Considering How Best to Allocate Limited Resources for Healthcare in Lower-Income Settings–Reflections on Ghanaian Community-Led Data Collection

Résumé

As the world begins to transition beyond the urgent phase of the pandemic response, countries are increasingly looking to "mainstream" their COVID-19 management comprising of vaccination and case management into routine healthcare.Access to routine healthcare was severely limited across much of 2020 and 2021, with the greatest impact noted in lower-income settings [1].Population health undoubtedly has been negatively impacted, and countries are even more unlikely to reach Sustainable Development Goal targets by 2030.Policymakers, therefore, need up-to-date evidence to plan healthcare delivery and direct their limited resources toward priority areas.One effective, but resourceintensive, approach to disease control is Mass Drug Administration (MDA).An MDA is where preventive chemotherapy is used as a strategic approach to treat populations at risk of infection, with medicines being distributed across communities [2].These form a core component of the 2021-2030 WHO Neglected Tropical Diseases (NTDs) Roadmap [3].The WHO targets for MDAs typically require greater than 80% uptake to be considered effective with disease control [4].With a community-wide intervention such as an MDA, local acceptance is vital to ensuring high engagement.Ghana is a lower-middle income country in West Africa with approximately 30 million people.Like many countries in sub-Saharan Africa, Ghana has used MDAs successfully to control diseases such as onchocerciasis and lymphatic filariasis [4].During the COVID-19 pandemic, and following WHO guidance, MDAs mostly did not take place in Ghana.There are ongoing research partnerships between the Ghana Health Service, the University for Health and Allied Sciences (Ghana), and the University of Southampton (UK).These include the Oti Regional Health Directorate and Nkwanta South Municipality (a rural area close to the Togo border) (Figure 1).In January 2022, a research survey took place around community viewpoints on the pandemic response and COVID-19 vaccination [5].Alongside this, a small number of supplementary questions were asked around knowledge, acceptance and value of MDAs to manage NTDs.The previous MDA in these communities took place in the last quarter of 2019, distributing ivermectin as a means to control (in particular) onchocerciasis.Onchocerciasis is a mosquito-driven NTD prevalent in parts of Ghana.Survey data was collected on electronic devices, using Kobo Toolbox platform, by 47 residents, known as Community-Based Surveillance Volunteers (CBSVs).This is similar to the methods used to distribute medicines during an MDA, albeit data collection that is usually paper-based.The survey was carried out in three hard-to-reach sub-municipalities within Nkwanta South, specifically Alokpatsa (population of 11,028), Brewaniase (14,483), and Tutukpene (15,453).A total of 1,370 responses were received.

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