Maintaining robust HIV and tuberculosis services in the COVID-19 era: A public health dilemma in Zimbabwe

Mukwenha, Solomon; Dzinamarira, Tafadzwa; Mugurungi, Owen; Musuka, Godfrey

doi:10.1016/j.ijid.2020.09.1425

Cited by 33 publications

(45 citation statements)

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“…In the current COVID-19 era, provision of essential health services in public health facilities, including HIV and TB care, maternity care and care for patients with other chronic diseases has gone down substantially by an estimated 90% [20,[22][23][24]. Additionally, public health services which are principally utilized by individuals with no health insurance have over the years suffered from neglect and under investment with a poorly motivated health force [25].…”

Section: Discussionmentioning

confidence: 99%

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

Musuka¹,

Dzinamarira²,

Cuadros³

et al. 2021

Preprint

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Objective: To determine factors associated with access to health insurance among adults in Zimbabwe. Methods: We used statistical analysis to determine the association between various variables and access to health insurance using the Zimbabwe Demographic and Health Survey, 2015-16 data.Results: Overall, only 11% of 7397 females and 12% of 7420 males included in the analysis had access to health insurance. Age, educational level, marital status, religion, area of residence and wealth quintile were associated with access to health insurance for both females and males. For females, HIV status was associated with access to health insurance. Although not statistically significant a smaller proportion of HIV positive males (10%) had access to any medical insurance compared to their HIV negative counterparts (12%), p=0.189. Conclusion: Our study showed that geospatial distribution of individuals with access to health insurance in Zimbabwe is concentrated around urban areas. Since the bulk of Zimbabweans do not have access to health insurance and mainly use the public health sector for services, there is need for the Ministry of Health to enhance its investment in these facilities so that the bulk of the population can also get quality healthcare.

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Section: Discussionmentioning

confidence: 99%

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

Musuka¹,

Dzinamarira²,

Cuadros³

et al. 2021

Preprint

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“…The pandemic has resulted in a diversion of resources meant for other existing public health threats, including TB. Threats to the TB response in the COVID-19 era have been well established elsewhere ( 10 ). These include movement restrictions due to the implemented lockdowns ( 11 , 12 , 13 ), diversion of human and diagnostic resources from TB services ( 10 ), misdiagnosis of TB in areas where COVID-19 testing is not available ( 14 ) and tuberculosis stigmatization as some of the symptoms of TB and COVID-19 are similar.…”

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confidence: 87%

“…The gains realized over the years in the fight against TB are under threat due to the COVID-19 pandemic ( 7 , 8 , 9 , 10 ). The pandemic has resulted in a diversion of resources meant for other existing public health threats, including TB.…”

mentioning

confidence: 99%

“…These include movement restrictions due to the implemented lockdowns ( 11 , 12 , 13 ), diversion of human and diagnostic resources from TB services ( 10 ), misdiagnosis of TB in areas where COVID-19 testing is not available ( 14 ) and tuberculosis stigmatization as some of the symptoms of TB and COVID-19 are similar. All these threats to the gains observed in TB control in Zimbabwe require swift strategic measures to mitigate the effects of, and manage the COVID-19 pandemic while implementing effective TB prevention and treatment programs ( 10 ).…”

mentioning

confidence: 99%

“…The healthcare system in the country was sub optimal pre-COVID-19 and the pandemic has worsened the situation. There is a need for political commitment to strengthen the healthcare system that can adequately address gaps in the health systems in the long term ( 10 ). In the immediate response, TB programs may use locally derived, simple risk stratification methods to focus interventions like active case finding and preventive treatment to family members at high risk of infection to increase their impact and cost-effectiveness ( 17 ).…”

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confidence: 99%

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Implementing effective TB prevention and treatment programmes in the COVID-19 era in Zimbabwe. A call for innovative differentiated service delivery models

Nhari

Dzobo

Chitungo

et al. 2020

Public Health in Practice

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The arrival of COVID-19 has disrupted health service provision globally. In this note, the authors discuss the impact of the COVID-19 pandemic on the provision of tuberculosis (TB) services in Zimbabwe. TB is endemic in the country and disruption of services may potentially have serious consequences for patients with existing and undiagnosed TB. In this letter, the authors discuss the need for innovative strategies that ensure TB prevention and treatment services in a manner which reduces COVID-19 risk of patients and healthcare workers.

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Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Diaconu

Falconer

Verbel

et al. 2021

Cochrane Database of Systematic Reviews

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Background There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low‐ and middle‐income countries (LMICs) is lacking; this is an update of the 2012 review on this topic. Objectives To assess the effects of paying for performance on the provision of health care and health outcomes in low‐ and middle‐income countries. Search methods We searched CENTRAL, MEDLINE, Embase, and 10 other databases between April and June 2018. We also searched two trial registries, websites, online resources of international agencies, organizations and universities, and contacted experts in the field. Studies identified from rerunning searches in 2020 are under 'Studies awaiting classification.' Selection criteria We included randomized or non‐randomized trials, controlled before‐after studies, or interrupted time series studies conducted in LMICs (as defined by the World Bank in 2018). P4P refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. To be included, a study had to report at least one of the following outcomes: patient health outcomes, changes in targeted measures of provider performance (such as the delivery of healthcare services), unintended effects, or changes in resource use. Data collection and analysis We extracted data as per original review protocol and narratively synthesised findings. We used standard methodological procedures expected by Cochrane. Given diversity and variability in intervention types, patient populations, analyses and outcome reporting, we deemed meta‐analysis inappropriate. We noted the range of effects associated with P4P against each outcome of interest. Based on intervention descriptions provided in documents, we classified design schemes and explored variation in effect by scheme design. Main results We included 59 studies: controlled before‐after studies (19), non‐randomized (16) or cluster randomized trials (14); and interrupted time‐series studies (9). One study included both an interrupted time series and a controlled before‐after study. Studies focused on a wide range of P4P interventions, including target payments and payment for outputs as modified by quality (or quality and equity assessments). Only one study assessed results‐based aid. Many schemes were funded by national governments (23 studies) with the World Bank funding most externally funded schemes (11 studies). Targeted services varied; however, most interventions focused on reproductive, maternal and child health indicators. Participants were predominantly located in public or in a mix of public, non‐governmental and faith‐based facilities (54 studies). P4P was assesse...

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Maintaining robust HIV and tuberculosis services in the COVID-19 era: A public health dilemma in Zimbabwe

Cited by 33 publications

References 2 publications

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

Access to Health Insurance in Zimbabwe and associated factors: Insights from data from the Zimbabwe Demographic Health survey, 2015

Implementing effective TB prevention and treatment programmes in the COVID-19 era in Zimbabwe. A call for innovative differentiated service delivery models

Paying for performance to improve the delivery of health interventions in low- and middle-income countries

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