Estimating the economic impact of COVID-19 disruption on access to sexual and reproductive health and rights in Eastern and Southern Africa.

Background: The Coronavirus disease 2019 (COVID-19) resulted in the disruption of Sexual and Reproductive Health Rights (SRHR) services in the Eastern and Southern Africa region. To date, studies estimating the impact of COVID-19 disruptions have mainly focused on SRHR services without estimating the economic implication. Method: We used national service coverage data on the effectiveness of interventions from the lives saved tool (LiST), a mathematical modeling tool that estimates the effects of service coverage change in mortality. We computed years lost due to COVID-19 disruption on SRHR using life expectancy at birth, number of years of life lost due to child mortality, and life expectancy at average maternal death. We calculated the economic value of the lives saved, using the values of statistical life year for each of the countries, comparing 2019 (pre-COVID-19) to 2020 (COVID-19 era). Findings: The total life-years lost were 1,335,663, with 1,056,174 life-years lost attributed to child mortality and 279,249 linked to maternal mortalities, with high case-fatality rates in the Democratic Republic of Congo, Burundi, and Tanzania. The findings show COVID-19 disruptions on SRHR services between 2019 and 2020 resulted in US$ 3.6 billion losses, with the highest losses in Angola (USD 777 million), South Africa (USD 539 million), and Democratic Republic of Congo (USD 361 million). Conclusion: The monetized value of disability adjusted life years can be used as evidence for advocacy, increased investment, and appropriate mitigation strategies. Countries should strengthen their health systems functionality, incorporating and transforming lessons learned from shock events.

Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review.

The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.

High impact health service interventions for attainment of UHC in Africa: A systematic review.

African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention, diagnostics, curative, rehabilitative and palliative interventions. We therefore explored the published evidence on the effectiveness of existing health service interventions addressing the diseases and conditions of concern in the Africa Region, for each age cohort and the public health functions. Six public health and economic evaluation databases, reports and grey literature were searched. A total of 151 studies and 357 interventions were identified across different health program areas, public health functions and age cohorts. Of the studies, most were carried out in the African region (43.5%), on communicable diseases (50.6%), and non-communicable diseases (36.4%). Majority of interventions are domiciled in the health promotion, disease prevention and curative functions, covering all age cohorts though the elderly cohort was least represented. Neonatal and communicable conditions dominated disease burden in the early years of life and non-communicable conditions in the later years. A menu of health interventions that are most effective at averting disease and conditions of concern across life course in the African region is therefore consolidated. These represent a comprehensive evidence-based set of interventions for prioritization by decision makers to attain desired health goals. At a country level, we also identify principles for identifying priority interventions, being the targeting of higher implementation coverage of existing interventions, combining interventions across all the public health functions-not focusing on a few functions, provision of subsidies or free interventions and prioritizing early identification of high-risk populations and communities represent these principles.

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients.

BACKGROUND: Despite the negative impact of tuberculosis (TB) on patients' quality of life, TB control programs focus on biological and clinical parameters to manage and monitor TB patients. In our setting, patients' perception of their experience with TB and the impacts of TB on patients' physical, mental, and social wellbeing remain unknown. OBJECTIVE: The objective of this study was to evaluate the health-related quality of life (HRQOL) among rifampicin/multidrug-resistant TB (RR/MDR-TB) in comparison to drug-susceptible TB (DS-TB) patients in Eritrea. METHODS: A cross-sectional study was conducted in RR/MDR-TB and DS-TB patients under treatment. Anonymized data collected using the WHOQOL-BREF questionnaire were analyzed using SPSS version 23. Frequency, mean and standard deviation were used to describe the data. Mean group score comparison and relationship between variables were assessed using t-test. Domain score was calculated with a mean score of items within each domain and scaled positively, a higher (increasing) score denoting a higher quality of life. Internal consistency was measured using Cronbach's alpha and statistical significance was set at p < 0.05. RESULTS: A total of 92 patients (46 RR/MDR-TB and 46 DS-TB) participated in the study. Environmental (40.63 ± 10.72) and physical domains (61.80 ±17.18) were the two most affected domains in RR/MDR-TB and DS-TB patients, respectively. The psychological domain was the least affected domain in RR/MDR-TB (48.28 ± 20.83) and DS-TB patients (76.63 ±15.32). RR/MDR-TB patients had statistically lower mean scores in all domains than DS-TB patients. CONCLUSION: HRQOL was impaired in both groups, but RR/MDR-TB patients had a worse health-related quality of life.