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Lukama L, Aldous C, Kuhn W, Michelo C, Kalinda C. Ten years of ear, nose and throat (ENT) services in Southern Africa: a scoping review. Glob Health Action 2024; 17:2370102. [PMID: 38932660 PMCID: PMC11212562 DOI: 10.1080/16549716.2024.2370102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While ear, nose, and throat (ENT) diseases are a substantial threat to global health, comprehensive reviews of ENT services in Southern Africa remain scarce. OBJECTIVE This scoping review provides a decade-long overview of ENT services in Southern Africa and identifies gaps in healthcare provision. From the current literature, we hope to provide evidence-based recommendations to mitigate the challenges faced by the resource-limited ENT service. DATA SOURCES PubMed, Web of Science, EBSCOhost, Cochrane Library, Cochrane Library, and Scopus. REVIEW METHODS On several databases, we conducted a comprehensive literature search on both quantitative and qualitative studies on ENT services in Southern Africa, published between 1 January 2014 and 27 February 2024. The extracted data from the analyzed studies was summarized into themes. RESULTS Four themes in the fourteen studies included in the final analysis described the existing ENT services in Southern Africa: 1. Workforce scarcity and knowledge inadequacies, 2. Deficiencies in ENT infrastructure, equipment, and medication, 3. Inadequate ENT disease screening, management, and rehabilitation and 4. A lack of telehealth technology. CONCLUSION The Southern African ENT health service faces many disease screening, treatment, and rehabilitation challenges, including critical shortages of workforce, equipment, and medication. These challenges, impeding patient access to ENT healthcare, could be effectively addressed by implementing deliberate policies to train a larger workforce, increase ENT funding for equipment and medication, promote telehealth, and reduce the patient cost of care.
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Affiliation(s)
- Lufunda Lukama
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Otorhinolaryngology, Head and Neck Surgery, Ndola Teaching Hospital, Ndola, Zambia
| | - Colleen Aldous
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Warren Kuhn
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Charles Michelo
- Global Health Institute, Nkwazi Research University, Lusaka, Zambia
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- Howard College Campus, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Alatise OI, Yibrehu B, Jackman J, Arije O, Olasehinde O, Keli E, Offei A, Jaiteh L, Aderounmu A, Kingham PT. Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment. HPB (Oxford) 2024:S1365-182X(24)01735-0. [PMID: 38862377 DOI: 10.1016/j.hpb.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND West Africa has among the highest rates of hepato-pancreato-biliary (HPB) malignancies in the world. Although surgery is critical for treatment, the availability of HPB surgery in Africa is unknown. This cross-sectional study investigated the current HPB surgical capacity of West African hospitals. METHOD The Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey was modified to include HPB-specific parameters and quantify capacity. The survey was completed by consultant surgeons from West Africa. A PIPES index was calculated, and a higher score corresponded to greater HPB surgical capacity. RESULTS The HPB PIPES survey was completed by 35 institutions from The Gambia, Ghana, Ivory Coast, and Nigeria. Most institutions (94.2%) were tertiary referral centres; five had an HPB-trained surgeon. The most commonly available procedure was an open cholecystectomy (91.4%), followed by gastric bypass (88.6%). Major hepatic resections (14.3%) and the Whipple procedure (17.1%) were rare. ICU capabilities were present at 88.6% of facilities while interventional radiology was present in 25.7%. CONCLUSIONS This is the first HPB capacity assessment in Africa. This study showed the limited availability of HPB surgery in West Africa. These results can be used for regional quality improvement initiatives and as a baseline for future capacity assessments.
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Affiliation(s)
| | - Betel Yibrehu
- Department of Surgery, University of Toronto, Toronto, Canada; Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Julia Jackman
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Elie Keli
- Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Cote d'Ivoire
| | - Asare Offei
- Department of Surgery, Korle Bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | - Lamin Jaiteh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | | | - Peter T Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
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Aderinto N, Olatunji G, Kokori E, Abdulrahmon MA, Akinmeji A, Fatoye JO. Expanding surgical access in Africa through improved health insurance schemes: A review. Medicine (Baltimore) 2024; 103:e37488. [PMID: 38489736 PMCID: PMC10939550 DOI: 10.1097/md.0000000000037488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodeji Akinmeji
- Department of Medicine, Olabisi Onabanjo University, Ogun, Nigeria
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Kibu OD, Kepgang E, Sinsai R, Conner A, Asahngwa C, Ngwa W, Ngo NV, Fobellah NN, Muenyi CS, Zalamea NN, Gobina RM, Foretia DA. Barriers and Motivations for Health Insurance Subscription Among Health-Care Users in Cameroon. J Surg Res 2024; 293:158-167. [PMID: 37774593 DOI: 10.1016/j.jss.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Surgical care is a significant component of the overall health expenditure in low- and middle-income countries. In Cameroon, out-of-pocket payments for surgical service are very high with many patients declining potentially curative surgical procedures. Less than 2% of the population is enrolled in a health insurance scheme leading to a propensity for catastrophic health expenses when accessing care. To assess the perceived barriers and motivations for health insurance subscription among health-care users in Cameroon. METHODS This was a cross-sectional community-based qualitative study conducted in the Center Region of Cameroon. A total of 37 health-care users (health insurance subscribers and nonsubscribers) were purposively identified. Four focused group discussions and thirteen in-depth interviews were conducted. All anonymized transcripts were analyzed using a thematic analysis approach. RESULTS The six major themes identified as barriers to health insurance subscription were lack of trust in the existing health insurance schemes, inadequate knowledge on how health insurance works, premiums believed to be too expensive, the complexity of the claims processing system, minimal usage of health-care services and practice of self-medication. Motivational factors included the knowledge of having access to quality health services even without money in the event of an unforeseen illness and having a large family/household size. The importance of mass sensitization on the benefits of health insurance was noted. CONCLUSION Health insurance is still very underutilized in Cameroon. This results in significant out-of-pocket payment for health services by Cameroonians with catastrophic consequences to households. With most Cameroonians in the informal sector and underemployed, it is imperative to put in place a national strategic plan to overcome existing barriers and increase health insurance coverage especially among the poor. This has the potential to significantly increase access to safe, quality, timely and affordable surgical care.
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Affiliation(s)
- Odette D Kibu
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Evrard Kepgang
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Regina Sinsai
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Anna Conner
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Anthropology, University of Yaoundé 1, Yaounde, Cameroon
| | - Wilfred Ngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Ngo V Ngo
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | - Nkengafac N Fobellah
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon
| | | | - Nia N Zalamea
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ronald M Gobina
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, Buea Regional Hospital, Southwest Region, Cameroon
| | - Denis A Foretia
- Division of Health Policy and Research, Nkafu Policy Institute, Denis and Lenora Foretia Foundation, Yaoundé, Cameroon; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, Tennessee.
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Kantawala B, Khattab M, Elawad SO, Assker M, Cherri B, Nazir A, Wojtara M, Uwishema O. Addressing hydrocephalus in Africa: Challenges and way forward. Health Sci Rep 2023; 6:e1759. [PMID: 38111744 PMCID: PMC10726764 DOI: 10.1002/hsr2.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
Hydrocephalus occurs when the cerebrospinal fluid (CSF) accumulates in the cerebral ventricles. This is due to either obstruction in the CSF flow, decreasing its absorption by the arachnoid villus to the Dural venous sinuses, or increasing production of the CSF. The most disproportionately and severely affected by the disease consequences are African children. This is because of the high incidence of postinfectious hydrocephalus and spinal dysraphism compared with other world children. The health care system in Africa has access to 488 neurosurgeons which represents less than 1% of the global neurosurgeons, thus pediatric hydrocephalus is considered an emerging public health problem in Africa because of the difficulty of the patient's access to proper care. Numerous studies conducted in Africa have revealed a significant imbalance in the distribution of neurosurgical resources across the continent. Specifically, South Africa and North Africa collectively account for 86% of the total practicing neurosurgeons, indicating a pronounced concentration of these specialized medical professionals in these regions. Having an abundance of case studies regarding hydrocephalus is vital to increase our awareness and understanding. Hydrocephalus should gain more priority by current policymakers as an important health concern. This may be achieved by proper resource allocation to ensure better quality means of diagnosis, intervention, and rehabilitation.
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Affiliation(s)
- Burhan Kantawala
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of General MedicineYerevan State Medical UniversityYerevanArmenia
| | - Maha Khattab
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineHorus UniversityEgypt
| | - Shaima O. Elawad
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | - Mohamad Assker
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Batoul Cherri
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineLebanese UniversityBeirutLebanon
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Magda Wojtara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
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Jabbari A, Zakeri A, Saghafi F, Hadian M. Iranian health financing system challenges to promote health outcomes: Qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:149. [PMID: 37404922 PMCID: PMC10317261 DOI: 10.4103/jehp.jehp_507_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/01/2022] [Indexed: 07/06/2023]
Abstract
BACKGROUND Adequate health financing system should have key criteria and characteristics such as risk distribution over time, risk accumulation, sustainable resource provision, and resource allocation based on meeting essential needs. Weakness of the tariff system, lack of attention to strategic purchasing, inefficient allocation of manpower, and a weak payment system are among the problems within the Iranian financing system. Given the weaknesses of the current health financing system, it seems necessary to identify challenges and provide effective solutions to address them. MATERIALS AND METHODS This qualitative study was conducted to explore the views of a group of 32 major policymakers and planners in the various departments and levels of the Ministry of Health, Universities of Medical Sciences, Medical System Organization, and Health Insurance Organization in Iran (n = 32), selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. RESULTS Based on the results of data analysis, a total of 5 categories and 28 subcategories were obtained. In this study, five main categories were obtained through the content analysis method, including (1) stewardship; (2) providing services; (3) production of resources; (4) collecting resources; and (5) purchasing and allocation of resources. CONCLUSION It is suggested that those in charge of the health system, following the reform of the organization of the health system, move toward the improvement and widespread implementation of the referral system and that clinical guidelines be carefully compiled. Also, appropriate motivational and legal tools should be used to implement them. However, insurance companies need to make cost, population, and service coverage more effective.
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Affiliation(s)
- Alireza Jabbari
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Zakeri
- Assistant Professor of Foresight, Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | | | - Marziye Hadian
- Department of Health Services Management, Student Research Committee, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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7
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Hasan BS, Bhatti A, Mohsin S, Barach P, Ahmed E, Ali S, Amanullah M, Ansong A, Banu T, Beaton A, Bolman RM, Borim BC, Breinholt JP, Callus E, Caputo M, Cardarelli M, Hernandez TC, Croti UA, Ejigu YM, Fenton K, Gomanju A, Harahsheh AS, Hesslein P, Hugo-Hamman C, Khan S, Kpodonu J, Kumar RK, Jenkins KJ, Lakhoo K, Malik M, Nichani S, Novick WM, Overman D, Quenot APM, Patton Bolman C, Pearson D, Raju V, Ross S, Sandoval NF, Sholler G, Sharma R, Shidhika F, Sivalingam S, Verstappen A, Vervoort D, Zühlke LJ, Zheleva B. Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework. BMJ Glob Health 2023; 8:e012049. [PMID: 37142298 PMCID: PMC10163477 DOI: 10.1136/bmjgh-2023-012049] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.
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Affiliation(s)
- Babar S Hasan
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Areesh Bhatti
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Mohsin
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Paul Barach
- Department of Public Health and Anesthesiology, Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Sigmund Freud University, Vienna, Austria
| | | | - Sulafa Ali
- Department of Pediatrics and Child Health, University of Khartoum, Khartoum, Sudan
- Department of Pediatrics and Child Health, Sudan Heart Center, Khartoum, Sudan
| | - Muneer Amanullah
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Annette Ansong
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Tahmina Banu
- Department of Pediatric Surgery, Chittagong Research Institute for Children, Chittagong, Bangladesh
| | - Andrea Beaton
- The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ralph Morton Bolman
- University of Minnesota, Minneapolis, Minnesota, USA
- Team Heart Inc, Newton Highlands, Massachusetts, USA
| | - Bruna Cury Borim
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - John P Breinholt
- Division Chief, Pediatric Cardiology, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Danato, San Donato Milanese, Lombardia, Italy
- Department of Biomedical Sciences, University of Milan, Milan, Italy
| | - Massimo Caputo
- Translational Health Science, University of Bristol, Bristol, UK
| | | | | | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital da Criança e Maternidade, CardioPedBrazil, São José do Rio Preto, Brazil
| | - Yayehyirad M Ejigu
- Department of Cardiothoracic Surgery, King Faisal Hospital, Kigali, Rwanda
| | - Kathleen Fenton
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
- NIH, Bethesda, Maryland, USA
| | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | | | - Christopher Hugo-Hamman
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Sohail Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mahim Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan
| | - Sanjiv Nichani
- Leicester Children's Hospital, Leicester, East Midlands, UK
- Healing Little Hearts Global Foundation, Leicester, UK
| | - William M Novick
- University of Tennessee Health Science Center-Global Surgery Institute, Memphis, Tennessee, USA
- William Novick Global Cardiac Alliance, Memphis, Tennessee, USA
| | - David Overman
- Division of Cardiac Surgery, The Children's Heart Clinic, Children's Minnesota, Minneapolis, Minnesota, USA
- Division of Cardiovascular Surgery, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota, USA
| | | | | | - Dorothy Pearson
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | | | - Shelagh Ross
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Nestor F Sandoval
- Department of Cardiac Surgery, Fundacion cardioinfantil -la Cardio.Instituto de cardiopatías Congenitas, Universidad del Rosario, Bogota, Colombia
| | - Gary Sholler
- Heart Center for Children, Sydney Children's Hospital Network, University of Sydney, Sydney, New South Wales, Australia
| | | | - Fenny Shidhika
- Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Amy Verstappen
- President, Global Alliance for Rheumatic and Congenital Hearts, Memphis, Tennessee, USA
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, SAMRC Francie Van Zil Drive Parow, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics Red Cross War Memorial Hospital, University of Cape Town, Cape Town, South Africa
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Barry L, Kouyaté M, Sow A, De Put WV, De Maesschalck J, Camara BS, Adrianaivo N, Delamou A. Ensuring continuity of care during the COVID-19 pandemic in Guinea: Process evaluation of a health indigent fund. Front Public Health 2022; 10:1018060. [PMID: 36466448 PMCID: PMC9714427 DOI: 10.3389/fpubh.2022.1018060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The emergence of the COVID-19 has disrupted the health and socioeconomic sectors, particularly in resource-poor settings such as Guinea. Like many sub-Saharan countries, Guinea is facing shortcomings related to its fragile health system and is further affected by the passage of the Ebola virus disease. The pandemic has worsened the socio-economic situation of the poorest people, leading to their exclusion from health care. To promote access to care for the most vulnerable populations, a system was set up to provide care for these people who are victims of health marginalization to promote their access to care. This study aimed to analyze access to health services by vulnerable populations during the COVID-19 pandemic in Guinea through the establishment of a health indigent fund (HIF). Methods This was a qualitative study to assess the project implementation process. A total of 73 in-depth individual interviews were conducted with beneficiaries, health workers, community health workers and members of the HIF management committee, and a few informal observations and conversions were also conducted in the project intervention areas. The data collected were transcribed and coded using the deductive and inductive approaches with the Nvivo software before applying the thematic analysis. Results A total of 1,987 indigents were identified, of which 1,005 were cared for and 64 referred to all 38 intervention health facilities within the framework of the HIF. All participants appreciated the project's social action to promote access to equitable and quality health care for this population excluded from health care services. In addition, the project has generated waves of compassion and solidarity toward these "destitute" people whose main barrier to accessing health care remains extreme poverty. A state of poverty that leads some to sell their assets (food or animal reserves) or to go into debt to ensure access to care for their children, considered the most at risk. Conclusion The HIF can be seen as an honest attempt to provide better access to health care for the most vulnerable groups. Some challenges need to be addressed including the current system of acquiring funds before the attempt can be considered scalable.
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Affiliation(s)
- Lansana Barry
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea,Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea,*Correspondence: Lansana Barry
| | - Mariama Kouyaté
- Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea
| | | | - Willem Van De Put
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - John De Maesschalck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bienvenu Salim Camara
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea,Centre National de Formation et de Recherche en Santé Rurale de Maférinyah, Forécariah, Guinea
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Abu-Bonsrah N, Totimeh T, Kanmounye US, Banson M, Bandoh D, Sarpong K, Dadey D, Adam A, Nketiah-Boakye F, Dakurah T, Boakye M, Haizel-Cobbina J, Ametefe M, Bankah P, Groves ML. Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities. World Neurosurg 2022; 167:e953-e961. [PMID: 36064120 DOI: 10.1016/j.wneu.2022.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.
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Affiliation(s)
- Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Teddy Totimeh
- Department of Neurosurgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Dickson Bandoh
- Department of Neurosurgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, USA
| | - David Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Abass Adam
- Department of Neurosurgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Thomas Dakurah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Joseline Haizel-Cobbina
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mawuli Ametefe
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Patrick Bankah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wilson S, Bah MM, George P, Caulker A, Holmer H, Leather AJ, Kamara TB. Challenges and solutions to providing surgery in Sierra Leone hospitals: a qualitative analysis of surgical provider perspectives. BMJ Open 2022; 12:e052972. [PMID: 35105579 PMCID: PMC8808401 DOI: 10.1136/bmjopen-2021-052972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to use qualitative interviews with surgical providers to explore challenges and solutions to providing surgical and anaesthesia care in Sierra Leone's hospitals. DESIGN Data were collected through anonymous, semistructured interviews. We used a qualitative framework approach to analyse interview data and determine themes relating to challenges that were reported. SETTING A purposive sample of 12 hospitals was selected throughout Sierra Leone to include district and referral hospitals of varying ownership (private, non-governmental organisation and government). PARTICIPANTS The most senior surgical provider available during each hospital site visit participated in a semistructured interview. A total of 12 interviews were conducted. RESULTS Providers described both challenges and solutions relating to the following categories: equipment and supplies, access to services, human resources, infrastructure, management and patient factors. These challenges were found to affect surgical care in hospitals by delaying surgical care, decreasing operative capacity and decreasing quality of care. Providers identified not only the root causes of these challenges, but also the varied workarounds and solutions they employ to overcome them. CONCLUSION Surgical providers can offer important insights into challenges affecting surgical services in hospitals. Despite working in challenging environments with limited resources, providers have developed innovative solutions to improve surgical and anaesthesia care in hospitals in Sierra Leone. Qualitative research has an important role to play in improving understanding of the challenges facing surgeons in low-income countries.
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Affiliation(s)
- Spencer Wilson
- General Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamed M Bah
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Peter George
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Augustus Caulker
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Jm Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
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11
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Musabeyezu J, Santos J, Niyigena A, Uwimana A, Hedt-Gauthier B, Boatin AA. Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000318. [PMID: 36962191 PMCID: PMC10021225 DOI: 10.1371/journal.pgph.0000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A scoping review of discharge instructions for women undergoing cesarean section (c-section) in sub-Saharan Africa (SSA). METHOD Studies were identified from PubMed, Globus Index Medicus, NiPAD, EMBASE, and EBSCO databases. Eligible papers included research based in a SSA country, published in English or French, and containing information on discharge instructions addressing general postnatal care, wound care, planning of future births, or postpartum depression targeted for women delivering by c-section. For analysis, we used the PRISMA guidelines for scoping reviews followed by a narrative synthesis. We assessed quality of evidence using the GRADE system. RESULTS We identified 78 eligible studies; 5 papers directly studied discharge protocols and 73 included information on discharge instructions in the context of a different study objective. 37 studies addressed wound care, with recommendations to return to a health facility for dressing changes and wound checks between 3 days to 6 weeks. 16 studies recommended antibiotic use at discharge, with 5 specifying a particular antibiotic. 19 studies provided recommendations around contraception and family planning, with 6 highlighting intrauterine device placement immediately after birth or 6-weeks postpartum and 6 studies discussing the importance of counselling services. Only 5 studies provided recommendations for the evaluation and management of postpartum depression in c-section patients; these studies screened for depression at 4-8 weeks postpartum and highlighted connections between c-section delivery and the loss of self-esteem as well as connections between emergency c-section delivery and psychiatric morbidity. CONCLUSION Few studies in SSA directly examine discharge protocols and instructions for women following c-section. Those available demonstrate wide variation in recommendations. Research is needed to develop structured evidence-based instructions with clear timelines for women. These instructions should account for financial burden, access to resources, and education of patients and communities.
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Affiliation(s)
| | - Jenna Santos
- Boston College, Boston, MA, United States of America
| | | | - Ange Uwimana
- University of Illinois College of Medicine, Chicago, IL, United States of America
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
| | - Adeline A Boatin
- Harvard Medical School, Boston, MA, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
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