Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.

Qualitative Analysis of One Primary Health Care per Ward in Ekiti State, Nigeria

The "One Primary Health Care (PHC) per Ward" policy is an important health care component for achieving health for all. This study assesses the functionality, successes and challenges in the implementation of 'one PHC per ward' policy in Ekiti State, Nigeria. In-depth and key informant interview guides serve as qualitative research instruments for data collection. Relevant information was sourced from different stakeholders, including the Executives of the State Primary Health Care Development Agency (SPHCDA), the Local Government Chairmen, the Heads of Departments in PHCs, Staff of PHCs and patients who visited PHC facilities, amounting to twenty-five in-depth and seven key informant interviews. Although all the wards assessed had at least one PHC facility, none of the PHC facilities visited met the minimum standards recommended by the National Primary Health Care Development Agency (NPHCDA). PHC facilities located in the rural areas had fewer infrastructural and human resources than those in the urban areas. Routine immunization exercises were improved across the PHC facilities as the Universal Drug Revolving Scheme adopted by the PHCs was successful, largely because of the re-investment of both principal and profit into the purchase of drugs. Results suggest that while routine immunization as an aspect of PHC services had received remarkable successes, the PHC facilities suffered from inadequate equipment and personnel. There is need for a political will and concerted actions that are designed to improve PHC facilities if PHCs are to realize the objectives for setting them up.

Protección de las conquistas de la salud pública cubana ante la crisis financiera y económica mundial / Protection of the Cuban public health achievements in the face of the world economic and financial crisis

Objetivos Analizar la repercusión de la crisis financiera y económica mundial sobre el Sistema Nacional de Salud y la preparación necesaria para preservar y mantener sus conquistas y logros. Métodos Investigación cualitativa descriptiva detipo documental. Se analizaron documentos y publicaciones relacionados con el tema. Resultados La crisis financiera tiene serias afectaciones sobre la salud de las poblaciones, se demostró que la mejor vía para enfrentarlas es a través de sistemas de salud con base en la atención primaria de salud, más equitativos y solidarios; con apropiado abordaje de los determinantes sociales e inversión en la formación de recursos humanos con otros valores éticos y morales. El ejemplo de Cuba con su Sistema Único de Salud y el nuevo modelo de formación de médicos corroboraron esta afirmaciones. Conclusiones Las crisis que vive el mundo repercuten en la salud, más aún en la económica financiera. Se requieren sistemas de salud con cobertura universal que permitan alcanzar las metas propuestas. La experiencia cubana de crisis anteriores demuestra que un país requiere de inversión social, para mejorar la salud y sus determinantes y enfrentar y mitigar los efectos que ellas producen. Se requiere de solidaridad internacional, compartir lecciones aprendidas y unidad para enfrentar las consecuencias. El bloqueo económico y comercial que el gobierno de EE.UU. ejerce sobre Cuba, refuerza los efectos negativos de la crisis económica global

Objectives To analyze the impact of the world economic and financial crisis on the national healthcare system, and the required preparedness for preserving (protecting) and keeping its achievements. Methods Documentary-type descriptive qualitative research. Documents and publications related to this issue were reviewed. Results The financial crisis has severe impact on the population's health. It was demonstrated that the best way to face these negative effects is to develop more equitable and solidarity primary care-based health systems with adequate approach to social determinants and suitable level of investment in the formation of human resources fitted with ethical and moral values. The unique healthcare system and the new model of medical formation in Cuba is an example that confirms the above-mentioned statements. Conclusions The world financial and economic crisis affects health; therefore, health systems with universal coverage are required to reach the suggested goals. The Cuban experience gained in previous crisis demonstrates that a country needs social investment to improve health and its determinants, and to face and mitigate the effects of such crisis. International solidarity is needed, sharing of learned lessons and unity of actions to face the consequences are required. The economic and commercial blockade imposed on Cuba by the US government reinforces the negative effects of the global economic crisis