Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Nigeria vaccine policy

Vaccines are recognised globally for their importance in the reduction of vaccines preventable diseases to improve the quality of life of the entire population. The importance of vaccines has been further demonstrated with the COVID-19 outbreak with countries scrambling to produce vaccines to combat the effect of the pandemic amongst their citizens. The purpose of this Vaccine Policy is to address the goal and objectives of achieving availability, self-sufficiency and vaccine security in the country. It is hoped that the development of this Policy will complement the already existing Immunisation Policy and provide the platform for the amelioration of vaccine-preventable diseases in Nigeria. Highlights of the Policy include: its vision, mission, goal, objectives, targets and implementation strategies for achieving local vaccines production and ownership of the vaccines supply chain management processes towards vaccine availability and security in the country. To achieve these, the Policy needs to be implemented and monitored hence the Policy provides for the establishment of appropriate governing structures to oversee the implementation process. The governing council and its various structures will pursue the achievement of the goal and objectives of the Policy. They will mobilise resources from the governments across all levels, individuals, the international communities, donor agencies. Other critical areas include the resuscitation of local production of vaccines, intensification of research and development and strengthening of the legislature and regulatory agencies to support the quality and safety of vaccines in Nigeria. It is recommended that all stakeholders responsible for implementing this policy should work collaboratively to ensure the goal and objectives are met

Public­private partnerships in Nigerian teaching hospitals: Potential and challenges

Background: Public­private partnership (PPP) has become a popular model used by public sector organizations that are usually under-funded by their respective governments to render services in fulfillment of their egalitarian responsibilities and goals. Lately, the health sector has been a recipient of such initiatives and the trend is growing. However, the successful delivery of services to patients is sometimes hampered because of difficulties encountered in both the development and interpretation of clauses contained in agreements including Memoranda of Understanding between the parties. The anticipated outcomes and impact often remain elusive due to the tensions encountered during implementation.Aim and Objective: The aim of this study was to determine the current operational status as well as explore potential benefits and challenges of the use of the PPP model in radiology departments of selected teaching hospitals within three South-Western States of Nigeria (Lagos, Ogun, and Oyo). It is hoped that the study findings would provide useful data needed for improvement of the PPP model as it is being currently practiced.Materials and Methods: This was a qualitative study in which 138 closed- and open-ended questionnaires were administered to all cadres of staff in radiology departments of the selected hospitals teaching hospitals within three South-Western States of Nigeria (Lagos, Ogun, and Oyo).Results: There was a 100% response from the participants. The age range of the participants was 25­65 years. Study findings showed that almost all radiological equipment can be acquired through PPP. There was improved service delivery and residency training with PPP. Jurisdictional conflict was the greatest challenge.Conclusion: PPP is a viable option that should be encouraged by government for the purchase of equipment in hospitals

Federation of infectious diseases societies of southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated candida auris colonisation and disease in South Africa

Candida auris has been detected at almost 100 South African hospitals, causing large outbreaksinsome facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C.auris disease in public- and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship

Perceptions of the impact of an advanced training programme on the management skills of health professionals in Gauteng, South Africa

Background. South Africa's health sector spans the private and the public sectors. Within the sectors, health managers take on strategic leadership roles without formal training in management or leadership ­ a trend more common in the public sector than the private sector. Health managers are selected based on their clinical skills rather than their leadership or management skills.Objective. To compare self-rated competencies in management and leadership before and after training of the participants; to assess participants' experience of the training programme; and to evaluate the management and leadership skills of the participants after training.Methods. A cross-sectional, descriptive analytical method and 360° interviewing were used in this study. Participants were evaluated ~18 months after completion of the training programme. A 360° evaluation (360° E) of six of the 12 leadership/management competencies was done with the supervisors, colleagues, and subordinates of the participants.Results. All participants rated themselves as improved in 12 managerial and leadership competencies. The 360° E affirmed five of these competencies as improved, with the ability to create and implement a marketing plan rating poorly.Conclusion. Training in management leads to improvement in both leadership and managerial skills of health professionals

Missed opportunities and barriers for vaccination: a descriptive analysis of private and public health facilities in four African countries

Introduction: missed opportunities and barriers to vaccination limit progress toward achieving high immunization coverage and other global immunization goals. Little is known about vaccination practices contributing to missed opportunities and barriers among private healthcare providers in Africa.Methods: Service Provision Assessments (SPA) of representative samples of health facilities in four African countries (Kenya, Tanzania, Senegal, Malawi) in 2010-2015 were used to describe missed opportunities and barriers for vaccination in public, private for-profit, private not-for-profit and faith-based facilities. Data included vaccination practices, observations during sick child and antenatal visits, and exit interviews following sick child visits.Results: data from 3,219 health facilities, 11,613 sick child visits and 8,698 antenatal visits were included. A smaller proportion of for-profit facilities offered child vaccination services (country range, 25-37%) than did public facilities (range, 90-96%). The proportion of facilities offering pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b antigens) daily ranged 0-77% across countries and facility types. Less than 33% of for-profit facilities in any country offered measles vaccination daily. A minority of public or private providers assessed the child's vaccination status during a sick child visit (range by country and facility type, 14-44%), or offered tetanus toxoid during antenatal visits (range, 19-51%). Very few providers discussed the importance of newborn vaccination. Conclusion: substantial missed opportunities for, and barriers to, vaccination were identified across this representative sample of health facilities in four African countries. Strategies are needed to ensure that private and public providers implement practices to minimize barriers and missed opportunities for vaccination

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

Background: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector; despite the high overall incidence rates. Aim: We conducted a survey to determine the extent of private-sector capacity; participation; practices and adherence to national guidelines in the control of TB. Setting: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. Methods: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis; management and prevention activities. Results: Out of 157 facilities surveyed; 40.5% were from the Copperbelt; 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme; the majority (62.7%) of these facilities did not show evidence of notifications. Conclusion: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment; Short Course (DOTS)

Constraints; Challenges and Prospects of Public-Private Partnership in Health-Care Delivery in a Developing Economy

Background: In Nigeria; concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise; Enugu State has developed a draft policy on PPP since 2005. However; non-validation and non-implementation of this policy might have led to loss of interest in the partnership. Aim: The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges; constraints and prospects. Subjects and Methods: Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members); selected by multi-stage sampling method from nine Local Government Areas of Enugu State; Nigeria; over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago; IL; USA). Results: Only 159 (34.1; 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8; 145/251) when compared with the community members (6.5; 14/215) (P 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4; 101/113) and community leaders/members (55.4; 119/215). Conclusion: PPP in health-care delivery in Enugu State is feasible with massive awareness; elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation

Innovative Financing for Health: What are the Options for South Africa?

The paper assesses the options for additional innovative financing that could be considered in South Africa; covering both raising new funds and linking funds to results. New funds could come from: i) the private sector; including the mining and mobile phone industry; ii) from voluntary sources; through charities and foundations; iii) and through further expanding health (sin) levies on products such as tobacco; alcohol and unhealthy food and drinks. As in other countries; South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviors and influence the determinants of health. South Africa could also expand innovative linking of funds to improve overall performance of the health sector; including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results: Most of the doctors were male GPs aged 30­50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector

The society of gynaecology and obstetrics of Nigeria (SOGON) plan for sustainable reduction in maternal mortality: a review

In the year 2000, SOGON formulated a strategic plan on women's health based on the reproductive health approach with the aim of reducing maternal mortality by 50% by the year 2010. In 2005, the Nigerian Road Map for accelerating the attainment of Millennium Development Goals 4 and 5 was launched. One of the key guiding principles of the Road Map was promoting partnerships and joint programming among stakeholders including professional associations. In response, SOGON decided to align her strategic plan with the Road Map by refocusing the plan to the key objectives of the Road Map. The new SOGON Plan involves interventions with a focal objective of reducing the case-fatality of emergency obstetric conditions. The plan is anchored on interventions where SOGON has comparative advantage such as providing human resources and promoting capacity building for emergency obstetric care and skilled attendance at delivery, and advocacy and information dissemination on maternal health (Afr. J. Reprod. Health 2010; 14[2]: 139-147)

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated

Tuberculosis Case Management and Treatment Outcome: Assessment of the Effectiveness of Public - Private Mix of Tuberculosis Programme in Kaduna State; Nigeria

Background: In an effort to increase tuberculosis (TB) case detection; the Kaduna State TB program in Nigeria started Public-Private Mix (PPM DOTS) in 2002. This study assessed and compared the TB case management practices and treatment outcomes of the public and private health facilities involved in the TB program. Methods: A comparative cross-sectional descriptive study was carried out in 5 private and 10 public health facilities providing TB services for at least two years in the four Local Governments Areas in Kaduna State where both public and private health facilities are involved in the TB program. The heads of the health facilities were interviewed and case notes of all the 492 TB patients registered in these facilities between January 2003 and December 2004 reviewed. Results: Except for the lower use of sputum microscopy for diagnosis; adherence to national TB treatment guidelines was high in both private and public health facilities. The private health facilities significantly saw more TB patients; an average of 51 patients per health facility compared to 23 patients in the public health facilities. There was better completion of records in the public health facilities while patient contact screening was very low in both public and private health facilities; 13.1and 12.2respectively. The treatment success rate was higher among patients managed in the private health facilities (83.7) compared to 78.6in the public health facilities. Conclusion: Private health facilities adhere to national guidelines had higher TB patient case load and better treatment outcome than public health facilities in Kaduna State. PPM-DOTS should be scaled-up and consolidated

Roll Back Malaria and the New Partnership for Africa's Development: Is there Potential for Synergistic Collaboration in Partnerships?

This synopsis seeks to highlight and promote the enormous potential that exists between these two initiatives that seek to address closely related issues and targeting the same populations at risk within a fairly well defined geographical setting. It also attempts to argue that malaria control; just like HIV-Aids control be given high priority in the New Partnership for Africa's Development (NEPAD) health agenda; as current statistics indicate that malaria is again on the rise. While much attention and billions of dollars have rightly been given to HIV-Aids research; treatment and prevention; malaria; and not Aids; is the region's leading cause of morbidity and mortality for children under the age of five years. This is the bad news. The good news is that unlike Aids; malaria treatment and prevention are relatively cheap. In addition; there is a payback to fighting malaria; support aimed directly at improving health; rather than poverty reduction; may be a more effective way of helping Africa to thrive. Robust and sustained growth may come to Africa through a mosquito net; Artemisinin-based Combination Therapies (ACTs) or a malaria vaccine; rather that a donor's cheque for economic development initiatives