Health Care In Africa Research Articles

Digital markets and the commercialization of healthcare in Africa: the case of Kenya

ABSTRACT With the widespread use of mobile phones, digital technology is gaining renewed interest in Africa. A growing number of international actors are proposing to use mobile phones as central tools for addressing health issues on the continent, specifically to ensure ‘health for all’. Based on the analysis of the ‘health wallet’ of the world most famous mobile money platform, MPESA in Kenya, this article questions the tenants and tribulations of implementing market- and digitally-based universal health coverage. It explores the way in which digital devices reconfigure the politico-economic modalities of governing health coverage in Africa. It shows how this platform model involves diverting funds formerly given to public structures to private operators in charge of deploying digital health infrastructures. The same private operators managing these infrastructures now have access to public and private health data and monetize them, thereby further aiding the expansion of corporate provisioning of health services.

Financing and payment reforms for primary health care and universal health care in Africa.

No abstract available.

Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units.

Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.

The impact of COVID-19 on patients with neurological disorders and their access to healthcare in Africa: A review of the literature.

IntroductionThe coronavirus disease 2019 (COVID‐19) pandemic has hampered the progress of neurological healthcare services for patients across Africa. Before the pandemic, access to these services was already limited due to elevated treatment costs among uninsured individuals, shortage of medicines, equipment, and qualified personnel, immense distance between residing areas and neurological facilities, and a limited understanding of neurological diseases and their presentation by both the health workers and the African population.MethodologyThe databases PubMed, Google Scholar, Science Direct, and the National Library of Medicine were searched for literature. All articles on neurological disorders in Africa were considered.AimThis review article explores the challenges of providing the best services for patients suffering from neurological disorders in Africa amid the COVID‐19 pandemic and provides evidence‐based recommendations.ResultsAs Africa's governments made more resources available to support patients affected by COVID‐19, neurological care received less priority and the capacity and competency to treat patients with neurological disorders thus suffered substantially. Both short‐term and long‐term strategies are needed to improve the quality of neurological services after the pandemic in the region.ConclusionTo strengthen Africa's neurological services capability during and after the COVID‐19 pandemic, African governments must ensure appropriate healthcare resource allocation, perform neurology management training, and increase health security measures in medication supply. Long‐term strategies include incorporating responsible finance and resource procurement and advancement of tele‐neurology. International collaboration is essential to promote the sustainable improvement of neurological services in Africa.

The Ground Is Full of Pitfalls: Association of Chronic Kidney Disease, Conflict Zones, and the Quality of Healthcare in Africa

Public health in sub-Saharan African countries is experiencing a double burden of diseases. First, for decades, these countries have been struggling against infectious diseases. Second, the demographic transition in the area is leading to a rising prevalence of non-communicable diseases (NCDs). Unfortunately, the health systems in sub-Saharan Africa are vulnerable, under-resourced, and unable to address these public health issues. Furthermore, protracted political instability and the consequent conflict zones are worsening the situation. In this short essay, the authors report their real-world experience of providing kidney care for patients with NCDs and chronic kidney disease (CKD) in Bunia, the capital city of the Ituri, a north-eastern district of the Democratic Republic of the Congo (DRC) that has been conflict-ridden for years. In conclusion, there is a lack of evidence and research regarding the heavy burden of NCDs and the appropriate healthcare policy in humanitarian settings such as conflict zones. A co-ordinated, standardised, and evidence-based approach is strongly recommended to reach affected populations in these areas.

Climate change and primary health care in Africa - A call for short reports.

No abstract available.

Hepatic Models in Precision Medicine: An African Perspective on Pharmacovigilance.

Pharmaceuticals are indispensable to healthcare as the burgeoning global population is challenged by diseases. The African continent harbors unparalleled genetic diversity, yet remains largely underrepresented in pharmaceutical research and development, which has serious implications for pharmaceuticals approved for use within the African population. Adverse drug reactions (ADRs) are often underpinned by unique variations in genes encoding the enzymes responsible for their uptake, metabolism, and clearance. As an example, individuals of African descent (14–34%) harbor an exclusive genetic variant in the gene encoding a liver metabolizing enzyme (CYP2D6) which reduces the efficacy of the breast cancer chemotherapeutic Tamoxifen. However, CYP2D6 genotyping is not required prior to dispensing Tamoxifen in sub-Saharan Africa. Pharmacogenomics is fundamental to precision medicine and the absence of its implementation suggests that Africa has, to date, been largely excluded from the global narrative around stratified healthcare. Models which could address this need, include primary human hepatocytes, immortalized hepatic cell lines, and induced pluripotent stem cell (iPSC) derived hepatocyte-like cells. Of these, iPSCs, are promising as a functional in vitro model for the empirical evaluation of drug metabolism. The scale with which pharmaceutically relevant African genetic variants can be stratified, the expediency with which these platforms can be established, and their subsequent sustainability suggest that they will have an important role to play in the democratization of stratified healthcare in Africa. Here we discuss the requirement for African hepatic models, and their implications for the future of pharmacovigilance on the African continent.

Multi-facetted Issues on Patient Safety and Perinatal Care Seen Through International Comparision: Changing Healthcare in Africa

Multi-facetted Issues on Patient Safety and Perinatal Care Seen Through International Comparision: Changing Healthcare in Africa

Prospects for financial technology for health in Africa

Over the years, technology has revolutionized the operations of many industries, ranging from manufacturing and agriculture to financial institutions which are usually the first users of innovations. Owing to the recent technological trends in the financial sector, such as mobile money, artificial intelligence, and medical robotics, as well as the rapidly increasing human population and the emergence of new patterns of disease, it is necessary for the healthcare sector to adopt new strategies to deliver efficient and effective healthcare services. Financial technology (FinTech), a combination of financial services and technology, entails the incorporation of modern, innovative technologies by industries into their financial services. FinTech is an endless array of applications, products, and services which includes mobile banking, cryptocurrency, insurance, and investment apps among many others. Any enterprise that employs technology to enhance or automate financial services and processes is referred to as FinTech. This fast-growing industry serves the interests of both the business sector and the consuming public. There have been many applications and uses of FinTech, however, its employment in the field of health remains to be explored further and maximized, particularly in the developing world like Africa. This paper aims to explore the prospects of FinTech for healthcare in Africa.

Rift Valley fever during the COVID-19 pandemic in Africa: A double burden for Africa's healthcare system.

A new rising incidence of Rift Valley fever (RVF) among livestock and humans in the African continent during the COVID‐19 pandemic has become of increasing concern. We analyzed the different ways COVID‐19 has contributed to the increase in RVF cases and how it has impacted the interventions allocated to the disease by comparing it with the status of the disease before the pandemic. There is enough evidence to conclude that the COVID‐19 pandemic has impacted the efforts being taken to prevent outbreaks of RVF. Therefore, with no definitive treatment in place and inadequate preventive measures and disease control, RVF may potentially lead to a future epidemic unless addressed urgently.

The Role of the Biotechnology Industry in Addressing Health Inequities in Africa: Strengthening the Entire Health Care Value Chain

There are many misconceptions surrounding health care in Africa, a continent of 54 sovereign countries and a population exceeding 1.2 billion souls which is growing at the fastest rate in the world. Enormous diversity has direct impact on the notion, practices, and availability of health care on the continent. There are no satisfactory generalizations about the state of health and the strength of health care systems for the continent as a whole. Indeed, differences between neighboring countries are enormous, as well as among population groups within countries. There is a significant mix of public, private, and faith-based health care providers. In most African countries, 60 percent of health providers fall into the latter two categories (IFC, 2008). Moreover, movements towards national and private risk pooling for payment of health care are underway in only a few countries, but virtually all modern African constitutions declare health care as a human right and aspire to some form of Universal Health Coverage (UHC). Despite these principles, Africans endure a dual burden of communicable and non-communicable disease. In the face of these challenges, Africans are confronted with out-of-pocket payment for health services – when it is available at all – and challenging logistics for accessing and maintaining consistency of care. The patient journey for Africans is a winding path, often exacerbated by an additional reliance on the importation of talent, pharmaceuticals and vaccines, medical and diagnostic tools, and digital support of the health systems. The health care value chain in Africa is incomplete. Each of Providers, Payers and Producers need further development. When any of these is weak or missing, there cannot be a sustainable health system. The issue, therefore, is not scientific or clinical competence; it is capacity and the necessity to promote a comprehensive and integrated health care ecosystem – including the Producer segment. To address the Producer link, more direct engagement by the global biopharmaceutical industry in assisting and investing in the advancement of indigenous laboratory and clinical development, product production and distribution, and the advancement of human capital necessary to achieve health care sovereignty for the continent is necessary. There is all the more reason to do so as humanity enters the age of genomic and precision medicine. There is a pathway for African health care to leapfrog as it has done in telecommunications.

Traditional healers to improve access to quality health care in Africa

In Cameroon, we like to say, “one finger cannot hold a piece of meat”. In other words, at least two fingers are required to eat a piece even with a fork. This thought is reminiscent of Africans customarily seeking health care from both traditional and western medicine. Traditional medicine has been used for the treatment of various diseases since before the advent of western medicine in Africa. In South Africa, for example, 80% of the population seek health care from traditional healers.1 It thus seems evident that they keep playing a major part in African health systems.

Gender differences in informal payments for healthcare: evidence from 34 African countries.

Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving universal health coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particularly in low- and middle-income countries. Our study aimed to examine gender disparities in paying informally for healthcare in Africa. We used Afrobarometer Round 7 survey data collected between September 2016 and August 2018 from 34 African countries. The final sample was composed of 44 715 adults. We used multiple logistic regression to evaluate associations between gender and paying informally to obtain healthcare. Our results show that 12% of women and 14% of men reported paying informally for healthcare. Men were more likely to pay informally for healthcare than women in African countries [odds ratio 1.22 (95% confidence interval 1.13-1.31)], irrespective of age, residential location, educational attainment, employment status, occupation and indicators of poverty. To make meaningful progress towards improving universal healthcare coverage in African countries, we must improve our understanding of the gendered aspects of informal payments in healthcare, which can act as both a barrier to accessing care and a determinant of poor health.

Negotiating South–South cooperation for mental health: the World Health Organization and the African Mental Health Action Group, 1970s–90s

AbstractThis article explores the African Mental Health Action Group (AMHAG), one of the earliest examples of the World Health Organization’s (WHO) attempts to promote ‘ownership’ over development through the South–South cooperation envisaged in Technical Cooperation in Developing Countries. Formed in 1978, the AMHAG was intended to guide national and regional policy on mental health, while also fostering national and collective self-reliance. For a short period, between the late 1970s and the early 1990s, it was central to the WHO’s strategy for promoting policies of mental health in primary healthcare in Africa. It was a largely ineffective tool, with national governments having different opinions on the value of mental health, and poor coordination between AMHAG countries. Approaching the AMHAG as a regional project and transnational network, however, the article provides explores the importance of regions and regionalism in international health cooperation, as well as the inequities of participation in health development. Drawing on WHO archival material spanning over twenty countries and two national liberation movements, it argues that participating countries were differently positioned not only to navigate relationships between countries, but also to contend with the shifting landscape of international assistance, as well as – for some – contexts of war, violence and political and economic instability. The article not only serves as a case study of power imbalances in a failed development initiative, but also sheds light on the WHO’s engagement with mental health during a period that historians of psychiatry in Africa have tended to overlook.

COVID-19 underscores the important role of Clinical Ethics Committees in Africa

BackgroundThe COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa.MethodsTwenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses.ResultsKenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking.ConclusionsThis study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation.

A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war. A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis. Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depression and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern healthcare. Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Westernized nosology and social factors. Traditional healer's attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with 'modern' health care providers, but this will require reciprocal trust-building.

Inequitable access to healthcare in Africa: reconceptualising the \u201caccountability for reasonableness framework\u201d to reflect indigenous principles

BackgroundThe “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA.MethodologyA4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity.ResultsSome of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle.ConclusionA health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.

Promises and perils of mobile health in Burkina Faso

Mobile health (mHealth) has attracted much attention in the global health community as a technological fix that can short-circuit inadequate health-system infrastructure and build access. But like many other technology-based approaches to remedy structural health inequities, mHealth interventions can be overhyped. We discusses here [email protected], an mHealth network launched in 2013 by the Centre de Recherche en Santé de Nouna (CRSN), Burkina Faso, with funding from the International Development Research Centre, Canada. Revitalising global social medicineWhat is global social medicine? This group of art of medicine essays argues for a revitalisation of the field of social medicine as a way to reaffirm a health agenda that promotes human rights and social justice. This approach requires understanding the histories of social medicine in diverse locations, the decolonisation and democratisation of knowledge flows in global health, and a more explicit acknowledgment of the historical and structural conditions that shape the burden of disease and the opportunities for health care and caregiving. Full-Text PDF Mutual aid, pandemic politics, and global social medicine in BrazilIn the face of persistent neglect and denial of the severity of COVID-19 by the administration of President Jair Bolsonaro, residents in many of Brazil's favelas have been left to organise their own responses to the pandemic. Community leaders have raised funds and volunteers are going door-to-door to distribute food, masks, and hygiene kits, using megaphones to educate residents about mask use, physical distancing, and handwashing. Local journalists are also using social media to counter fake news, and activists are converting schools into isolation wards, facilitating cash transfers, and fighting for the accurate documentation of COVID-19 deaths. Full-Text PDF Climate disasters and global social medicineHenry suffered a stroke in 2008, 3 years after Hurricane Katrina destroyed his home in New Orleans's Lower 9th Ward, a historic Black community. His diabetes had worsened in the aftermath of Katrina as he struggled to find pharmacies with insulin and other necessary supplies. His wife, Gladys, blamed the stroke on the receipt of a second denial-of-funds letter from the Road Home Program; without that assistance, they could not rebuild their home. The stroke left him paralysed. Gladys did her best to care for him, but she saw Katrina as the disaster that never ended. Full-Text PDF The social in psychiatries: depression in Myanmar, China, and JapanIn the wake of new ways of calculating disease burdens through disability-adjusted life-years, depression emerged as the world's second most common disorder after cardiovascular disease, affecting more than 264 million people worldwide. In Asia, depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases (ICD) has also become far more recognised and diagnosed over the past two decades. On the surface, this change seems to underline the universality of the neurobiological model of depression. Full-Text PDF Infant mental health in southern Africa: nurturing a fieldThe promotion of early cognitive and emotional development is a core aim of the field of infant mental health (IMH). Yet models of early development and IMH have often been developed for high-income settings, and sometimes carry under-examined assumptions about care and wellbeing. Although this discipline is well established in Euro–American contexts, questions have been raised about how to tailor it to contexts that may differ considerably from those in which these models were developed. The ways that care, attachment, and relationship are given form in everyday practices are not universally the same, raising the challenge of shaping therapeutic models and interventions so as to ask appropriate questions, design context-sensitive interventions, and meet caregivers and infants in ways that are meaningful to them while still retaining general applicability. Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in Africa – Authors' replyWe thank Yap Boum for taking the time to respond to our Perspective.1 Full-Text PDF Beyond COVID-19: scaling up and sustaining mobile health in AfricaIn their Perspective,1 N Hélène Sawadogo and colleagues highlight the challenges of mobile health care in Africa with the [email protected] project, which provided medical support to pregnant women but ran out of funding 3 years into operation. Securing longer-term funding to sustain mobile health is a challenge in Africa.2 Social innovations such as BIMA (Ghana), AccesAfya (Kenya), Idocta (Cameroon), and Healthforce (South Africa) use telemedicine to improve access to quality health care but have not managed to scale up. Full-Text PDF

Epilepsy Websites in Africa: State of the Art.

PurposeEpilepsy is one of the main brain disorders in the world and should be considered a priority for healthcare in Africa. Internet is a growing source of health information for healthcare and patients with epilepsy (PWEs). In this short communication, we tried to describe the status of websites on epilepsy in Africa in terms of availability and pertinence, and to suggest ideas on how to make them more effective.MethodsThe existence of epilepsy websites and their distribution in Africa were acquired using a questionnaire sent to different neurologists in the African continent.ResultsBased on the survey answers and the web search, our results show that out of 54 African countries, only 16 countries (≈30%) have an active epilepsy website.ConclusionThe need for reliable, clearly written, and easily comprehended information about epilepsy is considered as an important element to enhance the quality of care, for this all African countries should create and improve their epilepsy websites in order to promote education and awareness.

COVID-19 Resurgence: Lessons Learned to Inform the South African Response.

The risk of recurring coronavirus disease (COVID-19) resurgences that threaten Africa's health care systems, newly opened communities, schools, and businesses looms as communities abandon precautionary measures, such as mask-wearing, physical distancing, and regular handwashing. In this piece, we unpack the handling of both the first wave and subsequent resurgence in the context of 3 countries that are experiencing such a resurgence at the time of writing (December 2020): Israel, France, and the United Kingdom. While it is difficult to extrapolate on what to expect in South Africa, based on experience in these 3 countries, South Africa's preparedness for a COVID-19 resurgence should place emphasis on the role of expanded testing and isolation capacity, strengthening enforcement of adherence to non-pharmaceutical interventions, and protection of high-risk populations.