Digitalisation of Indian smart cities: post-Covid-19 approaches to data, recognition and health monitoring

There is a proliferation of digitalisation of urban and health services in India under the Smart City and Digital Health missions, respectively. This study brings digital and feminist geographies together to understand the role of technologies in urban areas, particularly in health service delivery and how healthcare workers mediate these health platforms. Using a case study of Varanasi city in Uttar Pradesh, India this study documents whether-and to what extent-digital technologies and services enable citizens and service providers to access and improve their lived experiences. The findings indicate a top-down, innovation-focussed model is adopted which excludes and alienates different user groups and citizens shaping their interaction and access to these services.

Use of provider-to-provider telemedicine in Kenya during the COVID-19 pandemic.

Introduction: According to the World Health Organization (WHO), about 90 percent of countries continue to report COVID-related disruptions to their health systems. The use of telemedicine has been especially common among high-income countries to safely deliver and access health services where enabling infrastructure like broadband connectivity is more widely available than low- and middle-income countries (LMICs). The Addis Clinic implements a provider-to-provider (P2P) asynchronous telemedicine model in Kenya. We sought to examine the use of the P2P telemedicine platform during the second year of COVID-19. Methods: To assess sustainability, we compared the data for two 12-month calendar periods (period A = year 2020, and period B = year 2021). To examine performance, we compared the data for two different 12-month periods (period C = pandemic period of February 2021 to January 2022, and period D = baseline period of February 2019 to January 2020). Results: Sustainability of the P2P telemedicine platform was maintained during the pandemic with increased activity levels from 2,604 cases in 2020 to 3,525 cases in 2021. There was an average of 82 specialists and 5.9 coordinators during 2020, and an average of 81 specialists and 6.0 coordinators during 2021. During 2020, there were 444 cases per coordinator, and 587 cases per coordinator in 2021(P = 0.078). During 2020, there were 32 cases per specialist, and 43 cases per specialist in 2021(P = 0.068). Performance decreased with 99 percent of cases flagged as "answered" during the baseline period (period D), and 75 percent of cases flagged as "answered" during the pandemic period (period C). Conclusion: Results suggest that despite a decline in certain sustainability and performance indicators, The Addis Clinic was able to sustain a very high level of activity during the second year of the pandemic, as shown by the continued use of the system. Furthermore, despite some of the infrastructure challenges present in LMICs, the P2P telemedicine platform was a viable option for receiving clinical recommendations from medical experts located remotely. As health systems in LMICs grapple with the effects of the pandemic, it is worthwhile to consider the use of telemedicine to deliver essential health services.

Effect of COVID-19 lockdown on lifestyle habits and self-care practices of diabetic and hypertensive patients in rural Shimla and Udaipur - Findings from the HealthRise India program.

Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self-care practices are not only associated with less severe COVID-19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID-19 pandemic. During COVID-19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

Understanding the effects of COVID-19 stigmatisation on job performance: a survey of frontline healthcare workers.

The level of stigmatisation among health care providers has increased during the COVID-19 pandemic, and understanding the effect of COVID-19 stigmatisation on job performance has become increasingly important. The study explores the influence of COVID-19 stigmatisation on job performance among frontline health workers via the mediating role of anxiety. Furthermore, the moderating effect of resilience in the association between COVID-19 stigmatisation and anxiety is further examined. Participants were made up of 820 frontline health workers working in the epicentres of the Bono Ahafo, Western, Greater Accra, and Northern regions of Ghana. The hierarchical regression technique was employed in estimating the relationship between the variables. COVID-19 stigmatisation among frontline health workers directly affected anxiety and performance. In addition, the results showed that resilience moderated the relationship between COVID-19 stigmatisation and anxiety. The findings again demonstrated that anxiety partially mediated the association between concern for disclosure and public attitude and negative experience and job performance, whereas personalised stigma was insignificant. The study provides implications for establishing anti-stigma interventions and programs to enhance job performance among health workers.Key messagesMany healthcare workers are subject to stigmatisation during the COVID-19 pandemic.The study employs hierarchical regression methods to examine the impacts of COVID-19 stigmatisation on job performance among frontline health workers.The health management team should strengthen interventions to control the stigma experienced by health workers during COVID-19 treatments.

"Working in the Dark": Experiences of Frontline Health Workers in Bangladesh During COVID-19 Pandemic.

Introduction: Frontline health workers (FHW) are working relentlessly to combat the COVID-19 pandemic globally. This is particularly challenging for low- and middle-income countries such as Bangladesh because of resource scarcity. Therefore, it is critical to understand the challenges of healthcare providers to help shaping a contextual pandemic response plan address current and future similar crises. Aim: This study aimed to describe the challenges faced by FHWs in Bangladesh in terms of information on COVID-19, managing patients with COVID-19, and what motivated them to continue providing service during the pandemic. Methods: This qualitative study explored the experiences of 18 FHWs who were purposely recruited from different health interventions of a development organization in Bangladesh. In-depth interviews and focus group discussions were conducted during July-August 2020 using a semi-structured interview guide. The interviews were transcribed verbatim and content analysis was used to analyze the data which led to four categories. Results: Four main categories and ten sub-categories emerged from the analysis. Categories derived from the analysis were as follows: i) experiences of the FHWs regarding information on COVID-19: "Working in the dark", ii) experience of providing care: "Patients are grateful", iii) impact on personal/family life: "Life is still in lockdown" and iv) motivation to carry on providing care. Conclusion: FHWs desire a stable information source to prepare themselves for future health care crises. Organizational support is essential for them to overcome physical and mental struggles and keep themselves motivated to continue service provision during pandemics.

Exploring female frontline health workers' role and capacities in COVID-19 response in India.

Background: Sendai Framework for Disaster Risk Reduction emphasises building local capacities for disaster risk management. This article asks: What role did female frontline health workers (FFHWs) play in preparing, responding and managing health emergencies in India and how did information and communications technology (ICT) platforms hinder or facilitate their capacities? Methods: FFHWs' experiences in providing subnational and local health response to the COVID-19 pandemic in six states in India - Odisha, Bihar, Madhya Pradesh, Uttarakhand, Kerala and Maharashtra - was collected using semi-structured interviews. Data were thematically analysed, and studied within the government policies and guidelines to tackle the emerging concerns in COVID-19. Results: FFHWs were involved in planning, responding and managing COVID-19 cases, providing awareness and undertaking surveillance within their regions. Moreover they were also responsible to continue with essential health and nutrition service delivery to pregnant women and young infants. They relied on various information and communications technology (ICT) platforms in managing their tasks despite facing several challenges. Besides receiving training from hospitals and health officials, FFHWs received information on COVID-19 and prevention through different channels and modes: majority of them reported TV channels, news coverage, and videos sent on Whatsapp groups. Conclusions: There are underlying gender inequalities within the health system whereby limited resources and opportunities are available for the FFHWs, which extends to their use of ICT platforms in health emergencies. Using ICT in an equitable and just manner provides an opportunity to support local action for health resilience swiftly and promptly by building capacities and increasing representation of the frontline workers. This understanding can be further grounded around issues of equity, participation, representation in a gender-responsive health system.

Effects of corruption and unaccountability on responses of frontline health workers to COVID-19 in Nigeria: Lessons and considerations for the social work profession.

COVID-19 stretched health systems, exacerbated by concerns about those that are corrupt and lack equity. Twelve (12) health workers and 12 hospital social workers across Nigeria were purposively sampled and virtually interviewed to explore unaccountability and corruption effects on COVID-19 responses. Findings show that corruption and unaccountability negatively affected responses of frontline health workers to the pandemic. Lack of social care and justice services for patients and health workers across health facilities in Nigeria worsened the negative effects. Effectively mainstreaming social care and justice services into Nigeria's healthcare led by well-trained social workers will improve the health sector via anticorruption.

Acceptability of covid-19 vaccine among frontline health care workers in north central and south western, nigeria

OBJECTIVE: To explore the acceptability of COVID-19 vaccines among frontline health workers in Nigeria. METHODOLOGY: A descriptive cross-sectional multi-centre survey was conducted among 115 randomly selected frontline health workers in two tertiary health facilities;Federal Medical Centre Abeokuta (South-Western, Nigeria) and University of Ilorin Teaching Hospital (North Central, Nigeria). The inclusion criteria were Frontline Healthcare Workers over the age of 18 years who gave consent for the study, while other hospital workers were absent from work and those unwilling to participate in the study. Data analysis was done using SPSS version 23. RESULTS: Accordingly, 59.1% of respondents accepted to be vaccinated with the COVID-19 vaccine when it becomes available. The level of acceptance increased with the effectiveness and safety of the vaccine. More respondents were also willing to wait 6 months to receive the vaccine than those willing to accept the vaccine at the moment. The age of respondents was statistically significant in the willingness to accept the vaccine. CONCLUSION: The acceptability of the COVID-19 vaccine among health workers increased with the effectiveness of the potential vaccines as well as the duration of vaccine usage. Trusted policymakers can be used for advocacy in combatting the misinformation on COVID-19 vaccines. © 2021, Liaquat University of Medical and Health Sciences. All rights reserved.

"Covid Just Amplified the Cracks of the System": Working as a Frontline Health Worker during the COVID-19 Pandemic.

The COVID-19 pandemic has intensified existing workplace stresses and created new challenges for people working on the healthcare frontline, including rapid workplace changes and increasing uncertainty at work, along with fear of contracting the virus. The purpose of this study is to examine the workplace challenges described by Australian frontline health workers during the pandemic. Drawing on a national online anonymous survey of 9518 healthcare workers, we analysed free-text responses to the question: "What did you find to be the main challenges that you faced during the pandemic?" A qualitative content analysis was undertaken. We identified five key themes relating to participant experiences of workplace challenges. These were: Work-life imbalance; Following orders or caring for patients; Unpredictability, disruption, and inconsistency at work; The right to be safe at work; and (Un)preparedness in the workplace. We argue that working during the COVID-19 pandemic illuminated existing occupational health and safety issues that have serious implications for job satisfaction, health workforce retention, and ultimately, patient care.

Training health workers at scale in Nigeria to fight COVID-19 using the InStrat COVID-19 tutorial app: an e-health interventional study.

BACKGROUND: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. METHODS: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated information about COVID-19 to frontline health workers and epidemic response officers across 25 states of Nigeria. The potential effectiveness of this app in training frontline health workers was assessed through online pre- and post-tests and a survey. RESULTS: A total of 1051 health workers from 25 states across Nigeria undertook the e-learning on the InStrat COVID-19 training app. Of these, 627 (57%) completed both the pre- and post-tests in addition to completing the training modules. Overall, there were statistically significant differences between pre- and post-tests knowledge scores (54 increasing to 74). There were also differences in the subcategories of sex, region and cadre. There were higher post-test scores in males compared with females, younger versus older and southern compared with northern Nigeria. A total of 65 (50%) of the participants reported that the app increased their understanding of COVID-19, while 69 (53%) stated that they had applied the knowledge and skills learnt at work. Overall, the functionality and usability of the app were satisfactory. CONCLUSION: Capacity building for epidemic control using e-health applications is potentially effective, can be delivered at minimal cost and service disruption and can serve as a tool for capacity building in similar contexts.

Responding to the Psychological Needs of Health Workers During Pandemic: Ten Lessons From Humanitarian Work.

When a complex emergency (CE) overwhelms infrastructure, the ability of health-care providers to work efficiently under duress saves lives. The author uses her experience of providing mental health supports to humanitarian aid workers and the pieces of training conducted for internal medicine practitioners to offer guidance on how to manage severe job-related stresses during the response to the coronavirus disease 2019 (COVID-19) pandemic. This work reminds responders about their professional mission and purpose, but its extreme physical and mental demands can take a toll on their well-being and health. In CEs, the sheer volume of work and the emotional over-engagement tend to produce toxic fantasies (eg, rescuer or helper fantasies), acting upon which threatens integrity of care and increases risks for both patients and providers. Accumulated fatigue and exposure to mass suffering and mortality can change the perceived value of life and increase reckless, risk-taking, and suicidal behaviors. Introducing a self-awareness framework prioritizes the awareness of the available choices and making situation-appropriate and informed decisions about balancing one's own and others' needs. The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening supports for managers are important parts of disaster preparedness. It also revealed that more research is needed to better understand and meet the special psychological needs of health-care responders.

Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry.

BACKGROUND: The COVID-19 outbreak has gravely impacted the physical and psychological health of people. As the outbreak is ongoing, it is crucial to equip the emergency healthcare workers (HCWs) to be medically and psychologically prepared. OBJECTIVE: To examine the psychological impact of COVID-19 on emergency HCWs and to understand how they are dealing with COVID-19 pandemic, their stress coping strategies or protective factors, and challenges while dealing with COVID-19 patients. METHODS: Using a framework thematic analysis approach, 15 frontline emergency HCWs directly dealing with COVID-19 patients from April 2, 2020 to April 25, 2020. The semi-structured interviews were conducted face-to-face or by telephone. Data were analyzed using thematic analysis. RESULTS: Findings highlighted first major theme of stress coping, including, limiting media exposure, limited sharing of Covid-19 duty details, religious coping, just another emergency approach, altruism, and second major theme of Challenges includes, psychological response and noncompliance of public/denial by religious scholar. CONCLUSIONS: Participants practiced and recommended various coping strategies to deal with stress and anxiety emerging from COVID-19 pandemic. Media was reported to be a principal source of raising stress and anxiety among the public. Religious coping as well as their passion to serve humanity and country were the commonly employed coping strategies.

Pharmacists and COVID-19.

In the fight against COVID-19, frontline health workers have been vital to keeping the pandemic at bay, but recognition of individual professions' efforts have been inconsistent at all levels. Pharmacists around the world have continued to provide direct patient care and perform frontline duties for their communities during this pandemic, but are often relegated to the background and overlooked when frontline workers are heralded. Community pharmacists are the most accessible healthcare practitioners, which is further proven during the pandemic as they continued to provide direct patient care despite restrictions imposed by the government due to the pandemic. Due to the inaccessibility of other healthcare practitioners during this time, community pharmacists have reduced the burden on the healthcare system by diverting the influx of patients away from hospitals through triaging and screening patients. Community pharmacists have played various roles in supporting the healthcare system during COVID-19: delivering medications to patients, educating patients on telehealth services, assessing patients for renewal of chronic medications, performing consultations on minor ailments, clarifying misconceptions about COVID-19 treatments, and contributing to COVID-19 screening. Alongside ICU nurses, physicians, and respiratory therapists, hospital pharmacists have been part of the COVID-19 efforts and their roles include management of drug shortages, development of treatment protocols, participation of patient rounds, interpretation of lab results for COVID-19, participant recruitment for clinical trials, exploration of new drugs, medication management advice, and antimicrobial stewardship. Further support from pharmacists will be needed once a vaccine is launched in order to reach population-wide coverage. Amid COVID-19, pharmacists have not stopped working as frontline workers and they should be recognized as such.