From silos to systems: Enabling off-grid electrification of healthcare facilities, households, and businesses in sub-Saharan Africa

One Earth ◽  
2021 ◽  
Vol 4 (11) ◽  
pp. 1543-1545
Author(s):  
Philipp A. Trotter
Keyword(s):  
Sub Saharan Africa ◽  
Healthcare Facilities ◽  
Sub Saharan

scholarly journals Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response

2020 ◽  
Author(s):  
Pascal Geldsetzer ◽  
Marcel Reinmuth ◽  
Paul O Ouma ◽  
Sven Lautenbach ◽  
Emelda A Okiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Travel Time ◽  
Healthcare Facility ◽  
Access To Healthcare ◽  
Sub Saharan Africa ◽  
Travel Times ◽  
Healthcare Resources ◽  
Healthcare Facilities ◽  
Sub Saharan ◽  
Physical Access

Background: SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km x 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA. Methods: We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km x 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km x 1km raster using a cost-distance algorithm. Findings: 9.6% (95% CI: 5.2% - 16.9%) of adults aged 60 and older years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged 60 years and older had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged 60 and older years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon. Interpretation: Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.

scholarly journals Utilization of healthcare services among Chinese migrants in Kenya: a qualitative study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jialing Qiu ◽  
Duo Song ◽  
Juan Nie ◽  
Mengyi Su ◽  
Chun Hao ◽  
...  
Keyword(s):  
Health Services ◽  
Language Translation ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Local Health ◽  
Quality Healthcare ◽  
Healthcare Facilities ◽  
Chinese Migrants ◽  
Sub Saharan ◽  
Local Healthcare

Abstract Background The number of Chinese migrants in Sub-Saharan Africa (SSA) is increasing, which is part of the south-south migration. The healthcare seeking challenges for Chinese migrants in Africa are different from local people and other global migrants. The aim of this study is to explore utilization of local health services and barriers to health services access among Chinese migrants in Kenya. Methods Thirteen in-depth interviews (IDIs) and six focus group discussions (FGDs) were conducted among Chinese migrants (n = 32) and healthcare-related stakeholders (n = 3) in Nairobi and Kisumu, Kenya. Data was collected, transcribed, translated, and analyzed for themes. Results Chinese migrants in Kenya preferred self-treatment by taking medicines from China. When ailments did not improve, they then sought care at clinics providing Traditional Chinese Medicine (TCM) or received treatment at Kenyan private healthcare facilities. Returning to China for care was also an option depending on the perceived severity of disease. The main supply-side barriers to local healthcare utilization by Chinese migrants were language and lack of health insurance. The main demand-side barriers included ignorance of available healthcare services and distrust of local medical care. Conclusions Providing information on quality healthcare services in Kenya, which includes Chinese language translation assistance, may improve utilization of local healthcare facilities by Chinese migrants in the country.

scholarly journals Travel-time, bikes, and HIV elimination in Malawi: a geospatial modeling analysis

2020 ◽  
Author(s):  
Laurence Palk ◽  
Justin T Okano ◽  
Luckson Dullie ◽  
Sally Blower
Keyword(s):  
Travel Time ◽  
Rural Areas ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Travel Times ◽  
Geospatial Modeling ◽  
Healthcare Facilities ◽  
Fast Tracking ◽  
Sub Saharan

Background: UNAIDS has prioritized Malawi and 21 other countries in sub-Saharan Africa (SSA) for "fast-tracking" the end of their HIV epidemics. To achieve elimination requires treating 90% of people living with HIV (PLHIV); coverage is already fairly high (70-75%). However, many individuals in SSA have to walk to access healthcare. We use data-based geospatial modeling to determine whether the need to travel long distances to access treatment and limited transportation in rural areas are barriers to HIV elimination in Malawi. Additionally, we evaluate the effect on treatment coverage of increasing the availability of bicycles in rural areas. Methods: We build a geospatial model that we use to estimate, for every PLHIV, their travel-time to access HIV treatment if driving, bicycling, or walking. We estimate the travel-times needed to achieve 70% or 90% coverage. Our model includes a spatial map of healthcare facilities (HCFs), the geographic coordinates of residencies for all PLHIV, and an "impedance" map. We quantify impedance using data on road/river networks, land cover, and topography. Findings: To cross an area of one km2 in Malawi takes from ~60 seconds (driving on main roads) to ~60 minutes (walking in mountainous areas); ~80% of PLHIV live in rural areas. At ~70% coverage, HCFs can be reached within: ~45 minutes if driving, ~65 minutes if bicycling, and ~85 minutes if walking. Increasing coverage above ~70% will become progressively more difficult. To achieve 90% coverage, the travel-time for many PLHIV (who have yet to initiate treatment) will be almost twice as long as those currently on treatment. Increasing bicycle availability in rural areas reduces round-trip travel-times by almost one hour (in comparison with walking), and could substantially increase coverage levels. Interpretation: Geographic inaccessibility to treatment coupled with limited transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV. Funding: National Institute of Allergy and Infectious Diseases

scholarly journals Determinants of Women Access to Healthcare Services in Sub-Saharan Africa

2019 ◽  
Vol 12 (1) ◽  
pp. 504-514 ◽  
Author(s):  
Azuh Dominic ◽  
Adeyemi Ogundipe ◽  
Oluwatomisin Ogundipe
Keyword(s):  
Health Service ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Generalized Method Of Moments ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Sub Saharan Africa ◽  
Service Availability ◽  
Healthcare Facilities ◽  
Sub Saharan

Background: The study examined the socio-economic determinants of women access to healthcare services in Sub-Saharan Africa for the period 1995-2015. Methods: The study adopted the dynamic panel model and estimated it using the System Generalized Method of Moments in a bid to overcome the endogeneity problem inherent in the model of study. Result: The study harmonized the theoretical strands in the literature by describing the measure of access determinants as three main components; i. Health service availability, ii. Health service utilization and iii. Health service decision. Conclusion: The indicators of health service availability such as community health workers, physicians, nurses and midwives and hospital beds improve women's access to healthcare facilities in Africa. Also, health service utilization indicators such as population density worsen the quality of healthcare services available to women while electricity access and private health expenditure enhance women’s access to quality healthcare delivery. Health service decision indicators such as female bank account ownership, female labour force participation, attainment of basic education and female household headship were important in enhancing women's access to healthcare facilities. Generally, women's health outcomes were more responsive to health service utilization; implying that service utilization is an important proof of healthcare access in Africa.

scholarly journals Gastrointestinal endoscopy capacity in Eastern Africa

2021 ◽  
Vol 09 (11) ◽  
pp. E1827-E1836
Author(s):  
Michael Mwachiro ◽  
Hillary M. Topazian ◽  
Violet Kayamba ◽  
Gift Mulima ◽  
Elly Ogutu ◽  
...  
Keyword(s):  
Online Survey ◽  
Healthcare Professionals ◽  
Gastrointestinal Disease ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Therapeutic Modality ◽  
African Countries ◽  
Healthcare Facilities ◽  
Material Resources ◽  
Sub Saharan

Abstract Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity. Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020. Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services. Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.

scholarly journals A Spatial Analysis of Hypertension Prevalence in Rural and Urban Malawi

2021 ◽  
Author(s):  
James Burns ◽  
Mia Crampin ◽  
Alison Price ◽  
Chris Grundy ◽  
James Carpenter
Keyword(s):  
Well Being ◽  
Sub Saharan Africa ◽  
Healthcare Facilities ◽  
Individual Level ◽  
Hypertension Prevalence ◽  
Rural And Urban ◽  
Prevalence Estimates ◽  
Two Factors ◽  
Sub Saharan ◽  
Associated Risk Factors

BackgroundNon-communicable diseases (NCD) represent a large and rapidly growing disease burden in Malawi and the wider sub-Saharan Africa region. National and regional NCD prevalence estimates and mapping, establishment of associated risk factors, and trend monitoring are vital for sustaining hard-won gains in well-being and life expectancy from the successful management of infectious diseases.MethodsBetween 2012 and 2016, blood pressure was measured in a population-representative sample of 29,628 Malawian adults (18+ years) residing in two locations; the southern part of rural Karonga district and urban Area 25 in Lilongwe city. Each location was divided into approximately 200 zones with individuals assigned the zone in which their home was located. A conditional autoregressive (CAR) model was fitted to estimate zonal hypertension prevalence. Estimates were plotted on regional maps featuring key amenities, healthcare facilities, and transport links. Individual-level economic and lifestyle covariates were then incorporated to assess how much of the variation could be explained by those covariates.ResultsVariation in hypertension prevalence was observed in both the rural and urban location (P < 0.0005), with high-prevalence zones clustering in areas near to major transport links and/or concentrations of amenities. Covariates explained most of the variation in both sites (P > 0.14).ConclusionsIn rural and urban Malawi, hypertension prevalence is higher among those of relatively high wealth, those who are closer to local amenities, or a combination of these two factors. More detailed data are needed to determine if these associations are explained by wealth-consequent behaviours such as sedentary occupations and deleterious lifestyle choices.

scholarly journals Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho

2019 ◽  
Vol 4 (2) ◽  
pp. e001217 ◽  
Author(s):  
Mark Hellowell
Keyword(s):  
Low Income ◽  
Healthcare Delivery ◽  
Sub Saharan Africa ◽  
Public Private Partnerships ◽  
Empirical Literature ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
High Profile ◽  
Sub Saharan

Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs—even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.

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