The COVID-19 pandemic has proven the need for countries worldwide to implement strategies that promote health systems strengthening and ensure epidemic preparedness. Many African countries are burdened by fragile healthcare systems, hence, this paper emphasises the need for African policymakers to improve healthcare quality in their countries. Through a brief review of various online literatures concerning health systems strengthening in Africa, this paper focuses on the nature of healthcare in Nigeria amidst the COVID-19 pandemic. The major stress areas include COVID-19 testing capacity, health workforce, infection prevention and control, health information and surveillance systems, health insurance, public-private partnerships, and governance. The COVID-19 pandemic has amplified several challenges ravaging Africa's already fragile healthcare systems, leaving the health sectors of most African countries ill-prepared to deal with the pandemic. If Nigeria and many other African countries had invested sufficiently in strengthening their healthcare systems prior to COVID-19, their pandemic response efforts would have been more effective. Health systems strengthening is necessary to ensure steady progress toward universal health coverage and global health security. Through health systems strengthening, Nigeria and other African countries can greatly improve their infection prevention and control measures.

COVID-19 calls for health systems strengthening in Africa: A case of Nigeria.

Background 
The World Health Organization (WHO) early warning indicators (EWIs) of HIV drug resistance (HIVDR) assess factors at individual ART sites that are known to create situations favourable to the emergence of HIVDR.


Methods 
In 2014, the Namibia HIV care and treatment program abstracted the following adult and pediatric EWIs from all public ART sites (50 main sites and 143 outreach sites): On-time pill pick-up, Retention in care, Pharmacy stock-outs, Dispensing practices, and Viral load suppression. Comparisons were made between main and outreach sites and between 2014 and 2012 using the Wilcoxon signed-rank test in a matched analysis.


Results 
The national estimates were: On-time pill pick-up 81.9% (95% CI 81.1–82.8) for adults and 82.4% (81.3–83.4) for pediatrics, Retention in care 79% retained on ART after 12 months for adults and 82% for pediatrics, Pharmacy stock-outs 94% of months without a stock-out for adults and 88% for pediatrics, and Dispensing practices 0.01% (0.001–0.056) dispensed mono- or dual-therapy for adults and 0.01% (0.001–0.069) for pediatrics. Viral load suppression was significantly affected by low rates of Viral load completion. Main sites had higher On-time pill pick-up than outreach sites for adults (p<0.001) and pediatrics (p<0.001), and no difference between main and outreach sites for Retention in care for adults (p = 0.761) or pediatrics (p = 0.214). From 2012 to 2014 in adult sites, On-time pill pick-up (p = 0.001), Retention in care (p<0.001), and Pharmacy stock-outs (p = 0.002) worsened. In pediatric sites, On-time pill pick-up (p<0.001) and Pharmacy stock-outs (p = 0.012) worsened.


Conclusions 
Results of EWIs monitoring in Namibia provide evidence about ART programmatic functioning and contextualize results from national surveys of HIVDR. These results are worrisome as they show a decline in program performance over time. The national ART program is taking steps to minimize the emergence of HIVDR by strengthening adherence and retention of patients on ART, reducing stock-outs, and strengthening ART data quality.

/pdf/assessment-of-the-world-health-organization-s-hiv-drug-4b0zoozy93.pdf

Assessment of the World Health Organization's HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia.

This study uses Demographic and Health Survey (DHS) data to examine patterns and trends in care seeking for children who have experienced recent fever symptoms of acute respiratory infection (ARI) or diarrhea in USAID maternal and child health (MCH) priority countries. Overall current levels of care seeking among children with recent illness vary widely across the 21 priority countries from nearly 90 percent in the Indonesia 2012 survey to 33 percent in Ethiopia 2011. Results show that care seeking from public sources is predominant in African MCH priority countries while care seeking from private sources is predominant in Asian MCH priority countries. The majority of countries did not show significant improvements between the two most recent DHS surveys in the level of care seeking for fever or symptoms of ARI although care seeking for diarrhea showed more widespread improvement. The use of appropriate antimalarial treatment varied widely across MCH priority countries. Despite the widespread increase in care seeking for diarrhea there has not been a parallel increase in coverage of appropriate treatment for diarrhea. In conclusion our results show that the percentage of children with diarrhea fever and symptoms of ARI who reach the health system remains low in many high childhood mortality settings. Findings would be most useful when interpreted at the country-level with national childhood illness management goals in mind.

/pdf/levels-and-trends-in-care-seeking-for-childhood-illness-in-5fd8vqh4b2.pdf

Levels and trends in care seeking for childhood illness in USAID MCH priority countries.

This document presents findings from a study conducted to identify and document ongoing public-private partnerships (PPPs) for improving access to quality laboratory services, especially for the poor, in the East Africa region. The East, Central, and Southern Africa Health Community (ECSA-HC) coordinated the study along with the partner states in the East African Community participating in the World Bank funded East Africa Public Health Laboratory Networking Project (EAPHLNP). The authors implemented key informant interviews in Kenya, Rwanda, Tanzania and Uganda, and analyzed the information gathered from the interviews which is presented in this report. The study finds that while there are numerous examples of public-private collaboration across all four countries, the number of formals PPPs remains scarce. The most common form of PPP is placement, whereby privately owned laboratory equipment in leased by public facilities. Most other instances of collaboration between public and private partners, did not meet the formal definition of a PPP. Key stakeholders from both public and private institutions showed a keen interest in learning about and setting up more, diverse kinds of PPPs. The numerous informal and semi-formal arrangements that currently exist all represent opportunities for establishing formal PPPs in accordance with global best practices.

/pdf/opportunities-abound-public-private-partnerships-ppp-for-riltdpvopd.pdf

Opportunities abound : Public Private Partnerships (PPP) for laboratory services in East Africa

Since the civil war began in 2011, 5.5 million Syrians have fled their home country and are now living as refugees. Building upon anthropological studies of precarity, the article draws upon 14 months of person-centered ethnographic fieldwork to examine the contextual specificities of Syrian women’s protracted displacement in Jordan. By foregrounding bodily experience as described by three interlocutors during person-centered interviews, the article considers how subjectivities are reshaped under such conditions. The narratives analysed here illustrate how the precarity of displacement fosters an embodied sense of tightness, constriction and stagnation while reconfiguring temporal horizons and rendering visions of imagined futures increasingly myopic.

/pdf/life-is-tight-here-displacement-and-desire-amongst-syrian-3p4c4azie5.pdf

‘Life Is Tight Here’: Displacement and Desire amongst Syrian Refugee Women in Jordan

The purpose of the final performance evaluation of SHOPS is to support USAID decision-making for future program design and implementation and for effective allocation of resources particularly as they relate to investments in the Jordan Association of Family Planning and Protection (JAFPP) and with private sector doctors. The evaluation is intended to provide evidence-based analysis of how effective the project was in meeting its objectives of increasing the demand for access to and quality of family planning services; to assess the sustainability of project outcomes and practices; to identify factors contributing to outcomes and sustainability; and to provide recommendations on how to make future projects with similar objectives more effective and more sustainable. (Excerpt)

Strengthening Health Outcomes Through the Private Sector (SHOPS) final performance evaluation. USAID / Jordan Monitoring and Evaluation Support Project (MESP) Contracted Under AID-278-C-13-00009.

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Strengthening Health Outcomes Through the Private Sector (SHOPS) final performance evaluation. USAID / Jordan Monitoring and Evaluation Support Project (MESP) Contracted Under AID-278-C-13-00009.