Why the public is torn over the contact-tracing app and how the government can maximize uptake

Drawing on a qualitative study consisting of five focus groups, Simon Williams, Christopher J Armitage, Tova Tampe and Kimberly Dienes find that people are currently torn over whether or not they will use the contract-tracing app when it is available. They discuss the main concerns that emerged from the research and offer some key recommendations for ensuring that there will be sufficient uptake

Public decisions about COVID-19 vaccines: a UK-based qualitative study

Objective To explore UK public decisions around whether or not to get COVID-19 vaccines, and the facilitators and barriers behind participants’ decisions. Design This qualitative study consisted of six online focus groups conducted between 15th March and 22nd April 2021. Data were analysed using a framework approach. Setting Focus groups took place via online videoconferencing (Zoom). Participants Participants (n=29) were a diverse group (by ethnicity, age and gender) UK residents aged 18 years and older. Results We used the World Health Organization’s vaccine hesitancy continuum model to look for, and explore, three main types of decisions related to COVID-19 vaccines: vaccine acceptance, vaccine refusal and vaccine hesitancy (or vaccine delay). Two reasons for vaccine delay were identified: delay due to a perceived need for more information and delay until vaccine was “required” in the future. Nine themes were identified: three main facilitators (Vaccination as a social norm; Vaccination as a necessity; Trust in science) and six main barriers (Preference for “natural immunity”; Concerns over possible side effects; Perceived lack of information; Distrust in government;; Conspiracy theories; “Covid echo chambers”) to vaccine uptake. Conclusion In order to address vaccine uptake and vaccine hesitancy, it is useful to understand the reasons behind people’s decisions to accept or refuse an offer of a vaccine, and to listen to them and engage with, rather than dismiss, these reasons. Those working in public health or health communication around vaccines, including COVID-19 vaccines, in and beyond the UK, might benefit from incorporating the facilitators and barriers found in this study

Urban Health Disparities in Sub-Saharan Africa and South Asia: Trends in Maternal and Child Health Care Access, Utilization and Outcomes among Urban Slum Residents

Background: As the world becomes more urban and slums continue to grow in developing countries, research is needed to measure utilization of health services, health outcomes, and access to health care providers among urban slum residents. Estimating trends in urban health among slum residents relative to other urban inhabitants provides evidence of health disparities for priority-setting by program implementers and policy-makers. Research on the negative effects of slum environments on human health has started to emerge, yet there remains a paucity of evidence on morbidity trends over time and inequalities between slum residents and other urban residents. The goal of this study is to quantify maternal and child health care access, utilization and outcomes among urban slum dwellers in selected countries in sub-Saharan Africa and South Asia over time. These three areas are addressed in three separate dissertation manuscripts. Methods: This dissertation offers an in-depth analysis of household and health facility data to measure trends in maternal and child health care utilization and health outcomes among slum residents over time, as well as inequalities in access, utilization and outcomes between other urban and rural populations. Manuscripts 1 and 2 apply a unique spatial inequality approach to existing population-based household data from the Demographic and Health Surveys (DHS) to identify a sample of slum residents. Manuscript 1 assesses trends in maternal and child health care (MCH) utilization and health outcomes using DHS data in Bangladesh, Ethiopia, Kenya, Malawi, Nepal, Nigeria and Tanzania between 2003 and 2011. In Manuscript 2, a trend analysis is performed in Kenya to examine diarrheal disease and acute respiratory infection (ARI) in children under-five in both slums and other urban and rural areas during the roll-out of a national slum upgrading program. Manuscript 3 further explores local-level dimensions of health care access from two slums in Kenya, generating evidence on service availability and readiness in slums. In this section, we analyze health facility data collected using a modified version of the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA). Results: Manuscript 1 reports significant disparities between slum dwellers and other urban residents’ utilization of key maternal health interventions—appropriate antenatal care (ANC), tetanus toxoid vaccination, and skilled delivery—in Bangladesh, Ethiopia, Kenya and Nigeria. In addition, child health outcomes examined in Manuscript 1 suggest that the prevalence of diarrheal disease in children under-five is declining among other urban and rural residents, but not significantly among slum residents. Nigeria was the only exception, with significant declines in diarrheal disease prevalence in slums over the study period. Because ARI improvements are found across populations, the data suggests this condition is not unique to slum settings. The trend analysis in Manuscript 2 supports these findings—ARI is declining steadily over time not only among slum residents, but also among other urban and rural residents as well. Diarrheal disease prevalence, on the other hand, has not changed significantly over time, with stable levels among slum dwellers between 1993 and 2014. In Manuscript 3, analysis of general service availability and readiness in two locations—the Nyalenda slum of Kisumu and the Langas slum of Eldoret—reveals that slums perform far below recommended benchmarks set by WHO. When we compare service availability and readiness indicators with regional, urban, and national averages, in general slums in Kisumu and Eldoret perform poorly. However, there were some instances—typically involving standard precautions for infection control—where Kenyan slums actually performed better than comparison sites. Conclusions: This research provides a comprehensive view of health systems dimensions in urban slums in sub-Saharan Africa and South Asia. Manuscript 1 confirms evidence of an urban penalty and emphasizes a need to focus on maternal health care utilization in slums. Manuscript 2 detects little improvement in child health outcomes among slum dwellers in Kenya during the roll-out of the country’s national slum upgrading program. An integrated approach to health and urban policy development is recommended based on these results. Manuscript 3 identifies areas of service availability and readiness in two Kenyan slums that fall below global targets and are in need of improvement in order to achieve desired health outcomes. Taken together, this study makes a significant contribution to the crucial demand for research on growing marginalized urban populations in developing countries

Design and implementation of a Primary Health Care (PHC) Toolbox for improving the impact of support from Global Development Partners

Acknowledgements: The authors would like to thank Suraya Dalil, Gerard Schmets, Awad Mataria, and Shams Syed for their leadership during the development of the Toolbox. In addition, we would like to thank Richard Gregory, as well as the Global Health Initiatives Task Team at WHO HQ and WHO EMRO and partner organizations for their feedback and contribution in the development of the Toolbox. All authors fully contributed to writing, reviewing and revising the manuscript. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.Primary Health Care (PHC) is the most equitable and cost-effective way to enhance the health of populations and improve health security and is a requirement for achieving universal health coverage (UHC). Vital to advancing the PHC agenda is effective global health partnerships, particularly with Global Health Initiatives (GHIs) which provide financial support for improving population health. Despite progress, GHI support at times remained parallel to rather than embedded in national health strategies. To improve the impact of GHI support, World Health Organization (WHO) member states requested specific guidance to better align GHI support to national health strategies and PHC principles. We present the PHC-GHI Toolbox as a comprehensive set of resources for use by countries to apply the PHC approach to development of plans for securing and optimally utilizing funding received from GHIs, such as Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM); and the Global Financing Facility (GFF) as well as other donors. The PHC-GHI Toolbox includes a PHC resource database, GHI-specific overviews, a database of health system strengthening (HSS) investments, COVID-19 funding rapid assessment tool, and a focal point database for identifying expert technical assistance. This paper describes the process undertaken for Toolbox development and outlines its potential applications