How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa

Abstract

Background The current Coronavirus disease pandemic reveals political and structural inequities of the world’s poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. Methods We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. Results Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. Conclusion Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in ‘normal’ circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.

The role of cultural safety and ethical space within postcolonial healthcare for Maasai in Tanzania

“…85 Factors important for Maasai participants to trust and access care are similar to those reported since this transition to more recently in Tanzania including availalbility of diagnostics and medicines, competent health workers and respectful communication. [86][87][88] Trust among indigenous groups is further complicated by historical experiences of being misled and marginalised. Maasai participants discussed mistrust in vaccination programmes possibly linked to colonial veterinary and human disease control methods used to capitalise on land resources and restrict their movement.…”

Curbing antimicrobial resistance in post‐COVID Africa: Challenges, actions and recommendations

“… 3 On the contrary, the understaffing and the lack of drug supply pose a challenge to the health systems, thus impelling poor health outcomes. 3 …”

“…The availability of staff and accessible quality medications play an essential role in responding to the outbreak and are considered critical bodies of health infrastructure. 3 On the contrary, the understaffing and the lack of drug supply pose a challenge to the health systems, thus impelling poor health outcomes. 3 As African health systems were inadequately prepared to respond to the pandemic, the adverse effects on health services have been numerous.…”

“…3 On the contrary, the understaffing and the lack of drug supply pose a challenge to the health systems, thus impelling poor health outcomes. 3 As African health systems were inadequately prepared to respond to the pandemic, the adverse effects on health services have been numerous. There was a lack of accessible quality health care services, compounded by the COVID-19 surge and paucity of equipment such as testing material.…”

“…The fear of mortality due to the pandemic has been high, 2 while health care services focus on the pandemic. The availability of staff and accessible quality medications play an essential role in responding to the outbreak and are considered critical bodies of health infrastructure 3 . On the contrary, the understaffing and the lack of drug supply pose a challenge to the health systems, thus impelling poor health outcomes 3 …”