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Street A, Vernooij E, Koker F, Baxter MS, Bah F, Rogers J, Gbetuwa M, Kohli M, Ansumana R. The "ready-to-hand" test: Diagnostic availability and usability in primary health care settings in Sierra Leone. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000604. [PMID: 36962729 PMCID: PMC10021322 DOI: 10.1371/journal.pgph.0000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
This article assesses the availability of essential diagnostic tests in primary health care facilities in two districts in Sierra Leone. In addition to evaluating whether a test is physically present at a facility, it extends the concept of availability to include whether equipment is functional and whether infrastructure, systems, personnel and resources are in place to allow a particular test to be "ready to hand", that is, available for immediate use when needed. Between February 2019 and September 2019, a cross-sectional mixed-methods survey was conducted in all 40 Community Health Centres (CHCs) in Western Area, one of five principal divisions in Sierra Leone. The number of rapid diagnostic tests (RDTs) available ranged from 1-12, with 75% of facilities having 9 or less RDTs available out of a possible 17. While RDTs were overall more widely present than manual assays, there was wide variation between tests. The presence of RDTs at individual facilities was associated with having a permanent laboratory technician on staff. Despite CHCs being formally designated as providing laboratory services, no CHC fulfilled standard World Health Organisation (WHO) criteria for a laboratory. Only 9/40 (22.5%) CHCs had a designated laboratory space and a permanently employed laboratory technician. There was low availability of essential equipment and infrastructure. Supply chains were fragmented and unreliable, including a high dependency (>50%) on informal private sources for the majority of the available RDTs, consumables, and reagents. We conclude that the readiness of diagnostic services, including RDTs, depends on the presence and functionality of essential infrastructure, human resources, equipment and systems and that RDTs are not on their own a solution to infrastructural failings. Efforts to strengthen laboratory systems at the primary care level should take a holistic approach and focus on whether tests are "ready-to-hand" in addition to whether they are physically present.
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Affiliation(s)
- Alice Street
- Department of Social Anthropology, School of Social and Political Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Eva Vernooij
- Department of Social Anthropology, School of Social and Political Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Francess Koker
- Kings Sierra Leone Partnership, King's Centre for Global Health and Health Partnerships, Freetown, Sierra Leone
| | | | - Fatmata Bah
- Kings Sierra Leone Partnership, King's Centre for Global Health and Health Partnerships, Freetown, Sierra Leone
| | - James Rogers
- James Rogers, Laboratory Technical Working Group, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Momoh Gbetuwa
- Momoh Gbetuwa, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mikashmi Kohli
- Mikashmi Kohli, FIND, Campus Biotech, Geneva, Switzerland
| | - Rashid Ansumana
- Rashid Ansumana, School of Community Health Sciences, Njala University, Bo, Sierra Leone
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Ballard M, Johnson A, Mwanza I, Ngwira H, Schechter J, Odera M, Mbewe DN, Moenga R, Muyingo P, Jalloh R, Wabwire J, Gichaga A, Choudhury N, Maru D, Keronyai P, Westgate C, Sapkota S, Olsen HE, Muther K, Rapp S, Raghavan M, Lipman-White K, French M, Napier H, Nepomnyashchiy L. Community Health Workers in Pandemics: Evidence and Investment Implications. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100648. [PMID: 35487542 PMCID: PMC9053152 DOI: 10.9745/ghsp-d-21-00648] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Community health workers have long played a critical role in preventing, detecting, and responding to pandemics across the globe. To expand, improve, and institutionalize these services, changes in the approach to bi/multilateral aid and private philanthropic investments in low- and middle-income countries are required.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, London, United Kingdom.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Nandini Choudhury
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Duncan Maru
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | - Harriet Napier
- Clinton Health Access Initiative, Salt Lake City, UT, USA
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Peña-Fernández A, Anjum U, Wadoum REG, Koroma S, Berghs M. Competing ethics in a pilot strategy to implement parasitology training and research in post-Ebola Sierra Leone. Int Health 2020; 12:509-514. [PMID: 33165547 PMCID: PMC7650977 DOI: 10.1093/inthealth/ihaa065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 08/27/2020] [Indexed: 01/10/2023] Open
Abstract
Much of the focus of public health research post-Ebola in Sierra Leone has been on rebuilding the healthcare system. However, very little attention has focused on capacity building in knowledge necessary for (bio)medical research, specifically around emerging opportunistic human pathogens that contribute to the high morbidity and mortality rates in Sierra Leone. In collaboration with academic staff from the University of Makeni, we engaged in a small-scale pilot intervention to strengthen medical parasitology teaching and research. The cultural competencies and ethical expertise provided by Sierra Leonean academics was critical to work in local communities and ensuring consent to undertake research. Yet, at the end of a day of collecting samples, in small pieces of conversation, the staff also explained ethical constraints they experienced taking part in research collaborations. They illustrate that, while on the surface all may seem well with a project, there can be harmful effects in terms of accessibility, ownership, cultural responsiveness and accountability, which should be taken into consideration when establishing networks and collaborations with universities from low-income countries.
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Affiliation(s)
- Antonio Peña-Fernández
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Umar Anjum
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
| | - Raoul Emeric Guetiya Wadoum
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
- Department of Public Health, University of Makeni, Makeni, Sierra Leone
| | - Sylvester Koroma
- Department of Public Health, University of Makeni, Makeni, Sierra Leone
| | - Maria Berghs
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
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