BackgroundThis article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.ObjectiveThe objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.MethodAn exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe.ResultsCountries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.ConclusionA potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.
BackgroundSub-Saharan Africa is the world region with the greatest number of people eligible to receive antiretroviral treatment (ART). Less frequent dispensing of ART and community-based ART-delivery models are potential strategies to reduce the load on overburdened healthcare facilities and reduce the barriers for patients to access treatment. However, no large-scale trials have been conducted investigating patient outcomes or evaluating the cost-effectiveness of extended ART-dispensing intervals within community ART-delivery models. This trial will assess the clinical effectiveness, cost-effectiveness and acceptability of providing ART refills on a 3 vs. a 6-monthly basis within community ART-refill groups (CARGs) for stable patients in Zimbabwe.MethodsIn this pragmatic, three-arm, parallel, unblinded, cluster-randomized non-inferiority trial, 30 clusters (healthcare facilities and associated CARGs) are allocated using stratified randomization in a 1:1:1 ratio to either (1) ART refills supplied 3-monthly from the health facility (control arm), (2) ART refills supplied 3-monthly within CARGs, or (3) ART refills supplied 6-monthly within CARGs. A CARG consists of 6–12 stable patients who meet in the community to receive ART refills and who provide support to one another. Stable adult ART patients with a baseline viral load < 1000 copies/ml will be invited to participate (1920 participants per arm). The primary outcome is the proportion of participants alive and retained in care 12 months after enrollment. Secondary outcomes (measured at 12 and 24 months) are the proportions achieving virological suppression, average provider cost per participant, provider cost per participant retained, cost per participant retained with virological suppression, and average patient-level costs to access treatment. Qualitative research will assess the acceptability of extended ART-dispensing intervals within CARGs to both providers and patients, and indicators of potential facility-level decongestion due to the interventions will be assessed.DiscussionCost-effective health system models that sustain high levels of patient retention are urgently needed to accommodate the large numbers of stable ART patients in sub-Saharan Africa. This will be the first trial to evaluate extended ART-dispensing intervals within a community-based ART distribution model, and results are intended to inform national and regional policy regarding their potential benefits to both the healthcare system and patients.Trial registrationClinicalTrials.gov, ID: NCT03238846. Registered on 27 July 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2469-y) contains supplementary material, which is available to authorized users.
IntroductionWe describe the VMMC uptake across in Rural Non-circumcising provinces of Luapula, Northern and Muchinga 2018 to 2020. Method This was cross sectional analysis of routine programme data targeting males 10 years older (from October 2018 to April 2020), 15 years (from May 2020) and above VMMC was undertaken using both static and outreach activities. A multi-pronged strategy was adopted that included procurement of VMMC kits to supplement the government’s shortfall, training of VMMC providers (doctors, clinical officers and nurses) dedicated space for circumcision in each facility, logistics support ( fuel and allowances) for outreach programs, mapping of catchment areas for community mobilization and demand creation. All circumcisions performed were recorded in MOH VMMC registers. Data collected was verified by Provincial Health Office. Daily Situation Room (DSR) reports were used to monitor performance. Poor performing districts were followed up and challenges addressed to improve performance. ResultsA total of 2,130 focused outreach activities were carried out between 2018 and 2020 across the three provinces and 486,750 participants were reached. Of the 486,750 participants reached, 151, 428 were circumcised; 56136 (37%) from Northern, 49297 (33%) from Muchinga, and 45995 (30%) from Luapula. There was a three-fold increase in circumcision between 2018 and 2019 (14,746 circumcisions in 2018 vs 54,287 circumcisions in 2019) and a 14% increase from 2019 (38%) to 2020 (52%; 58,287 circumcisions). Most (76%) of the circumcision were done in the age group 15 to 29 years. HIV testing was undertaken among 6,319 participants giving a positivity rate of 2.4% (149). Improved results were associated with logistical support such as transport, VMMC commodity supplies, and increased dedicated VMMC providers. ConclusionHealth systems support including training, logistical support, dedicated space and supply of commodities assisted in increase of VMMC uptake in these rural non-traditional circumcision provinces. even amidst the outbreak of COVID19. Health systems strengthening and community outreach programmes are recommended for building health programs resilience in era of the COVID pandemic.
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