How has Guinea learnt from the response to outbreaks? A learning health system analysis.

INTRODUCTION: Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS: We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS: The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION: Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.

Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017-2021.

OBJECTIVE: To implement a Flexible Operational Research Training (FORT) course within the Fistula Care Plus Project, Democratic Republic of Congo, from 2017 to 2021. METHODS: A descriptive study using design and implementation (process and outcome) data. Two to four members of medical teams from three supported sites were selected for the training based on their research interests and level of involvement in the program. RESULTS: Two courses (13-14 months each) involving nine facilitators and 17 participants overall were conducted between 2017 and 2021. Most participants in both courses were medical doctors (67% and 71%, respectively) from the supported hospitals (83% and 77%, respectively). About half were women. In addition to classic face-to-face didactic modules, the courses integrated online platforms to cope with the changing contexts (Ebola virus and COVID-19). Most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences. Participants subsequently published five papers from their research after the first course. The total direct costs for both courses were representing a cost of $3669 per participant trained. CONCLUSION: The FORT model proved feasible, efficient, and successful. However, scaling up will require more adaptation efforts from programs and participating sites.

Improving access to and use of maternal health services during COVID-19: Experience from a health system strengthening project in Guinea

The purpose of this study was to document the experience of health providers' capacity strengthening during health crises and the contribution of such to the health system and the population resilience in the face of the COVID-19 pandemic in Guinea. We conducted a cross-sectional study using routine data collected from 41 health facilities in the project intervention areas, including associative health centers, community health centers, and district hospitals,. These data covered the period between 2019 and 2021. Results showed that all the community health centers (CMCs) had a clean internal and external environment, compared to health centers (95.2%) and district hospitals (33.3%). Hand washing was systematic among visitors attending CMCs and district hospitals (HPs). However, 28.6% of visitors attending associative health centers (AHCs) did not wash their hands. Temperature taking for visitors was not carried out in all CMCs and in 90.5% of the AHCs;unlike in the HC and HP where the temperature of each patient was taken before entering the consultation room. The obligation to wear masks was higher in the HP and in the HC, compared to the CMC and AHC where the order of non-compliance with the wearing of masks was, respectively 36.4 and 19%. Non-compliance with social distancing in the waiting rooms and between users was observed in all facilities. The project's interventions mainly contributed to improving the utilization of prenatal consultation and institutional delivery services;the beginning of the interventions was marked by an increase of an average of 17 ANC1 per month in CMCs and 116 ANC1 in health centers. Ongoing training on capacity strengthening for providers in infection prevention and control, followed by the offering of delivery kits and materials during epidemics, would contribute to the improvement and utilization of health facilities by the population.

Facilitators and barriers to COVID-19 vaccination among healthcare workers and the general population in Guinea.

INTRODUCTION: The advent of the effective COVID-19 vaccine was the most eagerly expected worldwide. However, this hope quickly became hesitation and denial in many countries, including Guinea. Understanding the reasons for low vaccine coverage is essential to achieving herd immunity leading to disease control. This study aimed to comprehend the facilitators and barriers to the acceptance COVID-19 vaccine in Guinea. METHODS: The survey focused on healthcare workers (HCWs) and the general population (GP) in 4 natural regions in Guinea from 23 March 2021 to 25 August 2021. We used the Fishbein integration model to study the behaviours of HWCs and GP regarding vaccination. A mixed cross-sectional study collected knowledge, attitudes, norms, and perceptions. Regression and thematic content analysis identified the main facilitators and barriers to vaccination. RESULTS: We surveyed 3547 HCWs and 3663 GP. The proportion of people vaccinated was 65% among HCWs and 31% among the GP. For HCWs: the main factors associated with vaccination against COVID-19 were as follows: absence of pregnancy AOR = 4.65 [3.23-6.78], being supportive of vaccination AOR = 1.94 [1.66-2.27] and being an adult AOR = 1.64 [1.26-2.16]. Regarding the GP, the following factors increased the odds of vaccination: absence of pregnancy AOR = 1.93 [CI 1.01-3.91], being favourable for vaccination AOR = 3.48 [CI 2.91-4.17], being an adult AOR = 1.72 [CI 1.38-2.14] and being able to get the vaccine AOR = 4.67 [CI 3.76-5.84]. Semi-interviews revealed fear, lack of trust, and hesitant perception of the government as potential barriers to vaccination. CONCLUSION: This study suggests that beliefs and negative perceptions are potential barriers to vaccination against COVID-19 among HCWs and the GP. Policies should emphasise practical strategies to mitigate these barriers among young people and pregnant women. Lastly, there is a need to improve access to vaccines in the GP.

A rapid assessment of health system preparedness and response to the COVID-19 pandemic in Guinea.

Epidemic-prone diseases have high adverse impacts and pose important threats to global health security. This study aimed to assess levels of health facility preparedness and response to the COVID-19 pandemic in Guinea. This was a cross-sectional study in public and private health facilities/services across 13 Guinean health districts. Managers and healthcare workers (HCWs) from departments in each facility/service were interviewed. Descriptive statistics and comparisons were presented using Pearson's Chi-Squared Test or Fischer exact test. Totally, 197 managers and 1020 HCWs participated in the study. Guidance documents and dedicated spaces for management/isolation of suspected COVID-19 cases were available only in 29% and 26% of facilities, respectively. Capacities to collect (9%) and safely transport (14%) samples were low. Intensive care units (5%), dedicated patient beds (3%), oxygenators (2%), and respirators (0.6%) were almost lacking. While 36% of facilities/services had received infection prevention and control supplies, only 20% had supplies sufficient for 30 days. Moreover, only 9% of HCWs had received formal training on COVID-19. The main sources of information for HCWs were the media (90%) and the internet (58%). Only 30% of HCWs had received personal protective equipment, more in the public sector (p<0.001) and in Conakry (p=0.022). This study showed low levels of preparedness of health facilities/services in Guinea and highlighted a lack of confidence among HCWs who felt unsafe at their workplace. Better governance to improve and maintain the capacity of the Guinean health system to respond to current and future epidemics is needed.

The Salience of Trust to the Client-Provider Relationship in Post-Ebola Guinea: Findings From a Qualitative Study.

Lack of trust in the health care system can serve as a barrier to service utilization, especially in pandemic and postemergency settings. Although previous research has identified domains of trust that contribute to individuals' trust in the health system, little research exists from low- and middle-income countries, particularly during and after infectious disease outbreaks. The current study-conducted to inform activities for a post-Ebola program-explored perceptions and experiences of health care provision in post-Ebola Guinea, with particular attention to trust. Researchers conducted in-depth interviews with health workers (n=15) and mothers of young children (n=29) along with 12 focus group discussions with grandmothers of young children and 12 with male heads of household. The study occurred in Basse Guinée and Guinée Forestière-2 areas hardest hit by Ebola. Respondents identified a breach of trust during the epidemic, with several domains emerging as relevant for renewed trust and care-seeking practices. At the core of a trusting client-provider relationship was the inherent belief that providers had an intrinsic duty to treat clients well. From there, perceived provider competence, the hospitality at the facility, provider empathy, transparency about costs, and commitment to confidentiality emerged as relevant influences on participant trust in providers. Community members and providers expressed similar viewpoints regarding trust and discussed the role of open communication and community mobilization in rebuilding trust. Study findings informed a variety of program activities, including the development of campaign messages and interpersonal communication trainings for health workers. This study provides valuable insight about some underlying components of trust that can provide key leverage points to rebuild trust and promote care seeking in postemergency settings. This insight is informing program activities in the current Ebola response in Guinea and could be useful in other crises, such as the global coronavirus disease (COVID-19) pandemic.