Continued Provision Of Services Research Articles

Analysis on addressing the threats to cloud computing on the basis of security safeguards for sap cloud services

Cloud computing has become an integral part of combination/multi-cloud infrastructures due to its many benefits, including quick deployment, flexibility, cheap costs, and scalability, which have attracted businesses of all sizes. New possibilities and threats in terms of security flaws are cropping up in this field, even if cloud storage provides substantial advantages and inexpensive choices for IT administration and growth. When we talk about safeguarding cloud infrastructure systems, we're referring to a set of rules, regulations, and systematic procedures. This is also known as cloud computing security. The purpose of implementing these security measures is to safeguard cloud-based data, facilitate the enforcement of legislation, ensure the privacy of consumer information, and set standards for encryption in specific devices and applications. Modern cloud computing and security concerns throughout the cloud's many layers are addressed in this study. Within this context, the current study would make a substantial contribution to lowering the frequency of security breaches in cloud computing, paving the way for the continued provision of safe and reliable services. Storage of databases on the cloud is expanding rapidly in the IT industry, including SAP networks. Because enterprises are ultimately responsible for the security of their data, migrating databases to cloud computing environments brings with it a plethora of security risks. To guarantee data integrity, availability, and secrecy, appropriate security measures should be put in place before a company migrates its sensitive data to the cloud. When data is at rest, it is most vulnerable to unauthorized access; when it is in transit, it must be subject to strict supervision.

Efficient Resource Scheduling in Cloud-based Healthcare Systems

Cloud computing is becoming a key tool in the quickly changing healthcare industry, bringing about major changes to contemporary medical procedures. This study examines the various applications of cloud computing in the healthcare industry, highlighting how it can improve patient care, simplify processes, and stimulate creativity. Healthcare providers can enhance data management, interoperability, and scalability, resulting in more effective and efficient clinical procedures, by utilizing cloud-based solutions. The article explores important uses, emphasizing how cloud computing enables these developments, including electronic health records (EHRs), telemedicine, big data analytics, and AI-driven diagnostics. In addition, it presents a new effective load-balancing architecture for resource scheduling in cloud-based healthcare communications, guaranteeing maximum resource efficiency and continuous service provision. In addition, this paper discusses important issues including data security, privacy, and regulatory compliance while providing advice on how to reduce the risks involved. This paper highlights the transformative impact of cloud computing on healthcare delivery and illustrates its role in changing medical practices of the future through a thorough review of current trends, innovations, and case studies.

IT’S NEVER TOO LATE TO START: A CASE FOR PREVENTATIVE OUTPATIENT GERIATRIC SERVICES

INTRODUCTION & AIMS The population is ageing and the chronic disease burden growing, seeing more older adults present to hospital with preventable non-communicable diseases. Multidisciplinary outpatient teams are well placed to manage modifiable risk factors to prevent disease progression and hospitalisations. A preventative service was launched at Concord Hospital integrating geriatrician, exercise physiologist and dietitian care to optimise the physical and mental health of older adults with chronic disease and frailty. This evaluation aims to determine the success of service implementation and feasibility of the model. METHODS Between November 2022 and June 2023, 59 patients (mean age 80.2 years (SD 6.2), 47.5% female) completed 12-weeks of concurrent exercise and diet interventions with medical oversight. Patients were assessed pre- and post-interventions. Exercise was individualised and multimodal, performed twice weekly in a supervised group. Diet was individualised with a protein supplement prescribed as appropriate. The outcomes measured were Fried Frailty Phenotype (FFP), leg strength (one repetition maximum leg press), Short Physical Performance Battery (SPPB), Geriatric Depression Scale Short Form (GDS), and Mini Nutritional Assessment Long Form (MNA). Service activity was measured monthly via rate of referral and occasions of service (OOS). Data were analysed using JASP (v.0.18.1). RESULTS Monthly rate of referral and OOS increased from 18 to 51 patients and 49 to 479 occasions respectively, indicating service demand. After 12-weeks there were significant improvements in FFP (mean difference [95%CI] -0.4 [-0.7, -0.2] points), leg strength (34.0 [27.1, 40.8] kilograms), SPPB (1.1 [0.8, 1.5] points), GDS (-1.4 [-2.2, -0.6] points) and MNA (2.6 [1.6, 3.5] points), with no effect of sex observed. CONCLUSION Initial implementation of a preventative outpatient geriatric service was successful with increasing service demand and significant physical and mental health improvements. The service model is feasible; however, further evaluation is required to determine outcomes after continued service provision.

Impacts of the Covid-19 pandemic on the South African water sector

An analysis of the impacts of the Covid-19 pandemic on the South African water sector is presented. The study identified and focused on three main themes: water revenue collection, water service delivery, and water sector operations. The Covid-19 pandemic negatively impacted these aspects and exacerbated pre-existing problems in the water provision landscape of South Africa. Business continuity management was identified as a top priority for water sector institutions in South Africa to ensure the continued provision of critical water services. In-depth case study research is recommended to establish how water sector institutions in South Africa dealt with the Covid-19 pandemic and how this can inform their disaster preparedness and management going forward.

Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers.

Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times.

Evidence of drastic loss of dung beetle diversity after 25 years in an introduced Brazilian pasture

AbstractIn tropical forest ecosystems, pastures are considered a limiting environment for dung beetles, with long‐term negative effects on the diversity of this group. To understand how dung beetle diversity changes over time in introduced Brazilian pastures, studies comparing different periods are needed. Here, we conducted a study sampling dung beetles during 48 consecutive weeks in 1995 and 2020–2021. We used pitfall traps baited with fresh cattle dung in the same introduced pasture located in the Cerrado‐Pantanal ecotone of Brazil. Our study found that the total species richness of dung beetles decreased by 40% in 2020–2021 compared to 1995, which could negatively impact the ecological functions of the pastures. Given the importance of dung beetles for maintaining and functioning of pastures, the decline in dung beetle diversity could lead to the degradation of pasture landscapes. We advocate for management plans for livestock production in introduced pastures that include the long‐term conservation of dung beetle biodiversity. These plans will ensure the continued provision of dung beetle ecological services by dung beetles over the years.

ICT's in the Chilean and Latin-American civil justice. Analysis from the right of access to justice

AbstractThe incorporation of Information and Communication Technologies (ICTs) in the justice sector is not necessarily a new phenomenon. Nevertheless, the outbreak of the Covid-19 pandemic accelerated this process, as it required rapid solutions to mitigate the effects of social distancing and other security measures, for which ICTs proved crucial to ensure the continued provision of basic legal services. Initially used only for urgent matters, after two years it has become highly integrated into the regular functions of judicial institutions and is expected to continue as a critical tool against overburdened dockets. ICTs in the justice system can serve different purposes and can therefore be analyzed from different perspectives: efficiency in the administration of justice, interoperability between institutional actors, improvement of information for decision-makers, transparency and accountability, among others. This article focuses on access to justice. Therefore, it analyzes the ICTs implemented in Latin American countries, with a focus on the Chilean judiciary – particularly in the civil justice system – from a critical point of view, based on access to justice standards.

Seismic vulnerability assessment of buried water supply and sanitation pipelines using the analytic hierarchy process: a methodology and application

The evaluation of seismic vulnerability in buried pipelines within water supply and sanitation networks stands as a critical endeavor in safeguarding infrastructure against the impacts of earthquakes. In response, this study introduces a systematic methodology rooted in the Vulnerability Index (VI), leveraging the Analytic Hierarchy Process (AHP) to allocate weights to factors influencing pipeline seismic behavior. Through the derivation of an expression for calculating the VI based on these weighted factors, our objective is to furnish a comprehensive pipeline classification system, thereby providing a strategic overview of the networks' seismic resilience. This method's practical utility will be exemplified through the examination of concrete cases involving drinking water pipelines (DWP). Furthermore, the scope will extend to encompass sanitation pipelines, thereby validating the methodology's effectiveness across both domains. By systematically assessing the seismic vulnerability of these crucial infrastructures, we aim to fortify their resilience against seismic events, ensuring the continued provision of essential services even in the face of natural disasters. This study's significance lies not only in its contribution to the field of infrastructure resilience but also in its practical implications for urban planning and disaster management. By elucidating the factors influencing pipeline vulnerability and providing a robust framework for assessment, decision-makers can better prioritize resource allocation and mitigation efforts, ultimately enhancing community safety and well-being. Furthermore, the methodology's adaptability and scalability render it applicable to diverse contexts, facilitating its integration into broader risk management strategies. As such, this study serves as a valuable tool for policymakers, engineers, and stakeholders seeking to enhance the resilience of water supply and sanitation networks in earthquake-prone regions. Through informed decision-making and proactive measures, we can build more resilient communities capable of withstanding the challenges posed by seismic hazards.

A qualitative study examining the health system's response to COVID-19 in Sierra Leone.

The paper examines the health system's response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013-16 Ebola outbreak influenced the COVID-19 response and public perception. Using the WHO Health System Building Blocks Framework, we conducted a qualitative study in Sierra Leone where semi-structured interviews were conducted with health workers, policymakers, and patients between Oct-Dec 2020. We applied thematic analysis using both deductive and inductive approaches. Twelve themes emerged from the analysis: nine on the WHO building blocks, two on patients' experiences, and one on Ebola. We found that routine services were impacted by enhanced infection prevention control measures. Health workers faced additional responsibilities and training needs. Communication and decision-making within facilities were reported to be coordinated and effective, although updates cascading from the national level to facilities were lacking. In contrast with previous health emergencies which were heavily influenced by international organisations, we found that the COVID-19 response was led by the national leadership. Experiences of Ebola resulted in less fear of COVID-19 and a greater understanding of public health measures. However, these measures also negatively affected patients' livelihoods and their willingness to visit facilities. We conclude, it is important to address existing challenges in the health system such as resources that affect the capacity of health systems to respond to emergencies. Prioritising the well-being of health workers and the continued provision of essential routine health services is important. The socio-economic impact of public health measures on the population needs to be considered before measures are implemented.

Resilience of the BUDS Community-based Rehabilitation Institutions during the COVID-19 Pandemic: Supporting Role of Local Governments

Background: BUDS (not an acronym) institutions are free and open special institutions established by Kudumbashree in Kerala for children from low-income households with intellectual or psychosocial impairments. We explored the impact of COVID-19 pandemic on BUDS beneficiaries and the organizational adaptation for continued operations during the period. Methods: We conducted telephonic in-depth interviews with eight BUDS teachers, three beneficiaries’ parents, and two local government (LG) representatives. We did a deductive analysis to describe two major themes: one pertained to the physical, mental, and social challenges faced by beneficiaries and families of BUDS institutions and other on organizational adaptation to the situation in terms of sustaining classes for children and continued support for meeting basic needs. Results: Beneficiaries lost some therapeutic gains, while parents faced financial hardships. Trainers and LGs made active efforts for sustaining contact with children and parents, distribution of necessities for children, and home visits. Some trainers displayed an exemplary level of dedication. LGs facilitated service provision by continuing remuneration to trainers, and collaborating with various stakeholders like education and health, and initiating locally suitable measures. The Thenkoodu app for continued training was deemed not very useful by trainers and parents. Conclusion: Committed human resources, acceptance of ground realities, quick decision–making, and collaboration across stakeholders were important aspects of the response of LGs for continued service provision to BUDS beneficiaries during the COVID-19 pandemic. Our findings suggest that decentralized space where BUDS institutions emerged and expanded is beneficial for organizational resilience of community-based rehabilitation institutions.

FPGA Live Migration of Content‐Based Anonymization Mechanism with Network Consistency

In smart communities, data are aggregated, and various services are provided based on it. When considering the optimization of service delivery through cooperative processing between the edge and the cloud in smart communities, it is essential to realize network transparent edge services due to the constraints of not touching end devices in order to improve user convenience and additional cost reduction. Moreover, considering the minimization of service provision and service delivery latency at the edge, it is desirable to use field‐programmable gate arrays (FPGAs), which have lower power consumption, lower latency, and higher throughput than conventional processors. Additionally, to advance towards even lower latency, the distribution of processing load is important, and service migration is necessary for this purpose. Service migration is generally used to increase service availability, and even for edge services, service migration is important because the distribution of processing and the location where the service should be provided changes over time due to user mobility. When considering network transparency, service migration should be performed on the communication path between the end device and the cloud. Furthermore, to enhance service transparency, it is essential to maintain communication consistency for continuous service provision and minimize service downtime. Therefore, this study proposes a migration mechanism with FPGAs to satisfy these requirements. As an example of a real application, we target a network‐transparent data anonymization application to protect the privacy of data providers and evaluate the proposed architecture based on the reality of latency and other factors. © 2023 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

Introducing seasonal influenza vaccine in Bhutan: Country experience and achievements

Bhutan successfully introduced multiple vaccines since the establishment of the Vaccine Preventable Disease Program in 1979. Surveillance and subsequent introduction of influenza vaccination became a public health priority for the Ministry of Health following the influenza A(H1N1)pdm09 pandemic. Sentinel surveillance for influenza in Bhutan began in 2008, and a study of severe acute respiratory infection was conducted in 2017, which found the highest influenza burden in children aged <5 years and adults ≥50 years. Following review of surveillance and burden of disease data, the National Technical Advisory Group presented recommendations to Bhutan’s Ministry of Health which approved influenza vaccine introduction for all five high-risk groups in the country. Upon the official launch of the program in June 2018, the Vaccine Preventable Disease Program began planning, budgeting, and procurement processes with technical and financial support from the Partnership for Influenza Vaccine Introduction, the United States Centers for Disease Control and Prevention, the Bhutan Health Trust Fund, and the World Health Organization. Influenza vaccination for high-risk groups was integrated into Bhutan’s routine immunization services in all health care facilities beginning in November 2019 and vaccinated all populations in 2020 in response to the COVID-19 pandemic. Coverage levels between 2019 and 2022 were highest in children aged 6–24 months (62.5%–96.9%) and lowest in pregnant women (47.7%–62.5%). Bhutan maintained high coverage levels despite the COVID-19 pandemic by continued provision of influenza vaccine services at health centers during lockdowns, conducting communication and sensitization efforts, and using catch-up campaigns. Bhutan’s experience with introducing and scaling up the influenza vaccine program contributed to the country’s capacity to rapidly deploy its COVID-19 vaccination program in 2021.

The Acadian Forest of New Brunswick in the 21st century: what shifting heat and water balance imply for future stand dynamics and management

Climate change is altering the dynamics of New Brunswick’s forests. To mitigate the effects of climate change, it is crucial to account for future uncertainties in climate projections and natural disturbance trajectories when designing forestry practices. This paper presents the projected changes in key climatic drivers for New Brunswick’s forests, examines the impacts of climate change on forest stand dynamics, and reviews adaptive silviculture tools for climate change adaptation. By 2071–2100, a projected 4–6 °C increase in mean annual temperature will lead to a 39%–77% rise in growing degree-days and a reduction in summer atmospheric water balance by 48–79 mm across New Brunswick. Foresters should anticipate a doubling of annual area burned, the northward migration of spruce budworm ( Choristoneura fumiferana (Clemens)), and the introduction of novel insects and diseases. Forest simulation models project a severe decline in boreal tree species abundance, including a 50% decline in balsam fir ( Abies balsamea (L.) Mill) and black spruce ( Picea mariana (Mill.) Britton et al.), offset by an increase in temperate species, notably red maple ( Acer rubrum L.; +200%) and American beech ( Fagus grandifolia Ehrh; +135%). Forests in the highlands and lowlands ecoregions, with 40%–50% and 15%–30% spruce and balsam fir composition, respectively, are particularly vulnerable. To limit climate change effects on forest values, foresters must prioritize climate resiliency in their management plans. Strategies should ensure the steady provision of forest goods and services under changing climatic conditions. Forest thinning enhances stand productivity and resilience, while shelterwood and two-age harvest balances timber production with diversity. Clearcutting, despite drawbacks, establishes younger, more vigorous forests with higher carbon sequestration potential. Assisted migration offers promise in helping threatened tree species adapt. Climate change will have a significant impact on New Brunswick’s forests, leading to changes in key climatic drivers, increased risks of disturbances, and a shift toward more temperate tree species. However, there are existing adaptation strategies available. It is crucial to consider future uncertainties when designing and evaluating forestry practices, as this is essential for mitigating the effects of climate change on forest values and ensuring the continued provision of forest goods and services over time.

FTP2.4 Colorectal Resections at an Elective Hub; A service evaluation

Abstract Aim Rising acute hospital bed pressures that have persisted post-pandemic have led to increased surgical cancellations and growing waiting lists. Ashford and St Peters Hospital Trust set up a unique elective surgical hub at Ashford Hospital to ensure the continued provision of surgical services, unaffected by the capacity pressures of an acute hospital site. The introduction of a level 1.5 Enhanced Care Unit (ECU) has enabled many colorectal resections to be performed at the elective hub. We aim to evaluate elective colorectal resections at this hub since the introduction of ECU. Methods Evaluated all elective colorectal resections in the 12 month period since the introduction of ECU (1st April 2021 - 31st March 2022). Procedure, surgical approach, histology, length of stay, post-operative complications and inter-hospital transfers were recorded for each case. Statistical analysis was performed on the data collected. Results In 12 months,169 and 36 colorectal resections took place at the acute site versus the elective respectively. At the elective hub, 50% of patients were male, the median age was 62.5 yrs, 89% were ASA 2. Right hemicolectomy was the most common procedure (50%) followed by high anterior resection (36%). The open conversion rate was 8%. Three patients (8%) required transfer to St Peter’s, 2 of which had an anastomotic leak. Conclusions An elective hub provides a safe location for colorectal resections. Appropriate case selection involving consultant surgeons and anaesthetists ensures low transfer rates. Expanding this service will relieve bed pressures at St Peters and reduce waiting lists.

Strengthening systems to provide long-acting reversible contraceptives (LARCs) in public sector health facilities in Uganda and Zambia: Program results and learnings.

In Uganda and Zambia, both supply- and demand-side factors hamper availability of long-acting reversible contraceptives (LARCs), including implants and intrauterine devices (IUDs), at public sector facilities. This paper discusses results of a program aimed at increasing access to and uptake of LARC services in public sector facilities through capacity building of government health workers, strengthening government supply chains, and client mobilization. From 2018-2021, the Ministries of Health (MOHs) in Uganda and Zambia and Clinton Health Access Initiative (CHAI) worked to increase readiness to provide LARC services within 51 focal facilities in Uganda and 85 focal facilities in Zambia. Annual facility assessments of LARC-related resources were conducted and routine service delivery data were monitored. At baseline, few focal facilities had supplies and skilled staff to provide LARC services. At endline, over 90% of focal facilities in both countries had a provider trained to provide both implants and IUDs and 55% had the commodities and equipment needed for implant provision. In Uganda and Zambia, respectively, 65% and 38% of focal facilities had commodities and equipment for IUD provision at endline. Both programs observed significant increases in the number of implants provided at focal facilities; in Uganda implant volumes increased five-fold from 4,560 at baseline to 23,463 at endline, and in Zambia implant volumes increased nearly four-fold from 1,884 at baseline to 7,394 at endline. Uganda did not observe growth in IUD volumes, whereas Zambia observed significantly increased IUD service volumes from 251 at baseline to 3,866 at endline. Public sector facilities can be rapidly and sustainably capacitated to provide LARCs when both catalytic and systems strengthening interventions are deployed for health worker capacity building, supply chain management, and community mobilization to ensure client flow. Investments should be intentionally sequenced and coordinated to generate a virtuous cycle that enables continued LARC service provision.

Ecosystem-Based Adaptation Practices of Smallholder Farmers in the Oti Basin, Togo: Probing Their Effectiveness and Co-Benefits

The ecosystem-based adaptation (EbA) strategy is considered an effective approach to address the impact of climate change while ensuring the continued provision of ecosystem services on which farming depends. However, understanding the EbA’s effectiveness for smallholder farmers in the Savannah region remains limited. The focus of this study is to explore the EbA practices that have been implemented by farming communities in the Savannah region of Togo. The study aims to evaluate the effectiveness of these practices and the perceived co-benefits reported by 425 smallholder farmers who participated in the survey. Our findings show that five practices, namely agroforestry, crop rotation, grass hedge/stone bunds, in-field water drainage channel, and intercropping, were practiced mainly by smallholder farmers and perceived as effective in reducing their vulnerability to climate risks. In addition, the benefits observed were linked to all five EbA practices. As a result, we can determine the suitable combination of EbA practices that fulfil the requirements of smallholder farmers, including co-benefits such as food security, adaptation advantages, and ecosystem service provisions. Such findings provide insights for developing integrated agriculture and climate change policies suitable for weather-induced disaster-prone areas such as the Savannah region.

Plastic debris in lakes and reservoirs.

Plastic debris is thought to be widespread in freshwater ecosystems globally1. However, a lack of comprehensive and comparable data makes rigorous assessment of its distribution challenging2,3. Here we present a standardized cross-national survey that assesses the abundance and type of plastic debris (>250 μm) in freshwater ecosystems. We sample surface waters of 38 lakes and reservoirs, distributed across gradients of geographical position and limnological attributes, with the aim to identify factors associated with an increased observation of plastics. We find plastic debris in all studied lakes and reservoirs, suggesting that these ecosystems play a key role in the plastic-pollution cycle. Our results indicate that two types of lakes are particularly vulnerable to plastic contamination: lakes and reservoirs in densely populated and urbanized areas and large lakes and reservoirs with elevated deposition areas, long water-retention times and high levels of anthropogenic influence. Plastic concentrations vary widely among lakes; in the most polluted, concentrations reach or even exceed those reported in the subtropical oceanic gyres, marine areas collecting large amounts of debris4. Our findings highlight the importance of including lakes and reservoirs when addressing plastic pollution, in the context of pollution management and for the continued provision of lake ecosystem services.

An evaluation of the introduction of telehealth for remote antenatal and postnatal contacts in Bangladesh and Lao People's Democratic Republic during the COVID-19 pandemic.

From 2020, COVID-19 spread rapidly around the globe and continues to have a major impact on health system functioning, with a disproportionate impact on low- and middle-income countries (LMIC). Reduced service utilisation and coverage of essential childbirth interventions is likely impacting maternal and newborn morbidity and mortality. Telehealth has been identified as an important tool in the continued provision of essential healthcare services. The aim of this study was to explore the experience and impact of implementing telehealth services for the provision of remote antenatal (ANC) and postnatal (PNC) contacts in regions of Bangladesh and Lao People's Democratic Republic through 100 semi-structured interviews with health service leaders and providers, and childbearing women who organised, provided, or were the recipients of ANC and PNC telehealth during the COVID-19 pandemic response. The findings showed that a sudden pivot from face-to-face to telehealth services posed both health system and provision of care challenges. Health systems lacked funding to support telehealth and the infrastructure needed for service changes; however, some were able to work with key maternal child health departments within Ministries of Health to find the resources to implement the services. Health providers found telehealth beneficial during the pandemic response but identified a lack of training, guidance, and support as a barrier to changing practice. Childbearing women reported being fearful of accessing care at health services due to COVID-19, and whilst they appreciated the telehealth contacts, many continued to prefer face-to-face delivery of ANC and PNC care. Telehealth, however, was a good alternative in a time when face-to-face care was not possible. Considerations for post-pandemic broader implementation or scale-up of telehealth for routine antenatal and postnatal maternity care provision include the need for further research on issues such as accessibility, acceptability, quality of care, and sustainability of service provision.

Accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic: A rapid review.

Control measures for the COVID-19 pandemic brought unprecedented challenges to health care delivery. Some countries in sub-Saharan Africa (SSA) stopped the provision of essential health care except for those services that were deemed emergencies or life-threatening. A rapid review was conducted on March 18, 2022, on the accessibility and utilization of antenatal care services in sub-Saharan Africa during the COVID-19 pandemic. PubMed, Google Scholar, SCOPUS, and the World Health Organization library databases were searched for relevant studies. A modified Population, Intervention, Control, and Outcomes (PICO) framework informed the development of the search strategy. The review included studies conducted within Africa that described the availability, access, and utilization of antenatal services during the COVID-19 pandemic. Eighteen studies met the inclusion criteria. This review revealed a reduction in access to ANC services, an increase in the number of home deliveries, and a reduction in the number of women attending ANC visits during the COVID-19 pandemic. A decrease in ANC service utilization was reported in some studies in the review. Barriers to ANC access and utilization during the COVID-19 pandemic included movement restrictions, limited transport access, fear of contracting COVID-19 at the health facilities, and facility barriers. The use of telemedicine needs to be improved in African countries to allow for the continued provision of health services during pandemics. In addition, there should strengthening of community involvement in the provision of maternal health services post-COVID-19 so that services may be able to better withstand future public health emergencies.

Government responses to COVID-19 and impact on GBV services and programmes: comparative analysis of the situation in South Africa, Kenya, Uganda, and Nigeria

As governments impose restrictive policies to contain infectious disease outbreaks, pre-existing gender-based inequalities are often exacerbated, increasing the risk of gender-based violence (GBV). Despite international guidance on the need for continued provision of GBV services during emergencies, governments often de-prioritise GBV services and programmes. We conducted a rapid assessment in South Africa, Kenya, Uganda, and Nigeria to examine the impact of COVID-19 policies on the availability of GBV prevention and response services. The study team interviewed 80 stakeholders representing different GBV services in the four countries. The interviews revealed strikingly similar government mis-steps that disrupted the availability of comprehensive GBV services. In all four countries, the government’s failure to exempt the provision of multi-sectoral GBV services from initial lockdown restrictions led to confusion and disrupted the provision of critical GBV services such as clinical management of rape, legal and judicial services, psychosocial services, availability of shelters, and community-based prevention activities. The government’s imposition of curfews, stay-at-home orders, and transportation restrictions further diminished access to services. Governments must strengthen currently available GBV prevention and response services and be better prepared for future pandemics. Following international guidelines, governments should deem GBV services as essential from the beginning with clear implementation plans. Governments must invest in community-based solutions and the expansion of digital tools to ensure everyone, especially those likely to be structurally excluded, have access to critical services during an emergency.