Essential Health Package

From March to November 2012 Liberia’s Ministry of Health and Social Welfare (with technical support from MCHIP and supported by USAID) piloted a model for integrating the service delivery of immunization and family planning in 10 health facilities in Bong and Lofa counties. A final assessment on which this report is based was conducted in December 2012 to assess the outcomes of integrated service delivery.

Background: Calls for investing in essential public health functions (EPHFs) and common goods for health (CGH) are numerous, but it is often unclear to policymakers how such investments lead to health system improvements.
Objectives: To showcase plausible pathways between actions taken to improve specific health system functions—in other words, investments in EPHFs and CGH—and their impact on health system performance, the health systems performance assessment framework for Universal Health Coverage is used.
We draw on three examples—community engagement and social participation, taxes and subsidies, and public health surveillance and monitoring—to demonstrate how action in these areas can improve health systems.
Conclusions: This conceptual mapping also points to the crucial role of good governance and demonstrates how investing in multiple EPHFs and CGH can trigger a chain reaction to spur broader health system improvement

Background: Childhood development is highly influenced by feeding practices at the infancy and young age of children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. The latest Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is anticipated. Methods: A quasi-experimental study design was employed for this post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited af...

The majority of women prefer the deliveries at home because this option is affordable and accessible. Midwifery care results in lower costs due to fewer unnecessary, invasive, and expensive interventions. This research highlights the motivation, efficiency and proficiency of community midwives working at the grassroots level. This study shows the existing retention status of CMWs in their geographical area. This paper provides an overview of research and statistics that describe the practice of midwives in Punjab.Some key reasons including financial constraints, lack of trust and a fear of being mishandled by newly trained young CMWs resulted in low acceptance of CMWs for maternal healthcare. The awareness regarding availability of trained CMWs in the community along with backup support by the district health system is extremely important to address the concerns of the community, thus leading to enhanced acceptance of the CMWs by the community and gaining optimum confidence. This st...

A u t h o r ` s A f f i l i a t i o n 1Associate Professor (Radiology) Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PhD Scholar, Health Services Academy, Quaid -eAzam University, Islamabad 2Assistant Professor, PhD (Microbiology), Department of Molecular Biology, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, G-8/3, Islamabad 3Professor Emeritus, National Centre for Genetic Diseases, Department of Molecular Biology, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, G-8/4, Islamabad 4Vice Chancellor, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS, G-8/4, Islamabad A u t h o r C o n t r i b u t i o n 1Contributed towards conception and design of work and acquisition of the data 2Drafting of the manuscript and analysis of data for work 3Revision and critical analysis of the work 4Final review and approval of the manuscript H o w t o C i t e t h i s M a n u s c r i p t Majeed AI, Jadoon M, Riazuddin S, Akram J. Awareness and Screening of Breast Cancer Amon...

In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and ...

Rapid Need Assessment to identify the gap between the demand for post-abortion care (PAC) and family planning services by providing essential reproductive health services in Punjab and Sindh—two regions highly vulnerable to both slow-onset disasters, such as droughts, and sudden disasters, such as floods.

TASC was requested to review the Nutrition Information and Analysis Systems (NIS) including indicators, data collection, analysis and use in Yemen through a situational analysis exercise. The assignment aimed to systematically identify factors which affect the collection, analysis, dissemination, and utilization of timely, accurate and representative nutrition information in Yemen, through in-depth consultation with relevant stakeholders and an additional desk-based scoping review. The results of this exercise are intended to help stakeholders to clearly define a set of sequential actions (immediate, short-term and long-term) to address key challenges and barriers in the NIS to help improve the overall availability, quality, analysis and utilization of data.

A study through an analysis of secondary data of National Health Facility Research of 2011 had been done cross-sectionally on PHCs in districts/cities in East Nusa Tenggara Province, Indonesia. Data were presented as distribution tables of PHC percentage according to personnel involved, availability and adequacy of medicines and usable health supplies. Appropriate availability and adequacy out of 18 medicines could be found on amoxicillin and captopril tablet, injections of dexamethasone, diazepam, oxytocin and vitamin K, infusions of glucose, Ringer lactate and NaCl 0.9%. Drugs with minimal availability were diazepam suppository, furosemide and sodium bicarbonate inj. The availability of all consumable health supplies were inadequate. Less than a quarter of PONED PHCs in NTT Province had appropriate pharmacy service and storage room. There were still pharmacy services conducted by incompetent personnel.

Background: Pregnancy and childbirth is associated with health risks for both the mother and child. Timely and prompt referral service has been identified as one of the effective strategies to combat related risks and adverse outcomes. In rural areas, this problem is compounded by multiple factors and referral often plays a key role to ensure favorable outcome.

Objectives: Documentation of common indications & identification of constraints related to referrals in pregnancy related cases in a PHC of Gujarat.

Methodology: Secondary data analysis of referral slips of referred cases from one PHC, Gujarat was done. Referral slips between 2004 and 2009 were analyzed. A total 155 pregnancy related referrals were made during this period.

Results: Referral rate was 15.2%. The average age of women was 23.46±4.1 years, 12.2% women belonged to the high risk age group and 5.8% women were grand multipara. Referrals were nearly equally distributed between OPD and emergency hours highlighting the need for 24X7 services at the PHCs. Majority of referrals were during the intranatal period (64.5%), followed by antenatal cases (23.9%) and postnatal cases(11.6%). The common reasons for referral were non progressive labour (14.8%), severe anemia (10.3%), pre-eclampsia (10.3%), malpresentation (9.7%) and postpartum hemorrhage (9.7%). Out of 62.6% who required pre-referral treatment, 43.3% didn’t get pre-referral treatment. Majority of pre-referral treatment were not given in intranatal period (58.9%).

Conclusion: This study recommends the development of a standard referral protocol, proper training in this regard and universal adherence to this in practice.

In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and ...

Background: Childhood development is highly influenced by feeding practices at the infancy and young age of children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. The latest Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is anticipated. Methods: A quasi-experimental study design was employed for this post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited af...

This chapter uses a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong emphasis on organizing women, who also identified health services as a development priority at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by female health workers, as well as increased utilization of pre- and post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.

Infection remains an important cause of maternal and newborn morbidity and mortality globally despite evidence that it can be reduced with adherence to infection prevention and control (IPC) practices. The implementation of IPC has been especially challenging in rural health centres. This pilot study used a non-randomised quasi-experimental design to examine the impact of a low-cost intervention bundle at five rural health facilities in Southern Province of Zambia. We used the Infection Control Assessment Tool (ICAT) and surveyed the incharge nurse, observed deliveries and reviewed logbooks to collect pre- and post-intervention data on healthcare worker IPC practices and maternal and newborn outcomes. The intervention bundle included education sessions, provision of alcohol hand rubs (AHRs), short message service (SMS) text messages and poster reminders, and monthly study visits. The overall ICAT score did not significantly increase after the intervention (64.0 vs. 71.8, maximum sco...

Objective: To determine the effect of antenatal counselling at term on early initiation of breastfeeding. Method: The prospective, questionnaire-based study was conducted at two state-run hospitals in Islamabad, Pakistan, from July to December 2016. One hundred subjects at the Federal General Hospital represented intervention group A and received special antenatal counselling regarding benefits of early initiation of breastfeeding, while 100 subjects at the Islamabad Polyclinic formed control group B and received routine counselling. Data was analysed using SPSS Version 20. Results: Of the 200 subjects initially enrolled, 185 were included in the data analysis , 91 in the intervention group (A) and 94 among the control group (B) and Rest were excluded due to missing data. In group A, 46 (50.5%) women initiated breastfeeding within one hour of childbirth, while in group B 17 (18.08%) women did early inititation (p <0.001). Conclusion: Counselling was seen to be associated with early initiation of breastfeeding.

Background The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible. Methods We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data. Results Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 1...

Childhood development is highly influenced by feeding practices Background: at the infancy and young age of children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. The latest Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is anticipated. A quasi-experimental study design was employed for this Methods: post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited after obtaining verbal & written consent. The data was entered in EpiData (3.1) and analyzed in SPSS version 21. The mean age of these pregnant and lactating mothers was 30.5 Results: years ± 4.5 SD with the majority of mothers in the age group of 25 to 29 years. After the intervention, the overall knowledge of mothers regarding IYCF nutrition was raised to 69.6% among 94 mothers as compared to 74 (54.8%). Overall attitude regarding IYCF was found to be positive among 86 (63.7%) of the mothers, whereas 88 (65.2%) of the mothers had good IYCF related practices. Our post-intervention survey signifies the effectiveness of Conclusion: mhealth in raising knowledge, attitude, and practices of mothers regarding

Background In 1994, the Lady Health Workers (LHWs) Programme was established in Pakistan to increase access to essential primary care services and support health systems at the household and community levels. In Khyber Pakhtunkhwa (KPK) province in northern Pakistan, eye care is among the many unmet needs that LHWs were trained to address, including screening and referral of people with eye conditions to health facilities. However, despite an increase in referrals by LHWs, compliance with referrals in KPK has been very low. We explored the role of LHWs in patient referral and the barriers to patient compliance with referrals. Methods Qualitative methodology was adopted. Between April and June 2019, we conducted eight focus group discussions and nine in-depth interviews with 73 participants including patients, LHWs and their supervisors, district managers and other stakeholders. Data were analysed thematically using NVivo software version 12. Results LHWs have a broad understanding o...

Health is the top most priority in every individual&#39;s life. Good health accelerates human efficiency and the development procedure, and as a fundamental human right it should be accessible and reachable to all. According to World Health Organization&#39;s definition, &quot;Health of an individual or community is not only concerned with physical or mental state but also an individual&#39;s economic and social wellbeing.&quot; The research in hand focused on the Primary Health Care Services provided by the Basic Health Units in Mardan District of Khyber Pakhtunkhwa Province, Pakistan. The objectives of the study were: ? to assess the health care services provided by the BHUs and ? to find out the hurdles in the way of service delivery for the management of the BHUs. The universe of the study was District Mardan of Khyber Pakhtunkhwa Province of Pakistan. The sample of the study was selected by multi-stage cluster sampling techniques. The findings highlighted that most of the young...

Infection remains an important cause of maternal and newborn morbidity and mortality globally despite evidence that it can be reduced with adherence to infection prevention and control (IPC) practices. The implementation of IPC has been especially challenging in rural health centres. This pilot study used a non-randomised quasi-experimental design to examine the impact of a low-cost intervention bundle at five rural health facilities in Southern Province of Zambia. We used the Infection Control Assessment Tool (ICAT) and surveyed the incharge nurse, observed deliveries and reviewed logbooks to collect pre- and post-intervention data on healthcare worker IPC practices and maternal and newborn outcomes. The intervention bundle included education sessions, provision of alcohol hand rubs (AHRs), short message service (SMS) text messages and poster reminders, and monthly study visits. The overall ICAT score did not significantly increase after the intervention (64.0 vs. 71.8, maximum sco...

This study explores the on-ground facilities available at primary healthcare facilities (PHCFs) against the service quality standards set by the provincial government of Khyber Pakhtunkhwa (KP), Pakistan. Primary data through a structured questionnaire was collected from 109 PHCFs. Two hundred seven responses from patients, 109 responses from PHCFs doctors and medical staff, and 109 researcher’s observations were recorded. Most service provision standards were met in rural health centres (RHCs) and basic health units (BHUs). However, the situation at civil dispensaries (CDs) was very alarming. Patients preferred RHCs on BHUs and CDs because of relatively better quality services provided in RHCs. However, in general, patients prefer to go to secondary or tertiary health care facilities due to the number of reasons identified by this study. Among the areas which demand quality improvement include cultural constraints, lack of following standard operating procedures (SOPs) for referral...

In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and ...

Background: The majority of poor, illiterate women of reproductive years in Pakistan are living in underdeveloped regions and are solely dependent on free primary health services provided by the state. This project aims 1) to collect baseline health and social data, 2) to deliver a health and social literacy intervention, 3) to deliver a team-building intervention for primary-level healthcare providers, and 4) to conduct a community needs assessment. Methods: Electronic health and social data will be collected at baseline, which will be used to develop a comprehensive database and develop an index for Maternal Health and Wellbeing. A 24-month intervention will be delivered which will have 6 modules related to health and social literacy. The principal investigators will train the data collectors and intervention facilitators. Lady Health Workers will collect the electronic data and pre-post test data, and Community Social Workers will deliver the health and social literacy interventi...

Background The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible. Methods We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data. Results Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital. Conclusion It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.

In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and ...

Essential newborn care (ENC) is a comprehensive strategy designed to improve the health of newborns through interventions before conception during pregnancy at and soon after birth and in the postnatal period. This brief describes the components of ENC criteria for prioritizing them and strategies used in operationalizing them. Implementation of ENC will have a positive impact on neonatal and infant mortality. (authors)

Background In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) con rmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. Methods A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon sign ranked tests. A 5% statistical signi cance level was considered Results Over the study period, the median values for the annual number of PHC visits was 1.8, 55.3% for unreferred OPD visits, 69.4% for ART commencement, 95.1% and 18.7% for DS-TB con rmation and treatment commencement respectively, and 93.7% for BCG coverage. While BCG coverage increased by 5.85% (p=0.0101), declines were observed in PHC utilisation (10.53%; p=0.0010), unreferred OPD visits (12.05%; p=0.0006), ART commencement (9.53%; p=0.0174), and DS-TB con rmation (5.24%; p≥0.050) and treatment commencement (3.80%; p≥0.050). Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics-as well as the entire quadruple burden of disease-in South Africa, the nding that the PHC utilisation rate statistically signi cantly decreased in the Free State post-COVID-19 commencement is particularly concerning. Conclusions The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a signi cant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a declines in PHC service utilisation, the decreased numbers of new patients commencing ART and lower con rmed DS-TB case and DS-TB treatment commencement rates, we also learned that EPHS delivery in the province was fragile. Background The COVID-19 virus infected more than 600 million and killed more than 6.5 million people [1]. With the end of the pandemic in sight [2-4], it is prudent to assess its effects on health care systems to identify challenges in order to strike a balance between managing emergencies and maintaining essential public health services (EPHSs) in the future [5-11]. After declaring the COVID-19 outbreak a global pandemic on 11 March 2020, on 1 June 2020 the World Health Organization (WHO) provided operational guidance to avert indirect morbidity and mortality and prevent acute exacerbations of chronic conditions when services are disrupted. Although the WHO [11 p. 6] emphasised certain high-priority health service areas-such as essential prevention and treatment services for communicable diseases, including immunisations-it stressed that countries should identify context-relevant EPHSs to be prioritised for continuation during the acute phase of the COVID-19 pandemic. South Africa embarked on a rapid COVID-19 response, characterised by the temporary suspension of research, diversion of key HIV and TB control resources, and regulation of patient access to health care facilities (12]. Early in the COVID-19 pandemic, an assessment of its impact on access to publicsector health care in South Africa indicated a sharp reduction in primary health care (PHC) utilisation [13]. Based on analysis of routine health care utilisation data from the District Health Information System (DHIS), this study reported that the pandemic had a considerable in uence on healthcare utilisation during April and May 2020 when strict lockdown regulations were in effect. There was dramatic impact on total and under 5 utilisation of PHC, as well as HIV testing. However, early access to antenatal care was only somewhat affected and recovered quite quickly after this period. Based on data routinely collected via the DHIS in 2019 and 2020, Pillay et al. (2021) analysed the impact of the COVID-19 pandemic in South Africa and reported that the severely restrictive lockdowns to reduce transmission and limit the number of patients requiring hospitalisation had mixed consequences for routine health services [14]. The services most seriously affected were early child care, access to contraceptives, and testing for HIV and TB. While a wide variation of measurable effects on EPHSs were observed, this varied by type of service, province and district. The full extent of the impact of the COVID-19 on the EPHS spectrum in South Africa is not yet clear. This study aimed to address the need for evidence on the impact of COVID-19 on EPHSs in the Free State province. In order to learn lessons to mitigate the impact of future pandemics on EPHSs, the objectives were to establish the effects of COVID-19 on EPHSs related to 1) PHC and 2) outpatient department (OPD) utilisation, 3) the antiretroviral treatment (ART) commencement rate, 4) the drug-susceptible tuberculosis (DS-TB) con rmed rate, 5) the DS-TB treatment commencement rate, and 6) Bacillus Calmette-Guérin (BCG) coverage during January 2019 to March 2021. The DS-TB con rmed and treatment commencement and BCG coverage rates respectively relate to the overall global agenda to improve TB diagnosis, care, and prevention [15, 16]. The ART commencement rate relates to one component (care or treatment) of the global agenda to improve HIV diagnosis, care, and treatment [17]. Methods Setting One of the country's nine provinces, the Free State is located in inland South Africa. The province had a population of 2 928 903 million in 2020 [18] and accommodated about 5% of the public health sector dependant population in the country, of whom more than 80% are African [19]. The province is confronted with serious public health systems challenges, including fragmentation of service delivery [20, 21]. The majority of the citizens are historically

This study explores the on-ground facilities available at primary healthcare facilities (PHCFs) against the service quality standards set by the provincial government of Khyber Pakhtunkhwa (KP), Pakistan. Primary data through a structured questionnaire was collected from 109 PHCFs. Two hundred seven responses from patients, 109 responses from PHCFs doctors and medical staff, and 109 researcher's observations were recorded. Most service provision standards were met in rural health centres (RHCs) and basic health units (BHUs). However, the situation at civil dispensaries (CDs) was very alarming. Patients preferred RHCs on BHUs and CDs because of relatively better quality services provided in RHCs. However, in general, patients prefer to go to secondary or tertiary health care facilities due to the number of reasons identified by this study. Among the areas which demand quality improvement include cultural constraints, lack of following standard operating procedures (SOPs) for referral, no transport facility to referred patients, higher waiting time for patients, and no or fewer health education sessions, and unavailability of cold chain and waste disposal system. By addressing problem areas identified by this study, the KP government can reduce the patient burden on secondary and tertiary health facilities. As a result, service quality at PHCFs will improve access to primary health care, a world health organization's millennium development goal, and the united nations' sustainable development goal.

The Essential Nutrition Actions (ENA) is an approach for managing the advocacy, planning and delivery of an integrated package of interventions encompassing infant and young child feeding (IYCF), micronutrients and women's nutrition. This study was designed to assess the functionality of Essential Nutrition Actions for maternal and child health in Abeokuta Metropolis. The study was descriptive and cross-sectional in nature. Three Hundred respondents selected from Primary health care centre and Secondary health care centre in Odeda and Abeokuta South participated in the study. Data from the study was derived from administration of two set of structured questionnaires, one for the respondent and others for the staff of the facilities. Services delivery assessment tools were used to collect information about number of essential nutrition actions, human resources capacity, level of infrastructural materials and satisfaction with the services provided. Data were analyzed using the statistical package for social science (SPSS, version 25.0). Service delivery assessment tools for health care personnel was used to interpret the information collected. Majority of the respondents (60.7%) fell between the ages of 21-30years and were predominantly female (93%). Most of the respondents were satisfied with the conditions of services (94.3%). The predominant health facilities in the study area were Maternity and Community health post (40%). The number of Essential Nutrition Actions mostly carried out includes exclusive breastfeeding, adequate complementary feeding and maternal nutrition (10%). Majority (70%) of the health facility lack nutrition officers and which do not receive maximum number of in-training services. The level of Infrastructural materials and Human resources capacity to perform the key component of the Essential Nutrition Actions were Poor (70%) at the Health facilities. Capacity to offer nutrition services at the nutrition unit is Poor (60%), both at the Post-natal and Ante-natal clinics but Good capacity to offer nutrition services at the Young child clinics (YCC) (50%) was observed. The result further revealed that 60% of the health care personnel were not aware of the essential nutrition actions guideline. There was a strong correlation and level of significance relationship between Awareness of Essential Nutrition Actions by the Health care personnel and Key Practices at p<0.05 level of significance. This study revealed that the functionality of essential nutrition actions in the health facility assessed were poor. Thus it is suggested that Government and other key Stakeholder should allocates fund to all the primary and secondary health facility in the community to improve the technical capacity.

This study uses the Good Governance approach with five basic pillars: open government and transparency; public services delivery; citizen participation; accountability; and innovation and technology with 12 principles of good governance as a method and approach. The relevant literature and political parties’ commitment during the election campaign in 2018 was presented as evidence of the significance of the study. Primary data of 75 hospitals of two districts quantitatively 44 hospitals of district Swabi and 31 hospitals of district Buner visited and asked quantitative and qualitative question-near about infrastructure and healthcare facilities, equipment, and staff behaviour with researcher observations. The data analyzed with chi-Square SPSS Primary Health (PH) and Secondary Health (SH) into satisfactory and un-satisfactory PH found ignored and suggested, SH found facilitated as satisfactory. The result shows that primary data need waiting areas, drinking water, supply of up-to-da...

In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and ...

This overview aimed to describe the situation of healthcare access in sub-Saharan Africa, excluding South Africa, during the COVID-19 pandemic. A PubMed ® search from March 31, 2020, to August 15, 2022, selected 116 articles. Healthcare access and consequences of COVID-19 were assessed based on comparisons with months before its onset or an identical season in previous years. A general reduction of healthcare delivery, associated with the decline of care quality, and closure of many specialty services were reported. The impact was heterogeneous in space and time, with an increase in urban areas at the beginning of the pandemic (March-June 2020). The return to normalcy was gradual from the 3 rd quarter of 2020 until the end of 2021. The impact of COVID-19 on the health system and its use was attributed to (a) conjunctural factors resulting from government actions to mitigate the spread of the epidemic (containment, transportation restrictions, closures of businesses, and places of entertainment or worship); (b) structural factors related to the disruption of public and private facilities and institutions, in particular, the health system; and (c) individual factors linked to the increase in costs, impoverishment of the population, and fear of contamination or stigmatization, which discouraged patients from going to health centers. They have caused considerable socioeconomic damage. Several studies emphasized some adaptability of the healthcare offer and resilience of the healthcare system, despite its unpreparedness, which explained a return to normal activities as early as 2022 while the COVID-19 epidemic persisted. There appears to be a strong disproportion between the moderate incidence and severity of COVID-19 in sub-Saharan Africa, and the dramatic impact on healthcare access. Several articles make recommendations for lowering the socioeconomic consequences of future epidemics to ensure better management of health issues.

Our analysis of data revealed that new structures, committees, advisory bodies and lines of communication in government evolved during this pandemic and are underlying the current strategy development and decision-making on COVID-19 vaccines. The interviews gave insights into six major factors that will aid COVID-19 vaccine acceleration in Ghana. These factors are: (1) Access to vaccines through delivery, (2) national manufacturing of vaccines, (3) choosing the best vaccine candidates, (4) financial resources, (5) transparency, and (6) vaccine roll-out and administration. These results could guide policymakers and other relevant stakeholders in prioritizing activities that will aid COVID-19 vaccine acceleration in Ghana and other lower-middle-income countries, tailored to their specific context. As a recommendation, the Ghanaian government should embrace a multisectoral synergy approach to fight the disease. The study also provides insights into how vaccine adoption can be accelerated in the case of future pandemics.

MATERNAL MORTALITY (2006) per 100,000 live births 276 NEONATAL MORTALITY (2018) per 1,000 live births 42 1 Pakistan Bureau of Statistics http://www.pbs.gov.pk/content/population-census 2 Pakistan Demographic and Health Survey (2017-2018) https://dhsprogram.com/pubs/pdf/SR257/SR257.pdf 3 2016 https://data.worldbank.org/indicator/SH.ANM.ALLW.ZS Introduction Pakistan is the sixth-largest country in the world, with a population of more than 200 million, and projected to be the fourth-largest by 20501. The nutritional status of the population is generally poor throughout the country, especially among children under five years old, women of reproductive age and the elderly. About 9% of adult Pakistani women are thin or undernourished (BMI &lt;18.5 kg/m2), while overweight or obesity among women has increased from 40% in 201213 to 52% in 2017-182. Micronutrient deficiencies are also endemic among Pakistani women and almost 50% of women in Pakistan suffer from anaemia3. The country has a de...

IntroductionNon-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care.MethodologyThis is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs.ResultsThere was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest fo...

Introduction: Primary health care is essential healthcare made universally accessible to individuals and acceptable to them through their full participation and at an affordable cost. It can be effectively delivered at the Basic health unit (BHU). Assessment of its performance at regular basis is also crucial for the health care system. Objectives: To assess the services (EPI, antenatal care and basic healthcare) provided at selected BHUs of Peshawar with a view to determine service provision gaps in these BHUs. Materials & Methods: It was a questionnaire based descriptive survey conducted from September to November 2019, in which simple random sampling technique was used to select 15 BHUs of district Peshawar for assessment and evaluation purposes. Data were collected using a checklist and an indigenous structured questionnaire where responses were recorded in yes/no format. Data analyzed using SPSS V.22 for descriptive statistics. Results: All vaccines of the EPI program were bein...

The health status of pregnant women depends largely on the quality of the antenatal and delivery services available to them. Maternal mortality remains a major public health problem with antenatal and delivery care utilization remaining low in Pakistan. This study explores the perspectives of rural community members about the antenatal and delivery care services&#39; utilization by the community. A qualitative study was undertaken in the rural community of District Attock. Focus Group Discussions (FGD) were conducted with husbands, married women of child-bearing age with young children and mothers-in-law. Data was analysed manually using content analysis techniques. Majority of the respondents sought antenatal care (ANC) after 3-4 months. They further reported that home was the preferred place of delivery followed by the local &quot;rural health centre&quot;. The preferred attendant for delivery was the local Dai (traditional birth attendant). Major limitations to accessing ANC and ...

This study uses the Good Governance approach with five basic pillars: open government and transparency; public services delivery; citizen participation; accountability; and innovation and technology with 12 principles of good governance as a method and approach. The relevant literature and political parties’ commitment during the election campaign in 2018 was presented as evidence of the significance of the study. Primary data of 75 hospitals of two districts quantitatively 44 hospitals of district Swabi and 31 hospitals of district Buner visited and asked quantitative and qualitative question-near about infrastructure and healthcare facilities, equipment, and staff behaviour with researcher observations. The data analyzed with chi-Square SPSS Primary Health (PH) and Secondary Health (SH) into satisfactory and un-satisfactory PH found ignored and suggested, SH found facilitated as satisfactory. The result shows that primary data need waiting areas, drinking water, supply of up-to-da...

Ending Eclampsia seeks to expand access to proven, underutilized interventions and commodities for the prevention, early detection, and treatment of pre-eclampsia and eclampsia and to strengthen global partnerships. The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a non-governmental, non-profit organization governed by an international board of trustees.

The COVID-19 pandemic has confronted healthcare systems worldwide with societal, psychological, and economic burdens. The widespread use of the developed COVID-19 vaccines has been generally pursued to stop the spread, decrease mortality rates, and lift the economic burden of healthcare systems. However, it became apparent that the demand for vaccines outnumbers the supply provided by pharmaceutical manufacturers. This policy brief explores the use of centralized procurement globally to formulate recommendations on how the European Union (EU) and its member states can benefit from such an approach.  

As the fight against the coronavirus disease 2019 (COVID-19) pandemic continues, the necessity for wide-scale, global vaccine rollout to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and slow its mutation rate remains unassailable. The COVID-19 Vaccines Global Access (COVAX) initiative’s campaign involves a proportional framework to finance and distribute SARS-CoV-2 vaccines in low- and middle-income countries. However, the COVAX framework has critical limitations, including limited funding and the failure to account for the special epidemic risks and needs of its participating nations, as recommended by the World Health Organization’s Strategic Advisory Group of Experts on Immunization framework. These drawbacks disproportionately impact Africa, where many nations rely on COVAX as their main source of vaccines. The current plan to vaccinate only up to 20% of participating nations’ populations is short-sighted from both epidemiologic and moral per...

This study uses the Good Governance approach with five basic pillars: open government and transparency; public services delivery; citizen participation; accountability; and innovation and technology with 12 principles of good governance as a method and approach. The relevant literature and political parties’ commitment during the election campaign in 2018 was presented as evidence of the significance of the study. Primary data of 75 hospitals of two districts quantitatively 44 hospitals of district Swabi and 31 hospitals of district Buner visited and asked quantitative and qualitative question-near about infrastructure and healthcare facilities, equipment, and staff behaviour with researcher observations. The data analyzed with chi-Square SPSS Primary Health (PH) and Secondary Health (SH) into satisfactory and un-satisfactory PH found ignored and suggested, SH found facilitated as satisfactory. The result shows that primary data need waiting areas, drinking water, supply of up-to-da...

This study aimed to explore the association between the GDP of various countries and the progress of COVID-19 vaccinations; to explore how the global pattern holds in the continents, and investigate the spatial distribution pattern of COVID-19 vaccination progress for all countries. We have used consolidated data on COVID-19 vaccination and GDP from Our World in Data, an open-access data source. Data analysis and visualization were performed in R-Studio. There was a strong linear association between per capita income and the proportion of people vaccinated in countries with populations of one million or more. GDP per capita accounts for a 50% variation in the vaccination rate across the nations. Our assessments revealed that the global pattern holds in every continent. Rich European and North-American countries are most protected against COVID-19. Less developed African countries barely initiated a vaccination program. There is a significant disparity among Asian countries. The secu...

IntroductionNon-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care.MethodologyThis is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs.ResultsThere was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest fo...

As the fight against the coronavirus disease 2019 (COVID-19) pandemic continues, the necessity for wide-scale, global vaccine rollout to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and slow its mutation rate remains unassailable. The COVID-19 Vaccines Global Access (COVAX) initiative’s campaign involves a proportional framework to finance and distribute SARS-CoV-2 vaccines in low- and middle-income countries. However, the COVAX framework has critical limitations, including limited funding and the failure to account for the special epidemic risks and needs of its participating nations, as recommended by the World Health Organization’s Strategic Advisory Group of Experts on Immunization framework. These drawbacks disproportionately impact Africa, where many nations rely on COVAX as their main source of vaccines. The current plan to vaccinate only up to 20% of participating nations’ populations is short-sighted from both epidemiologic and moral per...

Background: Since the first confirmed case of the Novel Coronavirus Disease 2019 (COVID-19) in Nigeria, the pandemic has become a major public health challenge, affecting different sectors of the country. While Nigeria is battling to control the spread of COVID-19, the eruption of new cholera cases has put additional pressure on the strained healthcare system.Evidence: We showed how the overwhelming focus on COVID-19 has jeopardized key cholera containment measures such as disease surveillance, risk communication, and case management.Policy Options and Recommendations: We recommend provision and universal access to safe water and sanitation as key cholera preventive and control measures. However, these are resources that developing countries including Nigeria find rather challenging to provide. We also proposed the implementation of well-coordinated multi-sectoral interventions that involve strengthening disease surveillance including access to safe drinking water, vaccines, and tre...

Objectives: Our research aimed to evaluate the antenatal care (ANC) and pregnancy outcomes for pregnant cases registered with a family practice unit providing primary health services. Materials and Methods: Data for 385 pregnant cases aged 18 to 40 years registered with a family health center from 15/07/2010 to 01/02/2019 were screened from the "Family Practice Information Management System" database. Data regarding antenatal visits were statistically investigated and the p-value below 0.05 was accepted as significant. Results: The mean age was 28.66±5.36 years. The mean pregnancy week of first attendance was 9.59±5.52. Of pregnant cases, 89.61% received iron, 47.79% vitamin D and 63.63% folic acid supplements. Of the patients, 81.81% had the first trimester, and 76.88% had second-trimester screening tests. 71.42% of patients had gestational diabetes screening, and 88.83% had detailed ultrasonography. 78.44% of patients had tetanusdiphtheria vaccination, while no pregnant case had influenza vaccination. The age and gravida did not affect receiving ANC, vitamin D, iron supplementation and tetanus-diphtheria vaccination status. Vitamin D use was higher in groups receiving education compared to those not receiving education. When the educated group was assessed among themselves, the use of supplements reduced as the educational level increased. Conclusion: There is a need to increase referrals for iron, vitamin D, and folic acid supplementation and for screening during antenatal follow-up. The tetanus-diphtheria vaccination rate was observed to be lower than ideal. Additionally, it appears administration of seasonal flu vaccines is deficient, and necessary steps should be taken to reduce concerns related to vaccination.