The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
Browse
17 results
Search Results
Item The effectiveness of the Sierra Leone health sector’s response to COVID-19: a quantitative analysis(BioMed Central, 2025-03-12) Osborne, Augustus; Amara, Philip S.; M’Cormack-Hale, Fredline A.O.; Kanu, Mohamed; Kanu, Alhassan Fouard; Yillah, Regina Mamidy; Gooding, Kate; Witter, SophieBackground: The COVID-19 pandemic posed significant challenges to health systems globally, particularly in low-resource settings like Sierra Leone. Understanding the effectiveness of leadership, health workforce performance, community engagement, and service delivery during the pandemic is critical for strengthening future pandemic, preparedness and response. Methods: A cross-sectional study was conducted with 303 respondents, including stakeholders from the Ministry of Health, district health management teams, and community health workers. Data were collected using structured questionnaires and analyzed to assess perceptions of leadership, workforce performance, community participation, and disruptions to health services. Results: Leadership and governance were rated as “effective” or “very effective” by 58% of respondents, with key challenges including inadequate communication, delays in resource mobilization, and limited transparency. The health workforce demonstrated strong commitment (62%), but gaps in infection prevention and control training (48%) and shortages of personal protective equipment (39%) were significant barriers. Community engagement was moderately effective, with 54% rating it as “effective” or “very effective.” However, low trust in the health sector and misinformation hindered compliance with preventive measures. Maternal and child health services were the most disrupted, but innovative approaches such as telemedicine and mobile health units were adopted to mitigate service interruptions. Conclusion: Sierra Leone’s COVID-19 response highlighted both achievements and challenges. While leadership structures, workforce dedication, and community health worker contributions were notable strengths, gaps in communication, resource availability, and community trust limited the overall effectiveness of the response. Strengthening communication channels, investing in workforce training and resources, and enhancing community engagement strategies are critical for improving preparedness and response in future health emergencies.Item Women informal food traders during COVID-19: A South African case study(Taylor & Francis Group, 2022-07-01) Sinyolo, Sikhulumile; Jacobs, Peter; Nyamwanza, Admire; Maila, MatumeVaried roles of informal food traders, ranging from localised distribution of foods to provision of jobs, became more accentuated in the context of the COVID-19 pandemic in South Africa. While women might be the majority of informal food traders, they are more likely than men to suffer a heavier burden of the adverse outcomes, due to structural, social, institutional and administrative biases. This article draws from a survey of 840 informal food traders in South Africa to investigate the extent to which the impacts of COVID-19, and the government assistance measures, were gendered. Adopting a gendered lens and analysing the data using descriptive statistics, the findings show that the informal food traders experienced significant disruptions, which led to business closures, fewer customers, reduced supplies, and increased operating costs. Further, the study found that the informal enterprises operated by women experienced higher impacts than those owned by men. The analysis also shows that while access to COVID-19-related assistance from either state or non-state actors was generally limited, women had the least access to it. The findings of the study indicate that women experienced the worst economic effects of the pandemic, yet received the least assistance. This highlights the need to improve the gender sensitivity of interventions. The role of informal food traders and women in the country’s agri-food system needs to be acknowledged and harnessed. It is crucial that an updated information management system be established, that is not only inclusive of informal food traders, but that specific focus should be exerted in identifying those enterprises operated by marginalised actors, such as women.Item Users' Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study.(2024-12-23) Khatun, Fatema; Das, Novel Chandra; Hoque, Md Rakibul; Saqeeb, Kazi Nazmus; Rahman, Monjur; Park, Kyung Ryul; Rasheed, Sabrina; Reidpath, DanielCOVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service-Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18-39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (β=.946), service interaction (β=.974), and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=.327; P<.001) and intention to use teleconsultation services (β=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (β=.311; P<.001). The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. [Abstract copyright: © Fatema Khatun, Novel Chandra Das, Md Rakibul Hoque, Kazi Nazmus Saqeeb, Monjur Rahman, Kyung Ryul Park, Sabrina Rasheed, Daniel D Reidpath. Originally published in JMIR Human Factors (https://humanfactors.jmir.org).]Item Migrants’ entangled socio-political and biological lives during the COVID-19 emergency in Brazil(Taylor and Francis Group, 2024-09-04) Castro, Flávia Rodrigues; Zapata, Gisela P.; Vera Espinoza, Marcia;For migrants in Brazil, the COVID-19 global health crisis meant a considerable worsening of living conditions, with increased basic material needs. The reduction of individuals' existence to the mere search for survival had important repercussions on the activities of Civil Society Organisations (CSOs) in the country, whose work became increasingly focused on the distribution of emergency assistance for these populations. Drawing on 25 interviews with actors from CSOs, this paper unpacks the entanglement between the political and the biological aspects of migrants' lives. It argues that the pandemic brought to the fore the prominence of biological life to the detriment of migrants’ political and social lives in humanitarian responses to the health crisis. In this context, CSOs working with migrant populations in Brazil were pushed to reaffirm this dichotomy, while also contesting and reminding us that the impoverishment of migrants’ political and social lives can endanger the biological life that they meant to prioritise.Item Assessing New York City's COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution.(2024-04-05) Schwalbe, Nina; Nunes, Marta C; Cutland, Clare; Wahl, Brian; Reidpath, DanielThis study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45-64 years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. [Abstract copyright: © 2024. The Author(s).]Item Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal(BioMed Central, 2024-04-04) Regmi, Shophika; Bertone, Maria Paola; Shrestha, Prabita; Sapkota, Suprich; Arjyal, Abriti; Martineau, Tim; Raven, Joanna; Witter, Sophie; Baral, SushilIntroduction: The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. Methods: We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. Results: In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. Conclusions: The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.Item Risk communication and community engagement in the context of COVID-19 response in Bangladesh: a qualitative study(Frontiers Media S.A., 2024-01-05) Kamruzzaman, Mohammed; Rahman, Aminur; Reidpath, Daniel; Akhter, SadikaBackground: The global COVID-19 pandemic profoundly impacted nations worldwide, and Bangladesh was no exception. In response, the government of Bangladesh implemented community awareness initiatives aimed at containing the spread of the virus, aligned with international guidelines and recommendations. Despite these efforts, a lack of comprehensive community awareness programs played an essential role during the pandemic, not the preventive measures. A qualitative study employing framing theory was conducted to gain a deeper insight into how the social context influenced risk communication and community response throughout the COVID-19 pandemic in Bangladesh. Methods: The study was conducted in four selected districts of Bangladesh from February to May 2022 using complementary data collection methods, including key informant interviews, in-depth interviews, and focus group discussions with purposely selected participants. Data were analyzed thematically by following six steps of the thematic analysis process. Codes were developed based on the data and summarized into themes and sub-themes grounded on the codes. Results: The findings indicate that the government of Bangladesh, along with development partners and non-government organizations, made a significant effort to raise awareness about COVID-19 in the community. However, there were certain limitations to this effort. These include a lack of social science and public health approaches to understanding the pandemic; inadequate coordination among the authorities for COVID-19 prevention and control; technological and geographical barriers for disseminating messages; the living conditions and lack of facilities; socio-cultural norms in understanding the COVID-19 health messages, and the gendered understanding of the messages. The findings also revealed that the awareness activities remained a one-way approach to inform the people and faced challenges to actively engage and create ownership of the community in the pandemic response. Conclusion: The study identified gaps in implementing risk communication and community engagement strategies in Bangladesh during the COVID-19 pandemic. Increasing focus on public health and prioritizing community ownership is essential to designing a more effective community awareness campaign. This approach will help ensure that health messages are communicated effectively and tailored to different communities’ needs.Item Weakening Practices Amidst Progressive Laws: Refugee Governance in Latin America during COVID-19(Taylor and Francis Group, 2023-10-05) Zapata, Gisela P.; Gandini, Luciana; Vera Espinoza, Marcia; Prieto Rosas, VictoriaThis paper develops a comparative assessment of the state of asylum in Brazil, Chile, Mexico, and Uruguay. It argues that an accelerated weakening of refugee protection, exacerbated during the pandemic, has taken place across the region. Faced with growing mixed flows, the region’s refugee framework has either been used as an ad hoc regularization mechanism or not been broadly used. Also, pandemic mitigation measures have further weakened access to asylum, through militarization and border closures, and a platitude of deterrence practices. These regressive practices may result in the undermining, abandonment and/or replacement of the region’s widely praised refugee governance.Item Learning from implementation of a COVID case management desk guide and training: a pilot study in Sierra Leone(BioMed Central, 2023-09-25) Witter, Sophie; Zou, Guanyang; Cheedella, Kiran; Walley, John; Wurie, HajaBackground: When the COVID pandemic hit the world, there was need for applied guides and training materials to support frontline health care staff to manage patients effectively and safely and to educate themselves and communities. This article reports on the development and piloting of such a set of materials in Sierra Leone, which were based on international evidence but adapted to the local context. Reflecting on this experience, including community and health system barriers and enablers, is important to prepare for future regional shocks. Methods: This study, in Bombali district in 2020, piloted user-friendly COVID guides for frontline health workers (the intervention), which was evaluated using facility checklists (pre and post training), routine data analysis and 32 key informant interviews. Results: Key informants at district, hospital and community health centre levels identified gains from the training and desk guides, including improved diagnosis, triaging, infection prevention and management of patients. They also reported greater confidence to share messages on protection with colleagues and community members, which was needed to encourage continued use of essential services during the pandemic. However, important barriers were also revealed, including the lack of testing facilities, which reduced the sense of urgency, as few cases were identified. Actions based on the Ebola experience, such as setting up testing and isolation centres, which the community avoided, were not appropriate to COVID. Stigma and fear were important factors, although these were reduced with outreach activities. Supplies of essential medicines and personal protective equipment were also lacking. Conclusion: This pilot study demonstrated the relevance and importance of guides adapted to the context, which were able to improve the confidence of health staff to manage their own and the community’s fears in the face of a new pandemic and improve their skills. Previous epidemics, particularly Ebola, complicated this by both creating structures that could be revitalised but also assumptions and behaviours that were not adapted to the new disease. Our study documents positive adaptations and resilience by health staff but also chronic system weaknesses (particularly for medicines, supplies and equipment) which must be urgently addressed before the next shock arrives.Item Community stressors and coping mechanisms in accessing the health system during a double crisis: a qualitative case study from Yangon Region, Myanmar(BioMed Central, 2023-03-06) Kyaw, Hnin Kalyar; Than, Kyu Kyu; Diaconu, Karin; Witter, SophieBackground: Due to the COVID-19 pandemic and political crisis, Myanmar’s health system has suspended routine services while struggling to respond to the pandemic. Many people who need continuous care, like pregnant women and people with chronic illnesses, have been facing challenges in seeking and receiving essential health services. This study explored community health seeking practices and coping mechanisms, including their views on health system stressors. Methods: This was a cross-sectional qualitative study based on 12 in-depth-interviews with pregnant people and persons with pre-existing chronic health conditions in Yangon. Sampling was purposive, convenience-based and snowball sampling was also used. The 3-delays framework was used to understand how persons were interacting with and accessing health care services; community and health system stressors and coping mechanisms in relation to COVID-19 were also identified. Results: Findings showed that Yangon region was the hardest hit with both the pandemic and political crisis and its health system was greatly affected. People were unable to access essential health services on time. The health facilities were not available to see patients, with serious shortages in human resources, medicines and equipment, resulting in interruption of essential routine services. The prices of medicines and consultation fees, and transportation costs, increased during this period. Limited options for accessing care were available due to travel restrictions and curfews. It became challenging to receive quality care because of unavailable public facilities and private hospitals being costly. Despite these challenges, the Myanmar people and health system have shown resilience. Cohesive and organized family support structures and extended and deep social networks played an important role in accessing health care. At times of emergency, people relied on community-based social organizations for transportation and accessing essential medicines. The health system also showed resilience through establishing new service provision options, such as teleconsultations, mobile clinics, and sharing medical advice through social media. Conclusions: This is the first study in Myanmar to explore peoples’ perceptions on COVID-19, the health system and their healthcare experiences during political crisis. Although there is no easy way to cope with this dual hardship, the people and the health system, even in a fragile and shock-prone setting like Myanmar, stayed resilient by developing alternative pathways for seeking and providing health services.