The impact of government- and institution-implemented COVID-19 control measures on tertiary- and regional- level intensive care units in Pietermaritzburg, KwaZulu-Natal Province, South Africa

Background. The COVID-19 pandemic has had a significant impact on healthcare systems globally as most countries were not equipped to deal with the outbreak. To avoid complete collapse of intensive care units (ICUs) and health systems as a whole, containment measures had to be instituted. In South Africa (SA), the biggest intervention was the government-regulated national lockdown instituted in March 2020. Objective. To evaluate the effects of the implemented lockdown and institutional guidelines on the admission rate and profile of non-COVID-19 patients in a regional and tertiary level ICU in Pietermaritzburg, KwaZulu-Natal Province, SA. Methods. A retrospective analysis of all non-COVID-19 admissions to Harry Gwala and Greys hospitals was performed over an 8-month period (1 December 2019 - 31 July 2020), which included 4 months prior to lockdown implementation and 4 months post lockdown. Results. There were a total of 678 non-COVID-19 admissions over the 8-month period. The majority of the admissions were at Greys Hospital (52.4%; n=355) and the rest at Harry Gwala Hospital (47.6%; n=323). A change in spectrum of patients admitted was noted, with a significant decrease in trauma and burns admissions post lockdown implementation (from 34.2 - 24.6%; p=0.006). Conversely, there was a notable increase in non-COVID-19 medical admissions after lockdown regulations were implemented (20.1 - 31.3%; p<0.001). We hypothesized that this was due to the gap left by trauma patients in an already overburdened system. Conclusions. Despite the implementation of a national lockdown and multiple institutional directives, there was no significant decrease in the total number of non-COVID-19 admissions to ICUs. There was, however, a notable change in spectrum of patients admitted, which may reflect a bias towards trauma admissions in the pre COVID-19 era

COVID-19: an opportunity for African governments to rethink social welfare benefits and protection

The emergence of COVID-19 in December 2019 has highlighted several lessons about Public health emergencies. One important lesson is on the role of social welfare benefits and protection in the overall management of public health emergencies. The absence of a functional and digitalized social welfare system in Africa may render ineffective public health measures to mitigate the spread of COVID-19. The social determinant of disease illustrates the nexus between poverty and health outcomes. Therefore, COVID-19 is an opportunity for African governments to rethink their stance on social welfare benefits and protection; and adopt mechanisms that protect the most vulnerable

Analysis of the Burdens of Caregivers Providing Care to People Living With HIV/AIDS in Botswana

Background: Caregivers; when providing care under the community home-based care (CHBC) programme; experience many burdens of a physical; emotional; financial or social nature. However; these problems are hardly ever considered by the planners of CHBC programmes. A comprehensive overview of the experiences of caregivers is desirable to help policy makers and public health planners formulate intervention measures to address caregivers' burdens. Methods: The sample size calculator programme that allows for 95 confidence (and an error margin of 4) was used: the estimated sample size for the study was 272. This number was derived from the eight sampled CHBC groups using probability proportional to size. Simple random sampling was employed in identifying the specific caregivers to be interviewed. Questionnaires were administered on this selected sample at their homes or CHBC headquarters by trained research assistants who ensured that all ethical considerations were observed. In the end; 169 caregivers responded within the study period. Results: The study shows that very little support is given to caregivers. In addition; while men's burdens are mainly economic; those of women are overwhelmingly emotional. Furthermore; there is an insignificant association between caregivers' expected and received support while providing care to people living with HIV/AIDS. Conclusion: The study concludes that; to reduce caregivers' burdens; a comprehensive CHBC programme; that will ensure that the role of CHBC caregivers is adequately recognised by the government and community; is needed

Evaluation of Health Knowledge of Teachers in Public Primary Schools in Bonny Local Government Area of Rivers State

Background: The noncompulsory nature of health education as a subject in some teacher training colleges and the generalists' position of teachers in primary schools raise concern over the teachers' health knowledge and the accuracy of health information that pupils are given. Aim: The study was undertaken to evaluate the health knowledge of primary school teachers and to assess the effect of short term training on their health knowledge. Methods: This was a school-based intervention study carried out in June 2006. Health knowledge of all teachers from the 20 public primary schools in Bonny Local Government Area of Rivers State was assessed before and after a workshop on school health using a health knowledge assessment test. Scores of 50and more were regarded as pass. Data was analyzed using SPSS version 11 software. Test for statistical significance was done using Chi-square test and student t-test. P value less than 0.05 was regarded as statistically significant. Results: Twenty nine of the 100 participants (29) passed the pre-test. These were holders of University degrees [13 (56.5)]; National Certificate of Education [13 (28.3)] and Teachers' Grade II Certificate (TCII) [3(10)]. Post workshop; health knowledge improved across board as all the teachers passed (p=0.000). Conclusion: The health knowledge of school teachers from public primary schools in Bonny local government area is low. This was worse among those with lower academic qualifications (TCII and below). However this improved following a short term training workshop

Government spending on social services and the impact of structural adjustment in Zimbabwe

For most of the 1980's real per capita expenditure by Government on health and education grew to unprecedentedly high levels. Real per capita recurrent expenditure on health grew from Z$8.19 in 1979/80 to Z$18.17 in 1990/91. Similarly; real per capita recurrent Government expenditure on primary education in Zimbabwe grew from Z$10.61 in 1979/80 to Z$28.70 in 1990/91. These increases were accompanied by significant improvements in many social indicators such as the under-five mortality rate and the school enrolment rate. Real per capita recurrent expenditure by Government on health and education peaked in 1990/91. Thereafter; with the Economic Structural Adjustment Programme (ESAP); Government sought to reduce its fiscal deficit; largely through expenditure control but also through greater use of user fees. From the start of ESAP; Government has tried to cushion the transitional effects of the economic reforms on vulnerable groups and has emphasised the need to protect basic social services during adjustment. In 1992/93; these sectors received among the highest nominal increases in recurrent budgets (22.2 increase for health; 29.5 for Higher Education and 15.4 for Education and Culture) over the 1991/92 outturn. However; real per capita recurrent expenditure on health and education has fallen since 1990/91; as inflation and population growth have outstripped nominal budgetary increases. Real recurrent expenditure on health fell by 11.8 in 1991/92 over 1990/91 and is expected to fall by 14.5 in 1992/93. Real per capita recurrent expenditure on all aspects of education fell by 8 in 1991/92 compared to the previous year and are projected to fall again by another 11 in 1992/93. At the same time; indicators of the quality and quantity of Government services also show declines. The number of nurses in Government service per 1000 population fell by 10 between 1991 and 1992 and the real value of the Government Medical Stores drug fund declined by about 13 over the same countries has become a serious problem as real government salaries have fallen in some cadres by almost 40 since 1990. Whilst the exact causes remain to be determined; this fiscal strain and these declines in Government services have been accompanied by alarming declines in key social and health indicators. The number of `O' Level candidated entries fell by 14 in 1992 over 1991 as the real value of `O' level fees increased and cost recovery was introduced into urban schools. The rate of maternal deaths recorded at two national referral hospitals increased from 251 deaths per 100 000 births in 1991 to 350 deaths per 100 000 births between January and June 1992. The number of babies born before arrival at hospital who were admitted at Harare Central Hospital increased by 17 between 1990 and 1991 whilst; over the same period; the proportion of BBA's admitted who died at that hospital rose 22. As part of its commitment of protect the vulnerable during adjustment; Government has set up a Social Development Fund under the Department of Social Welfare (DSW); which was also responsible for the expanded drought relief programme in 1992. While DSW has seen a huge growth in the tasks assigned to it in 1992; its vote for salaries and allowances actually fell by 7.4 in normal terms in 1992/93 over the previous year; a decline of almost 26 in real terms

Public/private sector mix for health care

"A baseline survey was carried out in order to establish the current status of the public/private mix in health care services in Zimbabwe. The findings were: 1. the current centralised budgetary and financing structures are not conducive to effective and efficient allocation of scarce financial resources. 2. the use of the ""incremental"" budgeting system which does not take into account important parameters like diseases types and patterns and demographic factors (population size; structure and distribution) leads to deficient and inequitable distribution of resources across the provinces. 3. the policy of free health services for those who earn below a given income threshold has not achieved the intended created implementation problems especially as regards the screaning process of who should pay and who should not. Running two parallel systems where some people pay for health services and others do not has also created inefficient problems; and is administratively expensive to run. 4. the public sector is indirectly subsidizing the private sector in some way which should not be the case e.g private patients occupying beds in public institutions are paying fees which are below actual costs; most doctors trained using public funds desert the public sector before they have served long enough to satisfy government investment in them; tax rebates on health insurance..."

Health Sector Strategic Plan 2000/01 - 2004/05

The Health Sector Strategic Plan (HSSP - 2000/1 - 2004/5) has been developed as a collaborative undertaking of the Minsitry of Health; related ministries; the development partners and other stakeholders. The plan has been prepared within the framework of the Poverty Eradication Action Plan and health sector policy. It described the major technical helath programmes and support services and their outputs. The technical health programmes arise from the minimum health care package described in the policy; while the support services include HUman Resources; Policy and Planning; quality assurance; information management system; research and development; health infrastructure; procurement of drugs; equipment; supplies and logistics; health care financing and legal and regulatory framework. The overall purpose of the Plan is to reduce morbidity and mortality from major causes of ill health in Uganda and the disparities therein; as a contribution to poverty eradication and economic and social development of the people. Health sector reforms; including decentralisation; have led to administrative and structural changes in the health care delivery system. The district health system will be used to deliver a package of health services to the population of Uganda; while the Minsitry of Health will be responsible for policy formulation; standards and guidelines; overall and other national level health care institutions will provide the necessary back up support to the district health services. The objectives of the plan are to:. Relate the ongoing health sector reforms to health development . Provide a framework for three year rolling planns at all levels. Involve all stakeholders in health development. Exhibit a health sector strategic framework; with coherent goals; objectives and targets for the next five years. Indicate the level of investment in terms of costs required for achieving the policy objectives agreed upon by Government of Uganda and its development partners. Articulate the essential linkages between the various levels of the national health care delivery system. The Strategic plan is presented in a Logical Framework Matrix in figures I and II. The overall programme Goal and the Programme Purpose are presented at the top of the matrix. There are five major outputs of the health Sector Strategic Plan. Below are the Outputs: Output 1 defines the minimum package of health services . Output 2 describes the health organisation and management system. Output 3 to 5 describe important support services that are necessary for the successful delivery and implementation of the minimum health package. Each of these outputs consists of a number of major elements which when considered together will allow the output to be produced. Figure I presents an overview of the plan; which outlines the elements that make up each output. Each of these elements is fully described in narrative form and supported by a Logical Framework Matrix in subsequent chapters. The elements have outputs and represent a broad guide for operational activities. Within the extensively decentralised service delivery system in the country; and the nature of the Budget Framework and the Medium Term Expenditure Framework (MTEF) formulation process; it is considered inappropriate to develop a detailed costed five year operational plan for the HSSP. Cost estimates for the five year plan are presented in chapter five. Detailed operational plans and budgets will be developed annually by the central implementating proggrammess and implementation processes to ensure optimal use of resources within the framework of the minimum health care package. The indicative cost analysis for the Health Sector Stragetic Plan shows a total cost figure of US$954 million. The annual total costs are US$159 million in Year 1; US$179 million in Year 2; US$207 million in Year 3; US$ 209 million in Year 4; and US$ 201 million in Year 5. The costs for delivering the Uganda Minimum Health Care Package are US$ 110 million in Year 1; US$117 million in Year 2; 138 million in Year 3; US$ 140 million in Year 4; and US$ 144 million in Year 5. They represent between 65and 73 of annual total costs. The Health Sector Strategic Planning financing framework anticipates an indicative resource envelope of US$ 956 million and government allocation totalling US$344 million over the five-year period. Government of Uganda (GOU) resource as a percentage of recurrent cost will range from 42in Year 1 to 55 in sector. The process of financial planning; programming and management requires commitement of all the stakeholders in the health delivery system namely; the government; the donoros; the private sector and the communities. It is envisaged that government will seek support from development partners to redirect spending through a flexible budgetary sudgetary support procedure. Furthermore; it would explore options for improving efficiency within the public health sector. The implementation of the Health Sector Stragetic Plan will be a dynamic process with constant refinement of the defined needs; modification of the minimum package; cost estimates and provision of financial resources for the health service needs. Following the initial plan design; the next step will include further preliminary technical analysis and preparation of operational plans at all levels. In subsequent years; it is envisaged that the performance of the Health Sector Strategic Plan will be monitored twice yearly through the Joint Missions and will be subjected to mid-term review and re-appraisal