Ensuring accessibility to health care services for vulnerable populations and strengthening health systems in the context of COVID 19
Enhancing fragile and weak health system during COVID 19 context
De Norohaingo Andrianaivo
On January 30, 2020, the WHO announced that the outbreak of coronavirus disease 2019 (COVID-19), was a "public health emergency of international concern" (Nations Unies Guinée, 2020). The Republic of Guinea recorded its first case of COVID-19 on March 12, 2020. Since then, the pandemic has spread throughout the country, with 28 524 confirmed cases as of August 20, 2021 despite the implementation of a set of response measures. In addition, the COVID context caused a significant socio-economic impact in an already precarious economic situation of the population. More than 30% of Guinean have had their income reduced to 50% since the COVID 19 occurred in the country (Ministère de l’Economie et des Finances de la Guinée, 2020). The pandemic has further worsened the poor health care access situation that already existed prior to the onset of COVID-19.
Strengthening the health system at the primary care level and frontline health workers
To tackle the issue of COVID 19’s impacts, the Belgian NGO Memisa and its local Guinean partner Fraternité Médicale Guinée, with funding from the European Union, are implementing a comprehensive programme that aims to enhance people’s access to quality health care, especially for the most marginalized and vulnerable population groups, and to respond to those health needs specifically related to COVID-19.
The project itself is built around Memisa’s strategic objectives. It has two action components: the health and the social protection.
First, the health care component encompasses the supply and demand side. At the supply side, the project is supporting 38 primary health centers and 3 district hospitals by building the capacity of health centers in infection control and prevention through training of 200 health care workers, provision of infection prevention kits with medical equipment and by building infrastructures such as incinerators and improving water supply.
"I have attended several infection control trainings before, but this workshop was different. This time, in addition to learning how to organize primary health care in an emergency case and the infection prevention technique, we paid a lot of attention to different adult training techniques so that we can in turn train health and community workers," one of the training participants said.
Concomitantly, at the demand-side, the project trained each community health workers of the supported health centers on communication techniques for behavior change; the project supported them with sensitization materials and equipment. They are now sensitizing the population to adopt needed measures to fight against Covid 19, to prevent infection and to keep seeking care at the health centers despite the COVID 19 epidemic context.
“I didn't know anything about COVID-19, I didn't believe in the existence of this disease at all. For us, it was this problem of political affairs to discourage us from voting. At the beginning, I didn't even want to listen to the community health worker’s words. However, through all the examples of Covid 19’s impact he gave me like the cancellation of the pilgrimage to Mecca, the closing of mosques, etc., I understood that all these could not happen if it was not because of a serious illness. I understood that it was necessary to take action for prevention measures from now on at my level and at the level of my family. The community health worker volunteered to accompany me to the vaccination center the next day. Since I was worried about how to pay my transportation to reach the health center for vaccination, the project helped me. I am now protected against the severe symptoms of COVID-19. Also, I am currently aware of the measures I need to take in order to not to get the COVID disease, such as social social distancing... I will ask my family members to be vaccinated from now on. I love my village and I will ask the other inhabitants of in my village to get vaccinated.”
This is the testimony of a sensitized vulnerable that was convinced to
get COVID 19 vaccine and benefited the project’s financial support.
Improving equity and access to health for the most vulnerable population
Another line of action focuses on the issue of social protection. Even if the (reported) specific death rate of COVID 19 remains relatively low as of yet, evidence indicates that its socio-economic impact further increased the vulnerability of poorer population groups. Memisa’s intervention consists of providing financial support to cover costs of health care utilisation, of transportation and of food during the health seeking behaviour trajectory of the most vulnerable and marginalized populations. Memisa’s action finds inspiration in the SDG’s ambition not to leave anyone behind and to prevent worsening of health inequalities.
“I have had to stop working and to leave my family. I wondered how I could be able to cope in this big city away from my family and what will become my family without me...This is how, at the end of the month, the project team informed us, brought us foods and money for for transportation. Thanks to this this help, I manage to pay for my transportation and I don't miss any day of my treatment…” said the 30 years old multidrug-resistant tuberculosis resistant patient who benefited from the project’s support in Conakry.
Eventually, Memisa aims to reach at least two million people in four out of the seven regions in Guinea, prioritising the most vulnerable people.
Key Points
First, it is crucial to support both the private and the public health sector to improve access to health especially in weak health systems context. If it is well organized, as in the case of Guinea where not-for-profit health care providers are united in a platform of, the private health sector can play an important role as health system stakeholder.
Secondly, to compensate the lack of governance at the national level, supporting the local level of the health system is effective and contributing to the health system strengthening for better impact. In this project, the regional and district health authorities were involved since the beginning of the project as they are the leaders of every health intervention at the decentralized level. This approach is even strengthening their stewardship and tightening the partnership between the public and private health sector which has proven to be quite difficult in the country. Flexibility is crucial while implementing a project in a complex
situation as the fight against the COVID 19 pandemic. Currently, in
order to comply with the government priorities and to contribute to its
objectives, some support for the COVAX vaccine deployment was added even
though it was not included in the initial action plan of the project.
Thirdly, intervening on health care only is not enough. The social protection and human aspects of the action are also important areas of intervention, mainly for the most vulnerable population especially in specific contexts like the COVID 19 that we are living currently.
Finally, in addition to all these actions, in order to enhance the sustainability of its intervention, Memisa is also supporting technically and structurally the local partners as well as the private non-for-profit health sector platforms.
Who we are:
Memisa is a medical development cooperation organisation which, together with local civil society organisations, aims to provide professional and sustainable support for health care.
Memisa’s aim is to improve the quality of care and access to care for all, with special attention to the most vulnerable populations.
Memisa’s strategic objectives are based on two pillars. On the supply side, the focus is to strengthen the primary care level in order to improve the quality and availability of the health care provided or provision. On the demand side, it fosters a community based approach that aims to support and strengthen the social solidarity, to inform and promote the health rights and finally to improve financial access to healthcare.
Norohaingo Andrianaivo is a medical doctor with an International Diploma in "Advanced Master's in Health
Policy and Health System Management" (Institute of Tropical Medicine of
Antwerp) and Specialized Master in Health Sciences, with more than 17
years of experience as a leader and program manager in health and health
system strengthening projects in sub-Saharan Region. Email .
La nécessité de renforcer les systèmes de santé : un constat clé en période de pandémie
