Services In sub-Saharan Africa Research Articles

The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa.

Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.

The use of and need for data and information by health professionals supporting the delivery of palliative cancer care services in sub-Saharan Africa: A qualitative study.

The ability to develop and evaluate approaches to the management of advanced cancer in sub-Saharan Africa is limited by the lack of local, reliable and valid data to ensure that practice is evidence-based, replicable and reflects the needs of the population served. A secondary qualitative analysis of in-depth interviews with 59 health professionals delivering palliative cancer care in Nigeria, Uganda and Zimbabwe were conducted to determine the use and needs for data and information for patient care and service delivery. Framework analysis was used, informed by a conceptual model for data use in low and middle-income countries. Three meta-themes include: (1) Current practice in data gathering and use; (2) Gaps for capturing, storing information and supporting communication, and; (3) Needs and opportunities for data use. Deficits in current data access and use were identified, alongside targets for improving the quality, accessibility and utility of data to inform the development of palliative cancer care. The availability and use of relevant and reliable data relating to the current provision of palliative cancer care are requisite for the contextually appropriate and effective development of health services. The requirements and constraints articulated by participants can guide future development and optimisation of digital health approaches for palliative cancer care in the participating countries, with relevance to the wider sub-Saharan Africa region.

Assessment of Interventions in Primary Health Care for Improved Maternal, New-born and Child Health in Sub-Saharan Africa: A Systematic Review

Primary health care (PHC) holds great potentials to improve maternal, newborn, and child health (MNCH) outcomes. However, there has been limited documentation of its effects on increasing universal access to maternal, newborn, and child health services in sub-Saharan Africa. Also, not adequately known are the most effective interventions to improve the delivery of PHC services in the region. The objective of this study was to conduct a systematic review of empirical evidence of interventions that improved access and quality of PHC services for maternal, newborn, and child health in sub-Saharan Africa. The protocol was registered on Prospero (Registration number CRD42019126029). Using terms related to primary health care and MNCH, we searched African Journals Online (AJOL), PubMed/Medline, Popline, ScienceDirect, Google Scholar, WHO Repository (IRIS), Directory of Open Access Journals (DOAJ), Cochrane Library, and reference lists for studies published in English between 2000 and 2019. Studies were included in the search if they reported interventions, and strategies implemented to improve quality and access to primary health care for maternal, newborn, and child health in sub-Saharan Africa. A total of 25 studies were included in the review. Effective interventions included financial incentives, task-shifting, community-directed engagements, training of providers, mobile health, cost-sharing, and supportive supervision among others. The result of this review contributes useful insight to guide the reformation, and development of new policies and programs for improving access and quality of primary health care delivery in sub-Saharan Africa, particularly to improve maternal and child health in the region. However, strategies to scale and sustain the successes need to be in place.

Understanding e-government services: integration of process virtualization theory and user resistance

PurposeLiterature reveals that citizens’ intentions or willingness to adopt and use e-government services in developing countries like Ghana have not been encouraging regardless of the importance of these services. This study aims to examine the factors that inhibit the virtualization of government to citizen e-government processes by assessing citizens’ intentions to resist or use government’s virtualized processes.Design/methodology/approachThis study used a survey questionnaire to collect data from public school teachers who are users of the Government of Ghana’s e-pay slip system. Out of 500 questionnaires administered, only 423 useable responses were obtained. The data was analyzed with both inferential and descriptive statistics.FindingsThe results of this study showed that process virtualizability significantly predicts virtual process use, and it is associated with user resistance toward virtual process use.Practical implicationsThe findings will help governments and managers to comprehend that certain processes are more acquiescent to virtualization than others.Originality/valueThis paper provides researchers with a contemporary perspective toward understanding the adoption and use of e-government services in sub-Saharan Africa through the lens of process virtualization theory.

Telepathology in Nigeria for Global Health Collaboration.

Inadequate pathology personnel and high cost of running a Pathology facility are factors affecting access to timely and quality pathology services in resource-constrained settings. Telepathology is a novel technology that allows Pathologists to remotely assess collected samples. Though the initial cost of setting up a telepathology facility is high, its overall benefits far outweigh the cost. Its usefulness as a quality assurance measure, as a permanent image data storage system, in reducing costs associated with repeated slide preparations, reducing turn-around time of pathology reports, in collaborative research and in teaching has been well documented. This paper highlights the experiences, gains and challenges encountered in the deployment of telepathology in two resource-constrained settings in Nigeria. Overcoming the challenges associated with setting up a telepathology service in sub-Saharan Africa is important as it has the potential to improve overall health outcomes in a medically underserved region while ensuring technology and knowledge transfer are achieved.

Country-specific challenges to improving effectiveness, scalability and sustainability of agricultural climate services in Africa

Climate services are playing an increasing role in efforts to build the resilience of African agriculture to a variable and changing climate. Efforts to improve the contribution of climate services to agriculture must contend with substantial differences in national agricultural climate services landscapes. Context-specific factors influence the effectiveness, scalability and sustainability of agricultural climate service, but in ways that are challenging to anticipate. In the context of six countries (Ethiopia, Ghana, Kenya, Mali, Senegal, Zambia), this paper addresses the need to consider differing national contexts when developing strategies to make agricultural climate services in sub-Saharan Africa more effective, scalable and sustainable. Based on authors' collective firsthand knowledge and a review of information from secondary sources, we identify key strengths and weaknesses of climate services relative to agriculture sector needs in the focus countries; and assess factors that have contributed to those differences. Focus countries differ substantially in areas such as the degree of public support, alignment of services with agricultural needs, service delivery channels, degree of decentralization, and public—private-sector balance. These differences have been driven largely by differing national policies, delivery capacity and external actors, but not by responsiveness to agricultural sector demands. Building on the analyses of country differences and their drivers, we then discuss four key opportunities to further strengthen the contribution of climate services to agriculture: (a) leveraging farmer demand to drive scaling and sustainability; (b) exploiting digital innovation within a diverse delivery strategy; (c) balancing public and private sector comparative advantage; and (d) embedding climate services in agricultural extension. For each of these opportunities, we consider how different country contexts can impact the potential effectiveness, scalability and sustainability of services; and how efforts to strengthen those services can account for context-specific drivers to manage the tradeoffs among effectiveness, scalability and sustainability.

Availability of services for the diagnosis and treatment of infertility in The Gambia`s public and private health facilities: a cross-sectional survey

BackgroundInfertility is a long-standing reproductive health issue, which affects both men and women worldwide and it is especially problematic in the Global South. In sub-Saharan Africa, understanding the current availability of diagnostic and treatment services for infertility is important because this could guide health systems to improve access to fertility care for all. Yet, few studies have explicitly started from a health system perspective to grasp the availability and integration of infertility services in sub-Saharan Africa. This quantitative study, the first in The Gambia, West Africa, examines the availability of infertility services in public and private facilities as part of a wider endeavour to improve fertility care policy and practice in the country.MethodsA cross-sectional survey using Qualtrics was administered to 38 health facilities. The survey was carried out between March and August 2021 and involved closed-ended questions. Data analysis consisted of descriptive statistics and t-tests performed using SPSS version 26.ResultsA total of 25 facilities (66%) offered infertility services, of which 13 (52%) were public and 12 (47%) private. Although the availability of screening tests was similar between health institutions, most diagnostic and treatment services were available only in the private sector. Treatment services included: (i) ovarian stimulation (n = 16, 42%); (ii) reversal of tubal ligation and/or blockage (tuboplasty) (n = 4, 11%); and (iii) intrauterine insemination (n = 3, 8%). Assisted reproductive technologies such as IVF and ICSI were not available in public or private sectors. The Gambian health management information system lacked a dedicated space to capture data on infertility. Reported barriers to integration of infertility services in existing reproductive health services included a lack of specialised training, an absence of national guidance on infertility management, and a shortage of appropriate equipment, supplies, and medication.ConclusionsThe availability of infertility services in The Gambia follows a trajectory that is similar to other SSA countries in which services are mostly obtainable through the private sector. Yet, access to private care is expensive and geographically restricted, which exacerbates inequalities in accessing fertility care for all. Improving the provision of infertility services in the public sector requires systematically capturing data on infertility and investing in the provision of a full-range fertility care package.

Chronic disease care integration into primary care services in sub-Saharan Africa: a ‘best fit’ framework synthesis and new conceptual model

ObjectiveTo examine the relevance of existing chronic care models to the integration of chronic disease care into primary care services in sub-Saharan Africa and determine whether additional context-specific model elements...

The Role of Community Health Workers in Oral Health Promotion and the Impact of their services in Sub-Saharan Africa: A Systematic Review.

Oral ailments are largely preventable but remain a significant public health concern afflicting nearly half the global population. These conditions account for 220 years of life lost per 100,000 people and about US$500 billion in health-related expenditures. SubSaharan Africa bears a significant burden of oral health problems thus exerting additional pressure on the scarce human resources for health. Community healthcare workers (CHWs) could be potentially utilised to bridge the shortage of oral health professionals in sub-Saharan Africa, hence, this systematic review that seeks to explore their current roles in oral health and potential impact on general physical health. This review follows the PRISMA guidelines and databases searched include PubMed, Web of Science, Medline, and CINAHL published between January 2010 and December 2019. Nine studies met the study eligibility criteria. The authors of this review established that CHWs perform variable roles cutting across primary, secondary, and tertiary prevention including providing oral hygiene education, recognising common pathologies, and treating oral lesions, administration of tooth extractions, dental pain management, and referral for advanced care. Although this could potentially improve oral health, our review did not establish the extent of the specific impact on general physical health of patients and the burden of oral condition.

Visual Impairment and Types of Visual Disorders Among Attendees of an Outreach 21 Clinic for Eye Care in Rural Ghana, 2006

Introduction: The international community for eye care has targeted 2020 for eliminating avoidable blindness as a public health problem in the VISION 2020 agenda. However, eye care services in sub-Saharan Africa remain poor. The burden of eye diseases is unknown countrywide and in many rural districts in Ghana.Setting: We present data on patients examined at an outreach clinic for eye disorders in Ejura-Sekyedumase, a rural district in Ghana, in December 2006.Objective: To determine the prevalence of vision impairment among eye clinic attendees. Our aim was to give a profile of eye diseases in the district as baseline data to health authorities for action.Methods: In January 2012, we studied the characteristics of 780 patients examined at an outreach clinic organised in December 2006, in Ejura-Sekyedumasi District, Ghana. We performed descriptive analysis of data from records and reviewed clinic reports.Results: Of 780 patients examined, 704 (90.3%) had a disorder in one or both eyes: 16.2% of all eyes examined were vision impaired while 14.5% of all patients had bilateral vision impairment including blindness. The topmost five eye diseases were allergy, cataract,glaucoma, pterygium and uncorrected refractive errors. Together, these constituted over 84% of all reported eye disorders.Conclusion: There was high prevalence of vision impairment among patients: more than three-quarters of reported visual disorders comprised five conditions namely cataract, glaucoma and uncorrected refractive errors which cause avoidable blindness; and allergy,and pterygium. Health authorities should assess the district prevalence of vision impairment and blindness, and ascertain burden of eye diseases. A sustainable VISION 2020 prevention of blindness programme should be adopted.

Inland fisheries and the four pillars of food security in Sub-Saharan Africa: Assessing current research trends

AbstractInland small-scale fisheries provide important ecosystem services in sub-Saharan Africa as a source of nutritious food to over 200 million people and offer avenues for countries to attain Sustainable Development Goal 2. However, there is a dearth of knowledge on the pathways of fish to food security, especially in the case of inland small-scale fisheries, which are often underrepresented in research and policy discussions. We review the literature from 2010 to the present to assess how fish food systems, specifically those associated with inland small-scale fisheries in sub-Saharan Africa, relate to the four pillars of food security: availability, access, utilization, and stability, as well as women's empowerment. We offer an assessment of the extent to which each of these pillars of food security has been thoroughly conceptualized and investigated in the literature, identifying important avenues for future research. Overfishing, post-harvest losses, and trade influences drive fish availability in many contexts. Income benefits from participating in small-scale fisheries were important for attaining access to fish for food security and other important livelihood outcomes. Few studies addressed utilization and stability compared to availability and access pillars. Further, few studies examined how gender shapes outcomes of women's empowerment. The results lead to the proposed research agenda of focusing on all pillars of food security that can enhance the sustainable contribution of inland small-scale fisheries to food security.

Building Modern Cancer Care Services in Sub-Saharan Africa Based on a Clinical-Research Care Model.

Cancer is as old as humankind; there are examples of cancer treatment in ancient Egyptian civilizations. Globally, there has been rapid evolution of oncologic practices over many decades using different modalities, their complexities notwithstanding. These developments have resulted in visible improvements in outcomes for a complex medical condition.

The effect of performance-based financing interventions on out-of-pocket expenses intended to improve access to and utilization of maternal health services in sub-Saharan Africa: protocol for a systematic review and meta-analysis

BackgroundOut-of-pocket expenses have been reported as a major barrier to accessing antenatal care and skilled birth delivery in most of sub-Saharan Africa. Performance-based financing (PBF) is one of several strategies introduced in lower- and middle-income countries to strengthen a weak health system. This review aims to synthesize evidence on the effectiveness of PBF interventions implemented with the objective of reducing out-of-pocket expenses and improving access to and utilization of ANC and skilled birth delivery and family planning in sub-Saharan Africa. It will consider evidence across health sectors and identify gaps in the evidence.Methods and analysisThis protocol is reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. The systematic review will apply a three-step strategy to search five databases (CINAHL, PubMed, Ovid Medline, EMBASE, Cochrane.) and grey literature with the help of a librarian. Two independent reviewers will conduct screening to determine eligibility and critical appraisal of selected studies using the risk of bias criteria developed by the Cochrane EPOC Group and the New Castle Ottawa Scale for observational studies. The certainty of evidence for the outcomes will be assessed using “Grades of Recommendation, Assessment, Development, and Evaluation” (GRADE) approach. This review will consider experimental and quasi-experimental study designs and observational studies. Studies published in English and French language(s) will be included. Studies published since the introduction of PBF in sub-Saharan Africa will be included. Data will be collected on each item that contributes to out-of-pocket expenses. This review will adopt the Multiple Dimensions of Access Framework to organize the findings.DiscussionThis systematic review will support evidence-informed data for the performance-based financing community and government by identifying, describing, and assessing the impact of performance-based financing interventions on out-of-pocket expenses in promoting access and utilization of ANC, skilled birth delivery, and family planning across health sectors.Systematic review registrationThis review has been registered with PROSPERO, Registration number CRD42020222893.

Unmarried Adolescents’ Experiences of Using Reproductive and Maternal Health Services in Nigeria and Uganda: A Qualitative Study

Adolescents’ access and use of reproductive and maternal health (RMH) services is a critical part of the global strategy for achieving the Sustainable Development Goals (SDGs). However, previous studies have shown that a complex range of factors, including restrictive policies and punitive laws, limit adolescents from accessing a full range of RMH services in Sub-Saharan Africa (SSA). Our study explores the experiences of unmarried adolescents’ access and use of RMH services in Nigeria and Uganda to understand the extent to which the diverse policy environment in both countries enables or hinders adolescents’ access to and use of RMH services. Our qualitative research design involved eight focus group discussions (FGDs) in Nigeria and in Uganda, 14 in-depth interviews, and eight FGDs among adolescents. The data were analysed thematically and organised according to the WHO’s five broad dimensions for assessing youth-friendly health services. Our findings show that RMH services were inequitably delivered in both countries. Adolescents were restricted from accessing services based on age and marital status. Being unmarried and having no partner, especially in Uganda, was a cause for discrimination during antenatal appointments. We also observed that the expectations of adolescents were not adequately met. Service providers tended to be impolite, judgemental, and unwilling to provide services, especially contraceptives, to younger and unmarried adolescents. Our findings suggest that the existence of a youth-friendly health policy does not translate into effective youth-friendly service provision. This underscores the need for further studies to understand the complexities surrounding this by using a realist evaluation method to examine how adolescent and youth-friendly health services can be designed to improve uptake of reproductive and maternal health services among adolescents in Sub-Saharan Africa.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services

IntroductionThere are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women’s, Children’s and Adolescents’...

Addressing the Barrier of Physical Access to Oncology Care in Sub-Saharan Africa (SSA) Through Establishment of Short-Stay Homes for Cancer Patients: A Case of International Cancer Institute, Child and Family Wellness Center in Eldoret, Kenya

PURPOSE Geographical distance to access services and lack of decentralized diagnostic and treatment facilities have been identified as barriers to positive treatment outcomes among cancer patients in Sub-Saharan Africa who have to undergo financial and logistical challenges. Potential approaches to reducing this barrier include providing transport/travel allowance to patients from far flung regions, decentralizing cancer care services or providing patient housing close to cancer treatment facilities. METHODS The International Cancer Institute Child and Family Wellness Center was established in June 2020 as a half-way home for patients undergoing treatment at the ICI Cancer Care and Research Clinic (ICI_CRC). The center aims to provide safe accommodation for patients having challenges to travel to and from their homes for diagnostic work-up and treatment. RESULTS Between June 2020 and October 2021, a total of 101 admissions were made to the ICI Child and Family Wellness Center, of these 76% were female while 24% were male patients. A majority of the patients were first time admissions while 22% of them were admitted more than once; 69% of them were accompanied by a caregiver. The longest duration of stay was 18 days while the shortest was 1 day depending on the reason for admission; the most common being treatment sessions ending late in the day or treatment sessions taking more than one day. The patients admitted were drawn from 15 different counties in Kenya. CONCLUSION Physical inaccessibility to cancer care services in SSA greatly affects patient compliance with treatment and follow-up. Patients who live far from specialist care hospitals are more likely to have an advanced disease at diagnosis, inappropriate treatment, a worse prognosis and poorer quality of life compared to those living closer to hospitals. In addition to decentralization of cancer care, provision of accommodation for cancer patients close to hospitals can greatly improve compliance to treatment resulting in positive treatment outcomes.

Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa – A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic

BackgroundThe unprecedented and ongoing COVID-19 pandemic has exposed weaknesses in African countries’ health systems. The impact of shifted focus on COVID-19 for the past 2 years on routine health services, especially those for the epidemics of Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality. MethodsIn this article, we reflect on the COVID-19 related disruptions on the Tuberculosis, HIV/AIDS and Malaria routine health services across Africa. ResultsThe COVID-19 pandemic resulted in disruptions of routine health services and diversion of already limited available resources in sub-Saharan Africa. As a result, disease programs like TB, malaria and HIV have recorded gaps in prevention and treatment with the prospects of reversing gains made towards meeting global targets. The extent of the disruption is yet to be fully quantified at country level as most data available is from modelling estimates before and during the pandemic. ConclusionsAccurate country-level data is required to convince donors and governments to invest more into revamping these health services and help prepare for managing future pandemics without disruption of routine services. Increasing government expenditure on health is a critical part of Africa's economic policy. Strengthening health systems at various levels to overcome the negative impacts of COVID-19, and preparing for future epidemics will require strong visionary political leadership. Innovations in service delivery and technological adaptations are required as countries aim to limit disruptions to routine services.

Keeping essential reproductive, maternal and child health services available during COVID-19 in Kenya, Mozambique, Uganda and Zimbabwe: analysis of early-pandemic policy guidelines

BackgroundThe COVID-19 pandemic has disrupted the provision of essential reproductive, maternal, newborn, and child health (RMNCH) services in sub-Saharan Africa to varying degrees. Original models estimated as many as 1,157,000 additional child and 56,700 maternal deaths globally due to health service interruptions. To reduce potential impacts to populations related to RMNCH service delivery, national governments in Kenya, Mozambique, Uganda, and Zimbabwe swiftly issued policy guidelines related to essential RMNCH services during COVID-19. The World Health Organization (WHO) issued recommendations to guide countries in preserving essential health services by June of 2020.MethodsWe reviewed and extracted content related to family planning (FP), antenatal care (ANC), intrapartum and postpartum care and immunization in national policies from Kenya, Uganda, Mozambique, and Zimbabwe from March 2020 to February 2021, related to continuation of essential RMNCH services during the COVID-19 pandemic. Using a standardized tool, two to three analysts independently extracted content, and in-country experts reviewed outputs to verify observations. Findings were entered into NVivo software and categorized using pre-defined themes and codes. The content of each national policy guideline was compared to WHO guidance related to RMNCH essential services during COVID-19.ResultsAll four country policy guidelines considered ANC, intrapartum care, FP, and immunization to be essential services and issued policy guidance for continuation of these services. Guidelines were issued in April 2020 by Mozambique, Kenya, and Uganda, and in June 2020 by Zimbabwe. Many elements of WHO’s 2020 recommendations were included in country policies, with some notable exceptions. Each policy guideline was more detailed in some aspects than others — for example, Kenya’s guidelines were particularly detailed regarding FP service provision, while Uganda’s guidelines were explicit about immediate breastfeeding. All policy guidance documents contained a balance of measures to preserve essential RMNCH services while reducing COVID-19 transmission risk within these services.ConclusionsThe national policy guidelines to preserve essential RMNCH services in these four countries reflected WHO recommendations, with some notable exceptions for ANC and birth companionship. Ongoing revision of country policy guidelines to adapt to changing pandemic conditions is recommended, as is further analysis of subnational-level policies.

Assessing various leadership styles used at a multinational company specialising in marine services in Sub-Saharan Africa

This study examined the various leadership styles used at marine services companies in Sub-Saharan Africa. A quantitative structured closed-ended questionnaire was used to gather data from its sample respondent. The target population was 215 employees. However, every second element was selected systematically to produce a sample size of 107. The findings of this study showed that the overwhelming majority of respondents agreed that their managers practice transactional leadership styles. On the other hand, most respondents disagreed that their managers practice laissez-faire and transformational leadership styles. Based on the findings, the company's management should teach and train staff to perform their responsibilities efficiently. Furthermore, the management of the marines services company is advised to be proactive, assist staff, build connections, give resources, and avoid a laissez-faire leadership approach.

Public awareness, knowledge of availability, and willingness to use neurosurgical care services in Sub-Saharan Africa: A cross-sectional study.

IntroductionLow- and middle-income countries bear the majority of neurosurgical disease burden and patients face significant barriers to seeking, reaching, and receiving care. We aimed to understand barriers to seeking care among adult Africans by evaluating the public perception, knowledge of availability, and readiness to use neurosurgical care services.MethodsAn e-survey was distributed among African adults who are not in the health sector or pursuing a health-related degree. Chi-square test and ANOVA were used for bivariate analysis and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.ResultsSix hundred and sixty-two adults from 16 African countries aged 25.4 (95% CI: 25.0, 25.9) responded. The majority lived in urban settings (90.6%) and were English-speaking (76.4%) men (54.8%). Most respondents (76.3%) could define neurosurgery adequately. The most popular neurosurgical diseases were traumatic brain injury (76.3%), congenital brain and spine diseases (67.7%), and stroke (60.4%). Unwillingness to use or recommend in-country neurosurgical services was associated with rural dwelling (β = -0.69, SE = 0.31, P = 0.03), lack of awareness about the availability of neurosurgeons in-country (β = 1.02, SE = 0.20, P<0.001), and believing neurosurgery is expensive (β = -1.49, SE = 0.36, P<0.001).ConclusionKnowledge levels about neurosurgery are satisfactory; however, healthcare-seeking is negatively impacted by multiple factors.