe S, Andom A, Tlali R, Gingras E, Mokoena M, Msuya M, Nkundanyirazo P, Mohlouoa T, Mosebo F, Motsamai S, Mabathoana J, Chetane P, Ntlamelle L, Curtain J, Whelley C, Birru E, McBain R, Andrea DM, Schwarz D, Mukherjee JS. Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage. PLOS Glob Public Health 2022; 2:e0000985. [PMID: 36962564 PMCID: PMC10021396 DOI: 10.1371/journal.pgph.0000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.
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Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America
| | - Emily Dally
- Partners In Health, Boston, Massachusetts, United States of America
| | | | - Afom Andom
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | - Meba Msuya
- Partners In Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | | | - Joel Curtain
- Partners In Health, Boston, Massachusetts, United States of America
| | - Collin Whelley
- Homebase Center for Common Concerns, San Francisco, California, United States of America
| | - Ermyas Birru
- University of Washington, Seattle, Washington, United States of America
| | - Ryan McBain
- RAND Corporation, Boston, Massachusetts, United States of America
| | - Di Miceli Andrea
- Analysis Group Inc., Boston, Massachusetts, United States of America
| | - Dan Schwarz
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Ariadne Labs, Boston, Massachusetts, United States of America
| | - Joia S Mukherjee
- Division of Global Health Equity: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
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Mbwele B, Slot A, De Mast Q, Kweka P, Msuya M, Hulscher M. The Use of Guidelines for Lower Respiratory Tract Infections in Tanzania: A Lesson from Kilimanjaro Clinicians. Ann Med Health Sci Res 2016; 6:100-8. [PMID: 27213093 PMCID: PMC4866362 DOI: 10.4103/2141-9248.181845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Evaluations of the guidelines for the management of Lower Respiratory Tract Infections (LRTI) Sub-Saharan Africa, particularly in Tanzania is scant. Aim: The aim of the study was to assess the usefulness of the current Tanzanian treatment guideline for the management lower respiratory tract infection. Subjects and Methods: A descriptive cross sectional study in 11 hospitals of different levels in the Kilimanjaro region Data were collected from May 2012 to July 2012 by semi-structured interview for clinicians using 2 dummy cases for practical assessment. Data were analyzed by STATA v11 (StataCorp, TX, USA). Qualitative narratives from the interviews were translated, transcribed then coded by colors into meaningful themes. Results: A variety of principles for diagnosing and managing LRTI were demonstrated by 53 clinicians of Kilimanjaro. For the awareness, 67.9% (36/53) clinicians knew their responsibility to use Standard Treatment Guideline for managing LRTI. The content derived from Standard Treatment Guideline could be cited by 11.3% of clinicians (6/53) however they all showed concern of gaps in the guideline. Previous training in the management of patients with LRTI was reported by 25.9% (14/53), majority were pulmonary TB related. Correct microorganisms causing different forms of LRTI were mentioned by 11.3% (6/53). Exact cause of Atypical pneumonia and Q fever as an example was stated by 13.0% (7/53) from whom the need of developing the guideline for LRTI was explicitly elaborated. Conclusion: The current guidelines have not been used effectively for the management of LRTI in Tanzania. There is a need to review its content for the current practical use.
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Affiliation(s)
- B Mbwele
- Kilimanjaro Christian Medical Center, Kilimanjaro Clinical Research Institute, Zanzibar, Tanzania; Programme Manager - Reproductive Maternal Newborn Child Health, Nutrition and WASH, Save the Children, Zanzibar, Tanzania
| | - A Slot
- Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Q De Mast
- Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Kweka
- Vijiji International, Kilimani Tower, Mawenzi Road, Moshi, Tanzania
| | - M Msuya
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - M Hulscher
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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