Preparing healthcare facilities in sub-Saharan Africa for future outbreaks: insights from a multi-country digital self-assessment of COVID-19 preparedness.

BACKGROUND: Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running. METHODS: Between May-November 2020, we performed a survey study with SafeCare4Covid - a free digital self-assessment application - to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities' location, type, and ownership was also collected. RESULTS: Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0-100 (n=471) was 58.0 (interquartile range 40.0-76.0), and the average supplies score (n=412) was 61.6 (39.0-83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3-57.0]/supplies score, 59.1 [55.5-62.8]) versus urban facilities (capability score, 65.2 [61.7-68.7]/supplies score, 70.7 [67.2-74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staff mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks. CONCLUSIONS: A large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epidemic preparedness efforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks.

Using mobile transport vouchers to improve access to skilled delivery.

INTRODUCTION: Reducing maternal death remains a challenge in many low-income countries. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at child delivery. The main objective of this study was to find out whether use of mobile transport vouchers would result in an increased number of pregnant women choosing to deliver at a health facility rather than at home. METHOD: A total of 86 expectant mothers living in Samburu County (Kenya), all having access to a mobile phone with Safaricom mobile SIM card, were enrolled into the project. Mixed methods research design was used to generate quantitative data on the voucher transactions and qualitative data from telephone interviews on technical usability of the transport voucher. RESULTS: The study demonstrated that the mobile transport voucher was a major driver for pregnant women to access healthcare facilities for skilled delivery. Illiteracy and resource scarcity were the main challenges experienced during implementation. CONCLUSION: Mobile technology can be successfully used in remote rural settings in Africa for targeting funds and guiding individuals towards better health care. The combination of such technology with communication agents (community health volunteers, ambulance drivers) proved particularly effective.

The Cashless Clinic: Acceptability and Benefits of Mobile Money in Kenya's Health Sector.

Mobile payment acceptance in healthcare is a relatively new area of research, under explored when compared to related areas of research such as mobile technology for health information and communication. The objectives of this study were to find out the effects of Safaricom's Lipa na M-PESA (LNM) use on clinic administrative costs and revenue, and to study the uptake and acceptability of LNM by patients. The study researched mobile payment acceptability by turning a clinic to be completely cashless for a six-week period. Baseline data was collected to gauge the effects of mobile payment on administrative costs and revenue. Surveys and in-depth interviews were carried out to assess the acceptability of mobile payment among staff and patients. Findings from this experiment demonstrate that mobile technology is acceptable when it is perceived as useful and more convenient to use.