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Many global health institutions, including the World Health Organization, consider primary health care as the path towards achieving universal health coverage (UHC). However, there remain concerns about the feasibility and effectiveness of this approach in low-resource countries. Ethiopia has been implementing the primary health-care approach since the mid-1970s, with primary health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a document review of publicly available qualitative and quantitative data. Using the framework of the Primary Health Care Performance Initiative we describe and analyse the practice of primary health care and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia has been possible through policies, strategies and programmes that are aligned with country priorities. There has been a diagonal approach to disease control programmes along with health-systems strengthening, community empowerment and multisectoral action. These strategies have enabled the country to increase health services coverage and improve the population's health status. However, key challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow health-systems transition to provide services for noncommunicable diseases, inadequate quality of care, and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country needs to improve its domestic financing for health and target disadvantaged locations and populations through a precision public health approach. These challenges need to be addressed through the whole sustainable development agenda. De nombreux organismes sanitaires internationaux, dont Organisation mondiale de la Sante, considerent que les soins de sante primaires representent un jalon essentiel du cheminement vers une couverture maladie universelle (CMU). Neanmoins, des inquietudes subsistent quant a la faisabilite et a l'efficacite de cette approche dans les pays a faible revenu. LEthiopie a adopte cette approche depuis le milieu des annees 1970, et les soins de sante primaires figurent au creur du systeme sanitaire depuis 1993. Pourtant, rares sont les preuves exhaustives et generalisees concernant la pratique et le role des soins de sante primaires dans l'evolution vers une CMU en Ethiopie. Nous avons donc procede a un examen des documents contenant des donnees qualitatives et quantitatives accessibles au public. A l'aide du cadre instaure par l'initiative PHCPI (Primary Health Care Performance Initiative), nous avons decrit et analyse la pratique des soins de sante primaires; nous avons egalement identifie les reussites et les defis. C'est grace a des politiques, strategies et programmes en adequation avec les priorites nationales que cette methode axee sur les soins de sante primaires a pu etre mise en reuvre en Ethiopie. Le pays a emprunte une approche diagonale vis-a-vis des programmes de controle des maladies, tout en renforqant les systemes de sante, l'autonomie des communautes et l'action multisectorielle. Ces strategies lui ont permis d'augmenter la prise en charge des services de sante et d'ameliorer l'etat de sante de la population. Il reste cependant d'importants defis a relever: couverture insuffisante des services, inegalites d'acces, lenteur de transition entre systemes sanitaires pour la fourniture de prestations liees aux maladies non transmissibles, qualite mediocre des soins et frais non remboursables eleves. Afin de combler les lacunes au sein et en dehors du systeme de sante, le pays doit revoir le montant du financement octroye aux soins de sante a la hausse, mais aussi cibler les regions et populations defavorisees par le biais d'une approche de precision en matiere de sante publique. Ces defis doivent etre abordes tout au long du programme de developpement durable. Varias instituciones sanitarias mundiales, incluida la Organizacion Mundial de la Salud, opinan que la atencion primaria de salud es la via hacia el logro de la cobertura sanitaria universal (CSU). Sin embargo, persisten las preocupaciones acerca de la viabilidad y la eficacia de este enfoque en los paises de bajos recursos. Etiopia aplica el enfoque de la atencion primaria de salud desde mediados del decenio de 1970, por lo que la atencion primaria de salud es el nucleo del sistema de salud desde 1993. No obstante, Etiopia carece de pruebas integrales y generales sobre la practica y la funcion de la atencion primaria de salud orientada a la CSU. Se realizo un analisis documental de los datos cualitativos y cuantitativos a disposicion del publico. Se describe y analiza la practica de la atencion primaria de salud y se determinan los exitos y los desafios por medio del marco de la Iniciativa sobre el desempeno de la atencion primaria de salud. La aplicacion del enfoque de la atencion primaria de salud en Etiopia fue posible gracias a las politicas, las estrategias y los programas que se adaptaron a las prioridades del pais. Existe un enfoque diagonal de los programas de control de enfermedades sumado al fortalecimiento de los sistemas sanitarios, a la participacion de la comunidad y a las medidas multisectoriales. Gracias a estas estrategias, el pais ha logrado aumentar la cobertura de los servicios sanitarios y mejorar el estado de salud de la poblacion. Sin embargo, aun quedan por resolver algunos desafios fundamentales, como la cobertura insuficiente de los servicios, la falta de equidad en el acceso, la lentitud de la transicion de los sistemas sanitarios para prestar los servicios correspondientes a las enfermedades no transmisibles, la calidad deficiente de la atencion y los elevados gastos de bolsillo. Para resolver las deficiencias del sistema sanitario y otros aspectos, el pais debe mejorar su financiamiento nacional para la salud y centrarse en los lugares y las poblaciones desfavorecidos a traves de un enfoque preciso de la salud publica. Se debe abordar estos desafios en todo el programa de desarrollo sostenible. [phrase omitted], Universal health coverage (UHC) is the main target of sustainable development goal (SDG) 3, i.e. to ensure healthy lives and promote well-being for all at all ages. UHC is about [...]

Introduction: HIV testing is the entry point to HIV prevention, care and treatment and needs continuous evaluation to understand whether all social groups have accessed services equally. Addressing disparities in HIV testing between social groups results in effective and efficient response against HIV prevention. Despite these benefits, there was no previous study on inequality and determinants over time in Ethiopia. Thus, the objective of this research was to examine socioeconomic inequality in individuals undertaking HIV testing over time, allowing for the identification of persistent and emerging determinants. Methods: Data sources for the current study were the 2011 and 2016 Ethiopian Demographic Health Surveys. The 2016 population health survey is the one that Ethiopia used to set national AIDS response strategies; there was no other recent survey with HIV/AIDS-related indicators in Ethiopia. The final sample size for the current study was 28,478 for the year 2011 and 25,542 for the year 2016. The concentration curve and Erreygers' concentration index were used to estimate socioeconomic inequality in HIV testing. Subsequently, decomposition analysis was performed to identify persistent and emerging contributors of socioeconomic inequality. Generalized linear regression model with the logit link function was employed to estimate the marginal effect, elasticity, Erreygers' concentration index (ECI), and absolute and percentage contributions of each covariate. Results: The concentration curve was below the line of equality over time, revealing the pro-rich inequality in HIV testing. The inequality was observed in both 2011 (ECI = 0.200) and 2016 (ECI = 0.213). A household wealth rank had the highest percentage contribution (49.2%) for inequality in HIV testing in 2011, which increased to 61.1% in 2016. Additional markers include listening to the radio (13.4% in 2011 and 12.1% in 2016), education status (8.1% in 2011 and 6.8% in 2016), and resident (-2.0% in 2011 and 6.3% in 2016). Persistent determinants of individuals undertaking HIV testing were age 20–34 years, geographic region, education status, marital status, religion, income, media exposure (listening to the radio, reading newspaper, watching television), knowledge about HIV/AIDS, and attitudes towards people living with HIV. Age between 35 and 44 years and urban residence emerged as new associated factors in 2016. Conclusions: The higher HIV testing coverage was among individuals with higher socioeconomic status in Ethiopia. Socioeconomic inequality amongst individuals undertaking HIV testing was diverging over time. Household wealth rank, mass media exposure, education status, and resident took the largest share in explaining the disparity in individuals undertaking HIV testing between the lower and higher income groups. Therefore, interventions to equalise HIV testing coverage should take account of these determinants. [ABSTRACT FROM AUTHOR]

Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers' inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship. [ABSTRACT FROM AUTHOR]

Patient satisfaction is a critical component of quality of care assessment in the pursuit of universal health coverage to end the tuberculosis epidemic and other diseases. This study aimed to review the level of satisfaction of tuberculosis patients and related factors. Articles were accessed from Web of Science, EMBASE, PubMed and Google Scholar. Twenty‐six papers fulfilled the eligibility criteria from 13 countries. The percentage of satisfied tuberculosis patients ranged from 53.5% to 97.0% in the five African countries, 67.8 to 97.2% in India, South‐East Asia, 82.0% in Pakistan, East‐Mediterranean and 92.9% in Armenia, the European region. Accessibility, healthcare cost, treatment duration and taking supervised‐directly observed treatment were healthcare service‐related determinants. Technical competency, interpersonal relationships, confidentiality, time spent with healthcare providers, time spent waiting for care and counselling and health education were health worker‐related determinants. Patient‐related variables that determine satisfaction were gender, age, ethnicity, place of residence, marital status, educational status, income and health status. Developing and/or approaching an internationally‐agreed tool to measure tuberculosis patient satisfaction in healthcare settings will improve the availability of high‐quality and comparable data to verify actual variation across and within a country. A multidimensional approach considering clients, health workers and healthcare settings is required to holistically address satisfaction issues of tuberculosis patients to gradually realise universal health coverage. [ABSTRACT FROM AUTHOR]

The study attempts to evaluate the efficacy of a 7-valent pneumococcal conjugate vaccine in the treatment of streptococcus pneumoniae in HIV-infected adults. The results indicate that the vaccine was very beneficial in protecting HIV-infected individuals from contracting the pneumoniae.

Background: The progress of Universal health coverage (UHC) is measured using tracer indicators of key interventions, which have been implemented in healthcare system. UHC is about population, comprehensive health services and financial coverage for equitable quality services and health outcome. There is dearth of evidence about the extent of the universality of UHC in terms of types of health services, its integrated definition (dimensions) and tracer indicators utilized in the measurement of UHC. Therefore, we mapped the existing literature to assess universality of UHC and summarize the challenges towards UHC. Methods: The checklist Preferred Reporting Items for Systematic reviews and Meta-analysis extension for Scoping Reviews was used. A systematic search was carried out in the Web of Science and PubMed databases. Hand searches were also conducted to find articles from Google Scholar, the World Bank Library, the World Health Organization Library, the United Nations Digital Library Collections, and Google. Article search date was between 20 October 2021 and 12 November 2021 and the most recent update was done on 03 March 2022. Articles on UHC coverage, financial risk protection, quality of care, and inequity were included. The Population, Concept, and Context framework was used to determine the eligibility of research questions. A stepwise approach was used to identify and select relevant studies, conduct data charting, collation and summarization, as well as report results. Simple descriptive statistics and narrative synthesis were used to present the findings. Results: Forty-seven papers were included in the final review. One-fourth of the articles (25.5%) were from the African region and 29.8% were from lower-middle-income countries. More than half of the articles (54.1%) followed a quantitative research approach. Of included articles, coverage was assessed by 53.2% of articles; financial risk protection by 27.7%, inequity by 25.5% and quality by 6.4% of the articles as the main research objectives or mentioned in result section. Most (42.5%) of articles investigated health promotion and 2.1% palliation and rehabilitation services. Policy and healthcare level and cross-cutting barriers of UHC were identified. Financing, leadership/governance, inequity, weak regulation and supervision mechanism, and poverty were most repeated policy level barriers. Poor quality health services and inadequate health workforce were the common barriers from health sector challenges. Lack of common understanding on UHC was frequently mentioned as a cross-cutting barrier. Conclusions: The review showed that majority of the articles were from the African region. Methodologically, quantitative research design was more frequently used to investigate UHC. Palliation and rehabilitation health care services need attention in the monitoring and evaluation of UHC progress. It is also noteworthy to focus on quality and inequity of health services. The study implies that urgent action on the identified policy, health system and cross-cutting barriers is required to achieve UHC. [ABSTRACT FROM AUTHOR]

The role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya is explored. The study helped initiate a new strategy of health center-based VCT in Kenya and indicated that the government health centers in Kenya can be appropriate providers of VCT.

The changes in number and type of hospital admissions to the medical wards of a small rural district hospital in Northern KwaZulu/Natal, South Africa, between 1991 and 2002 are studied. Comprehensive strategies are needed to reduce the community burden of disease and minimize the impact of HIV on the health services.

We assessed the impact of HIV-1 on malaria in the sub-Saharan African population. Relative risks for malaria in HIV-infected persons, derived from literature review, were applied to the HIV-infected population [...]

Background The Coronavirus Disease 2019 (COVID-19) pandemic takes variable shapes and forms in different regions and countries. This variability is explained by several factors, including the governance of the epidemic. We aimed to identify the key attributes of governance in response to the COVID-19 pandemic and gain lessons for an effective response to public health emergencies. Methods We employed a mixed-methods design. We mapped the attributes of governance from well-established governance frameworks. A negative binomial regression was conducted to identify the effect of the established governance measures on the epidemiology of the COVID-19 pandemic. We used publicly available data on COVID-19 cases and deaths in countries around the world. Document review was conducted to identify the key approaches and attributes of governance during the pre-vaccine era of the response to the COVID-19 pandemic. We conducted a thematic analysis to identify key attributes for effective governance. Results The established governance measures, including generation of intelligence, strategic direction, regulation, partnership, accountability, transparency, rule of law, control of corruption, responsiveness, effectiveness, efficiency, equity, ethics, and inclusiveness, are necessary but not sufficient to effectively respond to and contain the COVID-19 pandemic. Additional attributes of national governance were identified: 1) agile, adaptive, and transformative governance; 2) collective (collaborative, inclusive, cooperative, accountable, and transparent) governance; 3) multi-level governance; 4) smart and ethical governance: sensible, pragmatic, evidence-based, political, learner, and ethical. Conclusions The current governance frameworks and their attributes are not adequate to contain the COVID-19 pandemic. We argue that countries need agile, adaptable, and transformational, collaborative, multi-level, smart and ethical governance to effectively respond to emerging and re-emerging public health threats. In addition, an effective response to public health emergencies depends not only on national governance but also on global governance. Hence, global health governance should be urgently renewed through a paradigm shift towards universal health coverage and health security to all populations and in all countries. This requires enhanced and consistent global health diplomacy based on knowledge, solidarity, and negotiation. [ABSTRACT FROM AUTHOR]