scholarly journals Inequitable access to healthcare in Africa: reconceptualising the “accountability for reasonableness framework” to reflect indigenous principles

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Samuel J. Ujewe ◽  
Werdie C. van Staden
Keyword(s):  
Health Equity ◽  
John Rawls ◽  
The United States ◽  
Access To Healthcare ◽  
Ethical Principle ◽  
Sub Saharan Africa ◽  
Accountability For Reasonableness ◽  
Fair Equality Of Opportunity ◽  
Sub Saharan ◽  
Communal Responsibility

Abstract Background The “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa (SAA). Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in addressing inequitable access to healthcare. Yet, the conceptual match is yet to be examined between A4R and communal responsibility as a common fundamental ethic in SAA. Methodology A4R and its applications toward health equity in sub-Saharan Africa were conceptually examined by considering the WHO’s “3-by-5” and the REACT projects for their accounting for the communal responsibility ethic in pursuit of health equity. Results Some of the challenges that these projects encountered may be ascribed to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle. Conclusion A health equity framework informed by the African communal responsibility principle should enhance suitability for SAA contexts, generating impetus from within Africa alongside the affordances of A4R.

scholarly journals Inequitable Access to Healthcare in Africa: Reconceptualising the “Accountability for Reasonableness Framework” to Reflect Indigenous Principles

2021 ◽  
Author(s):  
Samuel Jonathan Ujewe ◽  
Werdi C. van Staden
Keyword(s):  
Health Equity ◽  
John Rawls ◽  
The United States ◽  
Access To Healthcare ◽  
Ethical Principle ◽  
Sub Saharan Africa ◽  
Accountability For Reasonableness ◽  
Fair Equality Of Opportunity ◽  
Sub Saharan ◽  
Communal Responsibility

Abstract BackgroundThe “Accountability for Reasonableness” (A4R) framework has been widely adopted in working towards equity in health for sub-Saharan Africa. Its suitability for equitable health policy in Africa hinges, at least in part, on its considerable successes in the United States and it being among the most comprehensive ethical approaches in current literature in addressing inequitable access to healthcare. Methodology/FindingThis article considers applications of A4R towards health equity in sub-Saharan Africa – including the WHO’s “3-by-5” and the REACT projects – and ascribes some of the challenges that these projects encountered to an incongruity between the underpinning ethical principle of A4R and the communitarian ethical principle dominant in sub-Saharan Africa. These are respectively the fair equality of opportunity principle derived from John Rawls’ theory, and the African communal responsibility principle. ConclusionA health equity framework informed by the latter, we contend, should be more suitable for African contexts, generating impetus from within Africa alongside the affordances of A4R.

Comparing breast cancer characteristics across Sub-Saharan Africa and the United States

2018 ◽  
Vol 92 ◽  
pp. S155 ◽  
Author(s):  
S. Grover ◽  
M. Narasimhamurthy ◽  
R. Bhatia ◽  
C. Benn ◽  
K. Fearnhead ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
The United States ◽  
Sub Saharan Africa ◽  
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.

Letter To The Editor

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 796-796
Author(s):  
Samuel L. Katz
Keyword(s):  
Oral Polio Vaccine ◽  
The United States ◽  
Sub Saharan Africa ◽  
Intestinal Immunity ◽  
Polio Vaccine ◽  
Polio Immunization ◽  
Individual Protection ◽  
Sub Saharan ◽  
Community Protection ◽  
Central Nervous System Invasion

Drs Terry and Schneider raise legitimate questions regarding changes in polio immunization recommendations. In response to the former, although two doses of inactivated polio vaccine provide humoral immunity that will protect an individual against central nervous system invasion by wild or revertant attenuated polioviruses, they do not provide intestinal immunity, a valued asset of oral polio vaccine (OPV). Because we live in a global community where jet transportation enables one to move from a polio-endemic area to a polio-free area in less than one day, the introduction of wild polio viruses from sub-Saharan Africa or Southeast Asia poses a legitimate threat and concern to those who wish to maintain community protection, in addition to individual protection, against possible reintroduction of wild virus to the United States.

There Is a Balm in Gilead

2020 ◽  
pp. 135-164
Author(s):  
Dan Royles
Keyword(s):  
International Security ◽  
The United States ◽  
Black Churches ◽  
Bill Clinton ◽  
Sub Saharan Africa ◽  
Aids Education ◽  
Religious Institutions ◽  
Faith Leaders ◽  
Control And Prevention ◽  
Sub Saharan

This chapter describes the work of The Balm in Gilead, which grew out of the efforts of Pernessa Seele, an immunologist at Harlem Hospital, to organize local Black faith leaders to address AIDS through the Harlem Week of Prayer for the Healing of AIDS. As Seele trained African American clergy to incorporate AIDS education into their ministry, she also confronted entrenched homophobia in Black religious institutions. Accordingly, The Balm in Gilead designed programs that would help churches accept and include gay members. In 2001, Seele contracted with the Centers for Disease Control and Prevention to extend her work with Black churches to sub-Saharan Africa, setting up programs in Côte d’Ivoire, Kenya, Nigeria, Zimbabwe, and Tanzania. She argued that because of Black people’s particular relationship with church and faith, the approach that The Balm in Gilead had developed in the United States would work in Africa as well. At the same time, this work intersected with a growing interest in addressing “global AIDS” among U.S. leaders, including Presidents Bill Clinton and George W. Bush, who saw the spread of the disease in Africa as a growing threat to international security.

Perspectives from Four Stages of Development

2019 ◽  
pp. 159-178
Author(s):  
Eleanor M. Fox ◽  
Mor Bakhoum
Keyword(s):  
South African ◽  
Gold Standard ◽  
Developed Countries ◽  
The United States ◽  
Point Of View ◽  
Sub Saharan Africa ◽  
The European Union ◽  
African Countries ◽  
Sub Saharan ◽  
The Developed Countries

This chapter identifies four clusters of nations based on state of development, in order to highlight significant qualitative differences that may call for different law and policies. The first cluster comprises the least developed sub-Saharan African countries with the most resource-challenged competition authorities, such as Benin and Togo. The second cluster compromises nations that have advanced economically to a perceptibly higher level. The third cluster is a “group” of one—South Africa. With all of its challenges, the South African competition regime is as close to a gold standard as there is in sub-Saharan Africa. Finally, for comparison, the fourth cluster comprises the developed countries, led in particular by the European Union and the United States. These nations have open economies, fairly robust markets, good infrastructure, and good institutions. The chapter proceeds to identify, from the point of view of each of the clusters, the most fitting competition framework nationally and globally. The chapter proposes how the divergences can be brought into sympathy.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1185-1186
Author(s):  
Nombulelo P. Magula ◽  
Akira Singh
Keyword(s):  
Black Women ◽  
Hiv Infection ◽  
The United States ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
High Burden ◽  
Immunodeficiency Virus ◽  
Widespread Availability ◽  
Sub Saharan ◽  
Young Black Women

Life expectancy has increased significantly with the widespread availability of antiretroviral therapy. Despite this, new human immunodeficiency virus (HIV) infection rates in low- to middle-income, high-burden countries remain a cause for concern. The greatest impact of infection remains in sub-Saharan Africa, among young black women. However, the majority of studies investigating cardiovascular disease associated with HIV infection have been conducted in the United States and Europe, in predominantly male cohorts.

The Emerging Market of Sub-Saharan Africa and Technology Adoption

2012 ◽  
Vol 3 (1) ◽  
pp. 14-26 ◽  
Author(s):  
Alice S. Etim
Keyword(s):  
Mobile Phones ◽  
Personal Development ◽  
Emerging Market ◽  
The United States ◽  
Emerging Economy ◽  
Sub Saharan Africa ◽  
Mobile Technologies ◽  
Information And Communication ◽  
Sub Saharan ◽  
Study Participants

In the United States, Organization for Economic Co-operation and Development (OECD) countries and several emerging economies in Asia, mobile technologies have become ubiquitous and core to everyday lives. The same cannot be said for many countries in Sub Saharan Africa (SSA). The availability, affordability and use of information and communication technology (ICT) continue to pose a major challenge to the progress of this important emerging economy and their participation in a networked and “flat world.” Writers (Bishop et al., 1999; ADB, 2003; Fisher et al., 2004; Elijah & Ogunlade, 2006; Etim, 2009; Ssewanyana, 2007) argue for the use of ICT to enable the SSA population in the area of economic and personal development. This paper examines the emerging economy of SSA adoption of mobile technologies in comparison to the U.S.A and reports a study on the features that SSA students desire in mobile phones. The key finding was that study participants desired Internet access via mobile phones.

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