In the fight against infectious diseases, social inequalities in health (SIH) are generally forgotten. Mali, already weakened by security and political unrest, has not been spared by the COVID-19 pandemic. Although the country was unprepared, the authorities were quick to implement public health measures, including a SARS-CoV-2 testing program. This study aimed to understand if and how social inequalities in health were addressed in the design and planning for the national COVID-19 testing policy in Mali. A qualitative survey was conducted between March and April 2021 in Bamako, the capital of Mali. Twenty-six interviews were conducted with key government actors and national and international partners. A document review of national reports and policy documents complemented this data collection. The results demonstrated that the concept of SIH was unclear for the participants and was not a priority. The authorities focused on a symptom-based testing strategy that was publicly available. Participants also mentioned some efforts to reduce inequalities across geographical territories. The reflection and consideration of SIH within COVID-19 interventions was difficult given the governance approach to response efforts. The urgency of the situation, the perceptions of COVID-19, and the country's pre-existing fragility were factors limiting this reflection. Over time, little action has been taken to adapt to the specific needs of certain groups in the Malian population. This study (re)highlights the need to consider SIH in the planning stages of a public health intervention to adapt its implementation and to limit the negative impact on SIH.

/pdf/exploring-how-social-inequalities-in-health-have-influenced-v5mcn6kk.pdf

Exploring how social inequalities in health have influenced the design of Mali's SARS-CoV-2 testing policy: a qualitative study.

ABSTRACT The COVID-19 syndemic has disproportionately affected socially vulnerable populations, such as low-income individuals, Indigenous peoples, and riverine communities. Social Determinants of Health (SDH) have played a crucial role in the state of Amazonas, where unique geography and social disparities pose significant challenges to health access and equity. This article examines whether and how SDH were considered during COVID-19 testing planning in Amazonas. For this analysis, we conducted a qualitative case study through document analysis and semi-structured interviews with key stakeholders involved in testing planning and implementation. Official documents were systematized using TIDieR-PHP, and data were analyzed using the REFLEX-ISS tool. SDH were not considered in testing planning in Amazonas. The respondents could not all agree on the importance of considering SDH in intervention planning. Testing was limited to patients with severe symptoms and specific categories of essential workers. Health policymakers need to understand the relevance of considering SDH in planning population interventions to ensure equitable policy implementation. 

The Social Determinants of Health in the planning of COVID-19 testing in Amazonas, Brazil

RESUMO A sindemia da covid-19 afetou desproporcionalmente populações mais vulneráveis do ponto de vista social, como pessoas de baixa renda, populações indígenas e ribeirinhas. No estado do Amazonas, onde a geografia única e as disparidades sociais apresentam desafios significativos para o acesso e a equidade em saúde, os Determinantes Sociais da Saúde (DSS) desempenham um papel crucial. Este artigo analisa se e como os DSS foram considerados durante o planejamento de testes para a covid-19 no Amazonas. Para tal análise, realizou-se um estudo de caso qualitativo por meio de análise documental e entrevistas semiestruturadas com atores-chave envolvidos no planejamento e na implementação da testagem. Os documentos oficiais foram sistematizados usando TIDieR-PHP. Os dados foram analisados empregando a ferramenta REFLEX-ISS. Os DSS não foram considerados no planejamento de testes no Amazonas. Não houve consenso entre os entrevistados sobre a importância de considerar os DSS no planejamento da intervenção. Os testes foram restritos a pacientes com sintomas graves e a algumas categorias de trabalhadores em serviços considerados essenciais. Faz-se necessário, aos gestores de políticas de saúde, conhecimento sobre a importância de considerar os DSS no planejamento em intervenções populacionais para realizar uma política equânime. 

Os Determinantes Sociais da Saúde no planejamento da testagem à covid-19 no Amazonas, Brasil

Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil. Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities. Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources. Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.

A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife

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A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife