Exploring the self-preparedness of frontline healthcare workers in a low- and middle-income country from a humanitarian context during the COVID-19 pandemic: A constructivist grounded theory study.

Background: While research has been conducted on the availability, accessibility, and affordability of personal protective equipment for healthcare workers during the COVID-19 pandemic, little information is available on the ways in which health workers, especially those in humanitarian settings see themselves, and engage in self-preparedness for social, physical, and mental health and practical care in the pandemic. We sought to address this gap. Methods: We followed a constructivist grounded theory approach to guide in-depth interviews with 30 frontline doctors, nurses, and community healthcare workers recruited from the Rohingya refugee camps in Bangladesh using the purposive and snowball sampling methods. Analyses were carried out through the identification of codes in three phases: an initial line-by-line open coding, then focused axial coding, and finally selective coding. Findings: An emergent-grounded theory of "Navigating Self-Preparedness through Pandemics" was developed as we built a five-phased theoretical framework examining health worker responses with the following pillars: (a) pandemic shock; (b) pandemic awareness; (c) pandemic learning; (d) pandemic resilience, and (e) pandemic resurgence. Interpretation: The theory emerged as a realistic, socially, and culturally sensitive COVID-19 strategy to support healthcare workers. Self-preparedness was characterized by two interwoven processes: (1) the experiences of the daily life span of healthcare workers attempting to improve their own protection using all their potential while providing care for patients in a vulnerable setting and time and (2) the inseparable role of physical, psychological, social, and spiritual factors in each stage of learning during the pandemic to achieve better outcomes.

Towards a global One Health index: a potential assessment tool for One Health performance.

BACKGROUND: A One Health approach has been increasingly mainstreamed by the international community, as it provides for holistic thinking in recognizing the close links and inter-dependence of the health of humans, animals and the environment. However, the dearth of real-world evidence has hampered application of a One Health approach in shaping policies and practice. This study proposes the development of a potential evaluation tool for One Health performance, in order to contribute to the scientific measurement of One Health approach and the identification of gaps where One Health capacity building is most urgently needed. METHODS: We describe five steps towards a global One Health index (GOHI), including (i) framework formulation; (ii) indicator selection; (iii) database building; (iv) weight determination; and (v) GOHI scores calculation. A cell-like framework for GOHI is proposed, which comprises an external drivers index (EDI), an intrinsic drivers index (IDI) and a core drivers index (CDI). We construct the indicator scheme for GOHI based on this framework after multiple rounds of panel discussions with our expert advisory committee. A fuzzy analytical hierarchy process is adopted to determine the weights for each of the indicators. RESULTS: The weighted indicator scheme of GOHI comprises three first-level indicators, 13 second-level indicators, and 57 third-level indicators. According to the pilot analysis based on the data from more than 200 countries/territories the GOHI scores overall are far from ideal (the highest score of 65.0 out of a maximum score of 100), and we found considerable variations among different countries/territories (31.8-65.0). The results from the pilot analysis are consistent with the results from a literature review, which suggests that a GOHI as a potential tool for the assessment of One Health performance might be feasible. CONCLUSIONS: GOHI-subject to rigorous validation-would represent the world's first evaluation tool that constructs the conceptual framework from a holistic perspective of One Health. Future application of GOHI might promote a common understanding of a strong One Health approach and provide reference for promoting effective measures to strengthen One Health capacity building. With further adaptations under various scenarios, GOHI, along with its technical protocols and databases, will be updated regularly to address current technical limitations, and capture new knowledge.

Conflict, epidemic and faith communities: church-state relations during the fight against Covid-19 in north-eastern DR Congo.

BACKGROUND: Understanding and improving access to essential services in (post)-conflict settings requires paying particular attention to the actors who occupy the space left 'empty' by weak or deficient State institutions. Religious institutions often play a fundamental role among these actors and typically benefit from high trust capital, a rare resource in so-called 'fragile' states. While there is a literature looking at the role faith organisations play to mobilise and sensitise communities during emergencies, our focus is on a different dimension: the reconfiguration of the relationship between religion and health authorities impelled by health crises. METHODS: We analyse observations, interviews, and focus group discussions with 21 leaders from eight different religious groups in Ituri province in 2020-2021. RESULTS: Faith institutions handled the Covid-19 lockdown period by using and redeploying structures at the grassroots level but also by responding to health authorities' call for support. New actors usually not associated with the health system, such as revivalist churches, became involved. The interviewed religious leaders, especially those whose congregations were not previously involved in healthcare provision, felt that they were doing a favour to the State and the health authorities by engaging in community-level awareness-raising, but also, crucially, by 'depoliticising' Covid-19 through their public commitment against Covid-19 and work with the authorities in a context where the public response to epidemics has been highly contentious in recent years (particularly during the Ebola outbreak). The closure of places of worship during the lockdown shocked all faith leaders but, ultimately, most were inclined to follow and support health authorities. Such experience was, however, often one of frustration and of feeling unheard. CONCLUSION: In the short run, depoliticization may help address health emergencies, but in the longer run and in the absence of a credible space for discussion, it may affect the constructive criticism of health system responses and health system strengthening. The faith leaders are putting forward the desire for a relationship that is not just subordination of the religious to the imperatives of health care but a dialogue that allows the experiences of the faithful in conflict zones to be brought to the fore.

Engaging faith communities in public health messaging in response to COVID-19: Lessons learnt from the pandemic in Ituri, Democratic Republic of Congo

Purpose To understand challenges faced by faith leaders in the Democratic Republic of Congo (DRC) in engaging with current public health strategies for the COVID-19 pandemic;to explain why long-standing collaborations between government, faith-based health services and leaders of faith communities had little impact;to identify novel approaches to develop effective messaging that resonates with local communities. Methods A qualitative participatory research design, using a workshop methodology was deployed to seek opinions of an invited group of faith leaders in the DRC provinces of Ituri and Nord-Kivu. A topic guide was developed from data gathered in prior qualitative interviews of faith leaders and members. Topics were addressed at a small workshop discussion. Emerging themes were identified. Findings Local faith leaders described how misinterpretation and misinformation about COVID-19 and public health measures led to public confusion. Leaders described a lack of capacity to do what was being asked by government authorities with COVID-19 measures. Leaders' knowledge of faith communities' concerns was not sought. Leaders regretted having no training to formulate health messages. Faith leaders wanted to co-create public health messages with health officials for more effective health messaging. Conclusion Public trust in faith leaders is crucial in health emergencies. The initial request by government authorities for faith leaders to deliver set health messages rather than co-develop and design messages appropriate for their congregations resulted in faith communities not understanding health messages. Delivering public health messages using language familiar to faith communities could help to ensure more effective public health communication and counter misinformation.

Consideration of COVID-19 beyond the human-centred approach of prevention and control: the ONE-HEALTH perspective.

Most of the new emerging and re-emerging zoonotic virus outbreaks in recent years stem from close interaction with dead or alive infected animals. Since late 2019, the coronavirus disease 2019 (COVID-19) has spread into 221 countries and territories resulting in close to 300 million known infections and 5.4 million deaths in addition to a huge impact on both public health and the world economy. This paper reviews the COVID-19 prevalence in animals, raise concerns about animal welfare and discusses the role of environment in the transmission of COVID-19. Attention is drawn to the One Health concept as it emphasizes the environment in connection with the risk of transmission and establishment of diseases shared between animals and humans. Considering the importance of One Health for an effective response to the dissemination of infections of pandemic character, some unsettled issues with respect to COVID-19 are highlighted.

Trabajo agrícola e inseguridad alimentaria de la población siria refugiada en Oriente Medio durante la primera ola de COVID-19

Resumen A partir de datos etnográficos de los proyectos SyrianFoodFutures (2019) y From the FIELD (2020), se proporciona evidencia sobre los primeros efectos de la pandemia de COVID-19 en el trabajo agrícola de refugiadas y refugiados en Iraq, Jordania, el Líbano, Siria y Turquía. En la primavera de 2020, las restricciones de movimientos y las interrupciones de la cadena de suministro hicieron que las y los trabajadores agrícolas sirios desplazados perdieran sus empleos y se enfrentaran a una mayor inseguridad alimentaria. Los autores destacan el uso de la ambigüedad legal por parte de los países de acogida hacia la población refugiada, la dependencia de la agricultura de Oriente Medio de la mano de obra migrante y la prolongada inseguridad alimentaria de la región. Llegan a la conclusión de que la formalización del trabajo de la población refugiada no es suficiente para hacer frente a la explotación.

La situation des réfugiés syriens employés dans l'agriculture au Moyen-Orient au début de la pandémie de COVID-19 sous l'angle du travail et de la sécurité alimentaire

Résumé Les auteurs utilisent des données ethnographiques issues de deux enquêtes auprès de réfugiés syriens employés dans l'agriculture au Moyen-Orient (SyrianFoodFutures et From the FIELD) pour décrire les premiers effets de la pandémie sur cette population particulière. Ils montrent que les restrictions de déplacement et la perturbation des chaînes d'approvisionnement ont compromis l'activité et la sécurité alimentaire de ces migrants, en rappelant certaines données du contexte régional: l'ambiguïté juridique entourant le statut de réfugié, la dépendance de l'agriculture à la main-d'?uvre immigrée et une insécurité alimentaire endémique. Ils concluent qu'il ne suffira pas de régulariser la situation des réfugiés au travail pour empêcher leur exploitation.

Syrian refugee labour and food insecurity in Middle Eastern agriculture during the early COVID-19 pandemic

Drawing on ethnographic data from the 2019 SyrianFoodFutures and 2020 From the FIELD projects, this article provides insights into the early effects of the COVID-19 pandemic on refugee labour in agriculture in Jordan, Turkey, Lebanon, Iraq, and Syria. In spring 2020, movement restrictions and supply chain disruptions caused displaced Syrian farmworkers to lose their jobs and experience increased food insecurity. We situate our findings in the context of host countries' use of legal ambiguity for governing refugees, Middle Eastern agriculture's reliance on migrant labour, and the region's longstanding food insecurity. We conclude that formalising refugee labour is not enough to address exploitation.

Global palliative nursing partnerships in the face of COVID-19.

BACKGROUND: Mutually respectful and long-term global partnerships are critical to increasing hospice and palliative care access as a key component of universal health coverage. The importance of sustained, transnational palliative care collaboration has become more urgent since the COVID-19 pandemic. AIM: To provide an overview of characteristics for successful global palliative nursing partnerships. METHOD: The authors highlight the need to adapt approaches to meet the challenges and demands of COVID-19 in both clinical and academic spaces. Exemplars of thriving global partnerships are provided, alongside palliative nursing considerations and strategies to advance and sustain them. CONCLUSION: The role of nursing to drive and enhance palliative care partnerships, especially with equitable input from low- and middle-income country stakeholders, must be leveraged to advance shared goals and reduce serious health-related suffering around the world.

Development of a partnership to improve palliative care services for children in the Gambia

BackgroundPaediatric palliative care services in LMIC countries compete for resources with many other priorities. Their provision is desirable and includes advocacy, training health and community care workers, policy development and mentorship.ObjectivesThe THET J&J start-up grants provided an ideal opportunity to establish a partnership with the Ministry of Health (MoH). The long term aim being to develop children’s palliative care services in The Gambia. A needs assessment was carried out in early 2020. We hope reporting the results raises awareness of the gaps and possible solutionMethodsThe study took the form of a cross-sectional design with a focus on estimating the need for CPC and gaps at the country level. A mixed methods approach utilising both quantitative and qualitative data was used. Both primary and secondary data sources were used. The estimation of the need for CPC was based on estimation techniques using the prevalence and mortality of the specific diseases known to require palliative care. The response to the need and existing gaps were analysed using interviews and focus groups with key persons as well as survey data from service providers.Ethical approval for this study was given by the University of the Gambia, School of Medicine. Reference number R020 004ResultsFive organisations completed a Capacity Self-Assessment Tool, 17 staff from 5 facilities were interviewed and 2 Focus Group Discussions conducted (8 staff). The leading cause of death in children was heart disease, then lower respiratory infections and neonatal disorders, with HIV/AIDS being 5th, Tuberculosis 7th and cancer 9th. Under 5 mortality is 47.8 per 1,000 live births. It was not possible to estimate prevalence. Facility capacity assessment to provide CPC ranged from 23%-74%. Themes identified were a need to improve diagnostic ability;a desire for training;improve access and utilisation of medicines;and provide support for families. Training in Palliative care is on the nursing and medical students syllabus. Senior staff were keen for more training. Topics that staff felt anxious about were breaking bad news, anticipating palliative needs and use of medication.ConclusionsThe establishment of a training and mentoring service for staff in palliative care is required and desired. Paediatric diagnostic facilities need improved including equipment and access to specialist opinions eg an echocardiogram. in the main hospital in Banjul.The use of online Palliative training through lectures and modules, supported by scheduled in person visits is thought to be a good solution particularly in the current Covid-19 situation. 1 online lecture session has already taken place for 30 participants, supported by the MoH. This had good media coverage and promoted CPC awareness within the country. M.Sowe is currently undertaking a Palliative Care Diploma in Uganda partly funded by this grant. The World Bank has recently provided funding for specialist paediatrician secondment to The Gambia to improve paediatric services and a memorandum of understanding for patient pathways has been signed with the much larger neighbouring country of Senegal.

'COVID-19 and palliative medicine: faith-based hospitals in India'.

OBJECTIVES: Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire. METHODS: All FBOs providing palliative care in India were invited to complete an online questionnaire. Descriptive analysis was undertaken. RESULTS: Response rate was 46/64 (72%); 44 provided palliative care; 30/44 (68%) were in rural or semiurban areas with 10-2700 beds. Fifty-two per cent (23/44) had dedicated palliative care teams and 30/44 (68%) provided it as part of general services; 17/44 (39%) provided both. 29/44 (66%) provided palliative care for cancer patients; 17/44 (34%) reported that this was more than half their workload.The pandemic led to reduced clinical work: hospital 36/44 (82%) and community 40/44 (91%); with reduction in hospital income for 41/44 (93%). 18/44 (44%) were designated government COVID-19 centres; 11/40 (32%) had admitted between 1 and 2230 COVID-19 patients.COVID-19 brought challenges: 14/44 (32%) lacked personal protective equipment; 21/44 (48%) had reduced hospital supplies and 19/44 (43%) lacked key medications including morphine. 29/44 (66%) reported reduction in palliative care work; 7/44 (16%) had stopped altogether. Twenty-three per cent (10/44) reported redeployment of palliative care teams to other work. For those providing, palliative care 32/37 (86%) was principally for non-COVID patients; 13/37 (35%) cared for COVID-19 patients. Service adaptations included: teleconsultation, triaged home visits, medication delivery at home and food supply. CONCLUSIONS: FBOs in India providing palliative care had continued to do so despite multiple challenges. Services were adapted to enable ongoing patient care. Further research is exploring the effects of COVID-19 in greater depth.

The Public Role of Churches in Early Responses to COVID-19 in Africa: Snapshots from Nigeria, Congo, Kenya and South Africa

The public role of Christianity in Africa has gained increased attention from scholars. This article gives four snapshots of the responses of churches to COVID-19 in Africa in the early weeks of disease spread on the continent. In many countries, churches are at the forefront of formal and informal health delivery and disease control, through medical services and faith healing. An examination of different approaches of Christian communities to the pandemic shows the influence and the limits of Christian action as governments acted quickly to reduce the spread of COVID-19. Using research methods (remote interviews and surveys, and analysis of authors' own denominations or congregations) consonant with physical distancing measures, the authors observed Churches attempting to carry out their mission as measures were put in place to arrest disease. They maintained worship services, moving them online. They helped Christians make sense of the pandemic and offered themselves as repositories of public trust. In some cases, however, they were less successful than they wished in carrying out their social responsibility because many of their institutions were closed as part of the measures to restrict the spread of disease. [ABSTRACT FROM AUTHOR] Copyright of Studies in World Christianity is the property of Edinburgh University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)