scholarly journals Gender and the impact of COVID-19 on demand for and access to health care: analysis of data from Kenya, Nigeria, and South Africa

2021 ◽  
Vol 9 ◽  
pp. S7
Author(s):  
Safa Abdalla ◽  
Elizabeth G Katz ◽  
Gary L Darmstadt
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dhokotera Tafadzwa ◽  
Riou Julien ◽  
Bartels Lina ◽  
Rohner Eliane ◽  
Chammartin Frederique ◽  
...  

Abstract Background Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. Methods We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. Results We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. Conclusions The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.


2013 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Solomon R. Benatar

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the potential to provide a modicum of protection when we find ourselves in those situations (for example, through legislation, effective emergency health services can be created to reduce the impact of our potential vulnerability). There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue.


2019 ◽  
Author(s):  
Sigge Andersson

The impact of occupation on health and access to health care is a significant issue for the state, health sector and citizens of Palestine, who struggle with difficulties related to an enduring sociopolitical stalemate. The study presents narratives from the field, conceptually exploring if and how occupation affects health and access to health care and how the situation is tackled by Palestinians in general and by health system actors specifically. A grounded theory approach analyzing in-depth interviews with health staff and field memos was used, with semi-quantification of emerging concepts through surveys of Hebron students that assessed health-related quality of life and health literacy with psychometric instruments (SF36 and GSE) and assumed health determinants. One key theme in the data analysis was isolation as a result of multiple barriers, including the wall and checkpoints, imprisonment and violence, which have an impact on determinants of health and quality of life in Palestine. In the survey 54% (n=90) were affected by such factors of occupation. Barriers affect access to health care, especially in rural areas. Mentally and materially breaking free from barriers of occupation seems to be a common task in all levels of Palestinian society. Achieving this goal requires different counter strategies and tactics. Presently, Palestine depends on ad hoc coping strategies, including the use of mobile clinics. Other ways to cope emerged in the data as well. Results from this mixed-methods study suggest that isolation is a main concern for Palestinians, resulting from barriers in policies of occupation that affect health and access to health care. Another concept emerging from the analysis was tactics and strategies against occupation in society.


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