Fighting COVID-19 and HIV through community mobilisation: lessons from an integrated approach to the Africa CDC Partnership to Accelerate COVID-19 Testing (PACT) initiative in seven countries

Recent literature has shown how the HIV architecture, including community systems, has been critical for fighting COVID-19 in many countries, while sustaining the HIV response. Innovative initiatives suggest that fostering the integration of health services would help address the colliding pandemics. However, there are few documented real-life examples of community mobilisation strategies responding to COVID-19 and HIV. The African Union and Africa Centres for Disease Control and Prevention (Africa CDC) launched the Partnership to Accelerate COVID-19 Testing (PACT) in june 2020 with the goal of training and deploying one million community health workers across the continent. UNAIDS partnered with Africa CDC to implement the PACT initiative in seven countries, i.e. Algeria, Côte d'Ivoire, Gabon, Ghana, Madagascar, Malawi and Namibia. The initiative engaged networks of people living with HIV and community-led organisations to support two of its pillars, test and trace, and the sensitisation to protective measures against COVID-19 for the most vulnerable populations. It later expanded to improve access to COVID-19 vaccines. Based on the assessment of country projects, this article explains how PACT activities implemented by communities contributed to mitigating COVID-19 and HIV among vulnerable and marginalised groups. This article contributes to a better understanding of the impact of a community-based approach in responding effectively to emerging health threats and provides lessons from integrated COVID-19 and HIV community-led responses.

Medical Students' Attitudes Towards the Primary Health Care Approach : What are they; how do they Change and where are they from?

Background: The context of the research presented in this article is the new MBChB curriculum at the University of Cape Town (UCT) that has been running since 2002. This new curriculum is PHC-driven and has an emphasis on the integration of the biological and psychosocial. This context of curriculum reform at UCT can be placed within the wider South African context in which the South African Department of Health has committed to the primary health care (PHC) approach. The aim of this research was to provide an understanding of medical students' attitudes towards the (PHC) approach. The findings presented in this article form part of a broader set of findings for a PhD research study that aimed to qualitatively explore medical students' attitudes towards and perceptions of the PHC.Methods: A qualitative approach was taken and focus groups and interviews were conducted with second; third and fourth-year medical students from UCT. A total of eighty-two students were purposively selected to participate in this research. A content analytic approach was used to analyse the focus group and interview data.Results: Students have a generally positive attitude towards the PHC approach and were positive about UCT's choice to promote this approach. Some however were concerned about the international relevance and status of their degree; and concerns were also raised about the contrast between the theory and reality of the approach; many labelling PHC as idealistic. Students' responses indicate that attitudes towards the PHC approach are open to change through the course of their academic career and are influenced by a range of factors. Some of these factors were related to the medical school environment; such as the PHC approach itself; how PHC was taught; and the views of other students and staff at UCT. Other factors that were not related to the university included personality; students' background and exposure to health facilities; and clinical exposure outside UCT.Conclusion: These findings raise the question of whether students are able to think and feel positively about the PHC approach but not actually internalise the philosophy of the PHC approach. Students' struggle with the incongruence between what is perceived as the idealistic theory of PHC and the reality of health care in South Africa is also an issue that needs to be acknowledged. These issues are particularly significant in South Africa where a commitment has been made by the South African Department of Health to the PHC approach; and where doctors are set to play a vital role in the implementation and success of this approach

Induced abortion in Nigeria: findings from focus group discussion

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning; unwanted pregnancy; abortion; adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects; high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted; if paternity of pregnancy is in dispute; or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier.Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning; unwanted pregnancy; abortion; adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects; high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted; if paternity of pregnancy is in dispute; or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier

Community Leaders' Perception of Reproductive Health Issues and Programmes in Northeastern Nigeria

Context: A faith-based NGO wanted to expand its reproductive health programmes to Northeastern Nigeria in view of its poor reproductive health indices compared to the other parts of the country. In order to make the programme more acceptable; accessible and successful; a rapid needs assessment was conducted. Objective: To assess the perception and acceptability of the various components of reproductive health among community and religious leaders in northeast Nigeria. Study Design. Setting and Subjects: A community-based qualitative study. One community leader and one Islamic religious leader each were interviewed in Ganjuwa; Dass and Shira local government areas of Bauchi state. Similarly; a community leader and a religious leader each were interviewed in Maiduguri; Konduga and Gwoza local government areas of Borno state. In Yobe state; one religious and one community leader were interviewed. Results: The community/religious leaders perceived reproductive health problems as prevalent and contributing to maternal morbidity and mortality. They believe women should seek healthcare services for preventive and curative care preferably from female providers. They suspect reproductive health programmes as Western agenda for population control. They have very strong feelings against the provision of elective abortion services. The only acceptable indications for elective abortion include death of the fetus in utero; gross congenital anomaly incompatible with life and serious maternal health risk. A committee of trusted; and preferably Muslim; Godfearing; doctors should assess and confirm these indications. They accept that women with complications of spontaneous abortion should seek care. The provision of contraceptive services to adolescents or married couples is not acceptable. In case of married couples; the only acceptable indication is on serious maternal health grounds. Even then; only harmless methods of contraception may be used specifically coitus interruptus or calendar method with prior spousal consent. The use and promotion of condoms as a barrier method or for the prevention of STIs is not acceptable. The prevention and care of those with HIV/AIDS is acceptable with emphasis on pre-marital abstinence and faithfulness among couples. Conclusion: The varied perceptions; cultural and religious barriers to reproductive health services need to be articulated in order to structure appropriate strategies that will inform and sensitize people about reproductive health programmes and services. Advocacy; monitoring and involvement in programme planning; implementation and social mobilization are useful strategies for addressing this issue

The Need for Law in the Control of HIV/AIDS in Uganda

Two decades have passed since the AIDS epidemic emerged. during this short period the disease has taken root particularly in sub-Saharan Africa where out of the total global estimate of 40 million by the end of 2001; 28.1 million are within sub-Saharan Africa as the epicentre of the disease. The disease is decimating the youth at a highly alarming rate and is putting considerable pressure on resources for the care of the AIDS victims and theor orphans. The disease has dawned on a region deeply colonised by poverty; wars and insurgency in the presence of inadequate health care infrastructures and economies. AIDS is making an already bad situation worse. HIV/AIDS has vehemently condemed sub-Saharan Africa to immense suffering. According to the end of 2001 global estimates for children and adults by the World Health Organisation; the new HIV infections during the year 2001 is 5 million. Such a figure is unacceptable; as it is a real threat to Africa where the problem is greatest

Voices of the poor: Health is important but badly managed

This paper has been prepared based on the findings of the studies carried out by the Uganda Participatory Poverty Assessment Project (UPPA) in nine districts of Uganda. The nine districts are Bushenyi; Kabarole; Kalangala; Kampala; Kapchorwa; Kisoro; Kotido; Kumi and Moyo. The author reviewed the nine reports; from which common themes were identified which are the basis for the paper. The reflections in the paper are to a greater extent those of the poor people in the nine districts. It is strongly believed that although the study by UPPAP involved only nine out of the then forty-five districts in the country; the views from the nine districts generally represent the interests that are shared by all the districts. The author has picked on the points brought out by the nine district reports and looked at them in line with the policies and development in the health sector and the poverty eradication action plan in general. The views and recommendations reflected in the paper are therefore not those of the author but rather views of the poor reflected in the perspective of the on-going developments in the health sector and the nation at large. While there are district variations in the way the communities perceive poverty; all the districts reviewed share a common view that health is an important factor in poverty both as cause and effect. Poor health and inadequate health services were indicated to be major causes of poverty at individual; household and community levels. The factors mentioned responsible for poor and inadequate health services include long distances to health facilities; inadequate drug and medical supplies; user-fees; untrained and inadequate health personnel; negative attitude of health personnel to patients/clients; poor infrastructure; and lack of referral system associated with poor transport systems in the districts. The communities also point out that the health sector policies are not well explained to the communities are not clear about what is being offered and what is expected of them. Poor health hinders the ability to work and therefore leads to decreased production. This may affect the individual persons that are sick but also family and community members who have to care for them. For example; in two of the four sites visited by the study team in Kisoro; it was reported that when an individual falls sick and requires to be taken to hospital; because of lack of transport; because of the lack of transport; a group of able bodied men including members of the family and other members of the community in the neighbourhood have got to accompany the sick person to hospital. This often means that at least a whole days work is lost for everyone involved. At times when a person fall sick; in order to get treatment and the necessary care; there may be no alternative to selling off the few assets the family has. The effect of loss of such assets on the poverty status of the individual and the family can be devastating. Communities have clearly identified malaria and AIDS as leading causes of death among their population. Specifically with reference to AIDS; it is reported that deaths; especially of the breadwinners; have resulted into family disintegration and more dependence. Whereas the family may e become an added burded to some other family. Where there is nobody to lean on; the family social and economic status may drastically change negatively. A case study of Basigayabo Anastazia ellucidates the point. Anastazia is a widow looking after six orphans. She underwent a surgery and currently she could not no most of the hard work. She solely depends on the son to cater for basic essentials. She feels that without the son; she cannot survive. She has no help from any of the other relatives. In some cases; after such deaths; windows and orphans may lose their land to relatives; the only land that would have helped them through

Monitoring Poverty Eradication in Health

The Ministry of Health (MOH) has identified three indicators for the broad purpose of monitoring actions in the context of health sector Poverty Eradication Action Plan (PEAP): The percentage of children under one year covered with DPT3 immunisation according to schedule; the proportion of health centres with the minimum staffing norms and OPD utilisation rates. We reviewed data available at the Resource Centre (RC); the Uganda National Programme for Immunisation (UNEPI) and the National Tuberculosis and Leprosy Programme (NTLP). In addition; field teams collected data from registers in randomly selected health units in 35of the districts. Objectives: 1. To derive baseline estimates for some of the HSSP indicators. 2. To assess the performance of districts with respect to the HSSP indicators

How operational are district health systems? Estimation of available resources

A study to assess the operationality of district health systems was carried out between February and May 2001. Operationality is defined as the state of the existing and functional structures and managerial processes that enable the provision of essential health care to the population. This was not an assessment of the performance of the district; but rather the availability of functional inputs required for health care delivery. A health care system is assessed in terms of the structures/inputs it has for health care provision; the processes used to convert these inputs into favorable products; and the outcomes that are achieved as a result of the actions of the system. The performance of a health system is a function of the available inputs; and the efficiency with which these inputs are utilized. We need to first determine the presence of inputs; before determining how these are used. The level of inputs into the health care system has not been determined. Different programs have some ideas as to the amount of input they have; but no study has ever comprehensively looked at inputs into te district system. This study quantifies the inputs into a score that can be compared over time and whithin districts for inter district comparisons. The study was very comprehensive; and this paper is a condensation of the findings. We explored thestructures/inputs that avail the users with an opportunity to receive adequate care. These features do not tel us whether the users are receiving quality care; but rather; they tell us whether there is an increased / decreased likelihood of receiving quality care. We do not explore the level of functioning of the inputs analysed; but rather the presence or absence of these inputs. Efficiency with which these inputs are utilized is a second stage of this analysis

A Cost Analysis of Kilifi and Malindi Public Hospitals in Kenya

Information on hospital costs is urgently needed in planning; budgeting; and hospital-based efficiency evaluations. The aim of this study was to estimate and compare the total and unit costs of providing care in Kilifi District hospital (KDH) and Malindi Sub-district Hospital (MSH). However; the specific objectives were: calculate the annual total cost of providing care in KDH and MSH; compare the unit costs for KDH with those of MSH; and demonstrate hospital costing methodology. The step-down procedure was used to apportion general costs to departments that provided direct patient care; i.e the wards and outpatient department. Results indicated that the Kenyan Government spent about Ksh 49.4 million and Kshs.22.7 million during the financial year 1993/94 on eh KDH and MSH; respectively. In KDH; the paediatrics ward absorbs the greatest proportion of inpatient department's share of the total cost; whereas; in MSH it is the maternity ward that consumes the greatest proportion. The KDH is more expensive than MSH even in terms of unit costs. For example; the cost per admission was Kshs.5;055 in KDH an dKshs.2;088 in MSH; cost per inpatient day was Kshs.445 in KDH and Kshs.365 in MSH; cost per bed was Kshs.119;590 in KDH and Kshs.112.064 in MSH; and cost per visit was Ksh.206 in KDH and kshs.118 in MSH. However it is likely that the level and quality of service provided between the two hospitals also differ. The public hospitals absorb a substantial proportion of the recurrent budget; so it is imperative that resource use and the role of the role (as district referral facility) in the district health system should be monitored and evaluated regularly

The Policy Basis for Community Health Financing in Cameroon : Establishment of the North West Provincial Special Fund for Health

National health systems in Africa and around the world have and are still undergoing reforms in response to the Alma Ata Declaration. In Africa; people centred; community based and locally managed strategies are widely accepted. And in many countries like Cameroon; revolving funds for essential drugs have been adopted as an entry point to the implementation of primary health care elements in community health centres. The current reforms are leading to a sharing of financing responsibilities between people and government; with catalytic support from external agencies. Economic; social and political crises in Africa in the past decade have earned the countries stiff structural adjustment policies with severe consequences on health budgets; health manpower; and health status. This paper describes the policy basis for community financing in Cameroon. It suggests that revolving essential drugs funds (as proposed in the Bamako Initiative) cannot be viewed in isolation; but as part of the community and national response to the crises situation; it also demonstrated the capacity of the health sector to fight back to overcome the ill effects of structural adjustment. And last but not the least; these funds have provided an opportunity for the exercise of democracy and the participatory management by these officials of public goods and services

VIH/SIDA; stigmatisation et discrimination: une approche anthropologique

Ce document presente les actes de la table ronde du 29 novembre 2002 a l'UNESCO (Paris). Les contributions d'eminents chercheurs contenus dans cette publication constituent des outils de reflexion sur le traitement et la prevention du VIH/sida dans lesquels la culture doit jouer un role fondamentale. Par la meme occasion; l'approche anthropologique de la prevention et du traitement devrait contribuer a reduire la stigmatisation et la discrimination