“Health Systems in the context of Covid-19”- Final Case Studies submissions from Countries

In September 2020, the Health Systems Thematic Circle has put out a call (link) to develop case studies on health systems in the context of Covid-19, under the different sub-themes and guidelines. We received very rich contribution about 15 case studies from about 12 countries on variety of subthemes. Many of them were provided feedback by a group of people and revised versions were sent. Below, please find case study summary table a with case study links.
Featured Image: Feedback sharing meeting with the CHWs who had trained under South African People’s Health University (SAPHU) in past.                                                                                                                                                                                                                                                                                                       
Case Study Summary Table and Links:                                                                                                                                                                                                                       

South East Africa- 1  (Revised)

1. Organization PHM Kenya
2. Title Impact of pre-existing gender inequalities on adolescent girls and women in the midst of the COVID-19 pandemic in Kenya.
3 Authors David Makori, Eunice Owino and Kristine Yakhama
4. Publication Status Not Published
5 Theme Gender inequality in covid response
6. Sub-Theme

Or 50 word summary

 Documents gender inequalities in covid 19 response as evidenced from PHM Kenya organized studies, and other CSO studies, and the activities of PHM Kenya on these issues.
7 Key Words Sexual and reproductive health, forced marriages, child marriages, teen pregnancy, sexual assault
8 References 8
9 Pages 6
10 Methods Documentation of PHM work, summary of studies done

SEA- 2 (Revised)

1. Organization PHM Malawi
2. Authors Organization
3 Title MALAWI CASE STUDY: CSO COVID-19 RESPONSE ACTIVISM ON PROVISION OF PPE, RISK ALLOWANCES FOR FRONTLINE HEALTH WORKERS AND INCLUSIVE COVID-19 RESPONSE BEARS FRUIT IN MALAWI
4. Publication Status Not published
5 Theme Documentation of PHM  and CSO response to health worker issues and lock downs in Covid 19 response
6. Sub-Theme

Or 50 word summary

 Health systems context of the Covid in Malawi,  issues faced by CHWs, mobilization and advocacy for CHW safety and working conditions, leading to major improvements, On April 17, 2020 a high court grants the Human Rights Defenders Coalition (HRDC) a seven day injunction stopping the government from implementing a 21-day national lockdown due to coronavirus. “Our message is simple, we are not accepting this issue of lockdown unless the government comes up with proper measures to protect the lives of Malawians. All we are saying is that different stakeholders such as religious leaders, civil society organizations should come together to digest this issue and come up with a proper solution,”
7 Key Words Health worker safety, PPE, CHWs, lock-down
8 References 14
9 Pages 8
10 Methods Documentation of PHM and CSO intervention

SEA- 3 (Revised)

1. Organization PHM South Africa
2. Title Starting at the base: Community Health Workers and their foundational role in the implementation of comprehensive Primary Health Care.
3 Authors Melanie Alperstein, Louis Reynolds and Tinashe Njanji
4. Publication Status Not Published
5 Theme Community Health Workers,  PHM interventions
6. Sub-Theme

Or 50 word summary

 The role that South Africa Peoples Health University programs, and PHM SA have played in mobilization, organization and empowerment of  CHWs.
7 Key Words IPHU, CHW empowerment
8 References 13
9 Pages 9
10 Methods Documentation of PHM work

SEA- 4 (Revised)

1. Organization PHM Uganda
2. Authors Organization
3 Title A People’s Health Movement Documentation of Case Studies on health activism in Africa: The Ugandan Perspective on Promoting Health for All – NOW!
4. Publication Status Not Published
5 Theme Documenting PHM Uganda work
6. Sub-Theme

Or 50 word summary

 Documents nature of issues in Uganda, especially in border region of Isingiro, and in relation to migrants and PHM approach to the same
7 Key Words —
8 References 5
9 Pages 3
10 Methods Documentation of PHM work

SEA- 5 (Revised)

1. Organization PHM Kenya
2. Title Health activism, citizen accountability and UHC in Kenya
3 Authors Organizational
4. Publication Status Not published
5 Theme Sample survey done in 2019 of perceptions of UHC
6. Sub-Theme

Or 50 word summary

 From 2018-2020, Kenya piloted a World Bank model of UHC, with an intent to scale up to national implementation. PHM Kenya presents a study of peoples perception of citizens on the state of health care and presents it local health authorities with an alternative view of the UHC model.
7 Key Words Peoples perception,  survey
8 References —
9 Pages 7
10 Methods documentation of PHM work : includes Summary of survey of perceptions on UHC, as also dissemination meeting
  1. Argentina
1. Organization MSP Argentina, TATU
2. Title TATU PROPOSAL”COMMUNITY HEALTH PROJECT
3 Authors Dr.Carmen Báez (MSP-Argentina), Dr.Luciano Blanco (TATU), PsyD.Viviana Palmbaum (TATU)
4. Publication Status Not published
5 Theme Community oriented primary health care
6. Sub-Theme

Or 50 word summary

 Documents direct action by activists forming part of the TATU-Proposal group, which documents the health promotion work done over the past 12 years in a community established through a land occupation action on the outskirts of Buenos Aires.
7 Key Words Comprehensive PHC; solidarity/mutual aid;  direct action; COVID-19
8 References —
9 Pages 4
10 Methods Documentation of political and health work done by TATU, before COVID-19 and during the pandemic
  1. Australia (Revised)
1. Organization PHM Australia
2. Title COVID 19 and Privatisation in Victoria
3 Authors Katy Osborne
4. Publication Status Unpublished
5 Theme Engagement with private health sector during COVID-19
6. Sub-Theme

Or 50 word summary

 Focuses on privatization as a driver of COVID-19 infections in Australia, in particular privatized aged care and privatised security services responsible for enforcing the hotel quarantine programme.
7 Key Words Hotel quarantine; aged care facilities; anti-privatisation struggles; precarious work
8 References 16
9 Pages 4
10 Methods Description and analysis of the ways in which private providers have ignored COVID-19 health protocols.
  1. India
1. Organization PHM India- Chhattisgarh state
2. Title Community Health Workers (CHWs)in Chhattisgarh during Covid-19
3 Authors Neelanjana Das
4. Publication Status Unpublished
5 Theme CHWs contributions to managing the COVID-19 crisis
6. Sub-Theme

Or 50 word summary

 Identifies the different ways in which CHWs are relied upon to combat COVID-19 despite being exploited due to their status at the bottom of the occupational hierarchy
7 Key Words CHWs, precarious work, social reproduction labour, occupational hierarchies
8 References 10
9 Pages 5
10 Methods Description of occupational challenges faced by CHWs; methods not explicitly described but quotes from CHWs included so presumably interviews were done
  1. Sri Lanka
1. Organization PHM Sri Lanka
2. Title Case study on health system response to Covid 19 in Sri Lanka
3 Authors Professor Manuj C Weerasinghe
4. Publication Status Unpublished
5 Theme Public health response during the initial phase of COVID-19
6. Sub-Theme

Or 50 word summary

 See above (section 5); includes timeline of COVID-19 responses from Jan 2020-March 2020
7 Key Words Public health sector; health systems
8 References —
9 Pages 3
10 Methods Describes policy interventions
  1. Tunisia
1. Organization Tunisian association for defending the right to health and Tunisia PHM circle
2. Title Tunisian case study about CSO struggle to protect the public health sector and to fight against rampant privatization of health care
3 Authors Belgacem Sabri
4. Publication Status Unpublished
5 Theme Health system response to COVID-19; impact of privatisaton
6. Sub-Theme

Or 50 word summary

 Provides an overview of the evolution of the Tunisian health system; the findings of a 2016 PHM report on inequalities within; advocacy to defend the public health system against privatization; arrangements and use of PPPs during the first wave of the COVID-19 pandemic; socioeconomic consequences of the COVID-19 pandemic; includes summary of “lessons learned”.
7 Key Words Privatisation, COVID-19 pandemic
8 References —
9 Pages 5
10 Methods Description of PHM activities
  1. Philippines 1
1. Organization PHM Philippines
2. Title Failing COVID-19 Response: A failure of a Weak and Privatized Healthcare system
3 Authors Not stated
4. Publication Status Unpublished
5 Theme Health system response to COVID-19, and adverse effects of privatization, militarization of COVID-19 response
6. Sub-Theme

Or 50 word summary

 “The response of many governments to the COVID-19pandemicreveals the systemic problem of the health care system further weakened by neo-liberal policies on health such as privatization, deregulation and liberalization. In the Philippines, privatization, the devolution of health care services and decreasing health budget eroded the country’s public health care system… As the COVID-19 pandemic exposes the weakness of the present health system, it is an opportune time to pursue fundamental change in the health system. A movement for a free, comprehensive health care in a tax-funded and integrated health care system will be waged”
7 Key Words COVID-19; Privatisation, commercialisation and militarisation of COVID-19 responses; test & trace; HRH
8 References 30
9 Pages 16
10 Methods Analysis of published materials, documenting experiences in-country
  1. Philippines 2– Viva Salud (Revised)
1. Organization Council for Health and Development, Philippines
2. Title Health system preparedness and response to Covid-19 in the Philippines
3 Authors Council for Health and Development, Philippines
4. Publication Status Unpublished
5 Theme Health system preparedness and response to Covid-19 in the Philippines
6. Sub-Theme

Or 50 word summary

 Public and private sector responses to COVID-19 both had serious weaknesses, which undermined access to healthcare services for COVID-19 patients and those seeking care for other conditions; deteriorating working and living conditions of health workers as a result of the pandemic; lack of transparency around COVID-19 related data.

“The Philippine’s COVID 19 experience is a perfect example of how decades of underfunding and implementation of a neoliberal policy of privatizing public health care have rendered the country’s health system weak, fragmented, and unprepared for a pandemic. If the government’s priorities and health-related policies will not change course, Filipinos will find themselves in serious trouble as recent research has shown that COVID 19 will not be the last pandemic that humans are going to face.”
7 Key Words COVID-19, under-funding of health system, Philippines, militarization of COVID-19 response
8 References 44
9 Pages 13
10 Methods Analysis of published data; description of country context
  1. Palestine
1. Organization Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland;

Council on Health Research for Development, Geneva, Switzerland;

Faculty of Medicine and Health Sciences, An-Najah National University,Palestine;

Gaza Community Mental Health Programme, Gaza, Palestine;

Great Ormond Street Hospital for Children,NHS Foundation Trust, London, UK;

University College London UCL, London, UK;

Women Deliver Organization,New York, NY, USA
2. Title Health system’s response to the COVID-19 pandemic in conflict settings: Policy reflections from Palestine (https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1781914)
3 Authors Mohammed AlKhaldi , Rasha Kaloti , Duha Shella , Aisha Al Basuoni & Hamza Meghari
4. Publication Status Published in Global Public Health
5 Theme Health systems response in conflict settings
6. Sub-Theme

Or 50 word summary

 “As the COVID-19 pandemic spreads, concerns are particularly serious in conflict and humanitarian settings. Tackling the pandemic in those countries is challenging due to the fragility of socioeconomic and health systems. Palestine is one of those countries that is facing compounding challenges, instability, fragility, living conditions, poverty, and mobility, all of which are caused by multifactorial etiology. The Pandemic shows triple tragedies; virus (COVID-19 Pandemic), ongoing Israeli occupation(Politics), and Intra-Palestinian divide (Policies). Yet, Palestine’s response to the pandemic is outperforming many countries in the region. The early preventative lockdown measures in the West Bank found effective and not overwhelming the already over-stretched health system. While in the Gaza Strip, the response was slow. Prisoners, labours, besieged people, socioeconomic-disadvantaged classes, and refugees were put at additional high risk. Nonetheless, measures taken were unconsolidated in both regions largely due to the political factors. A little collaboration and inter-agency task forces in preparedness and response was observed, and the mechanisms and governance remain ambiguous. A consolidated and evidence-based nation-wide plan is required, where by state and non-state actors have a clear and transparent exit strategy. Anew thinking approach to promote the public health system and evidence-informed policies in Palestine is an urgent national priority.” (abstract)
7 Key Words Health systems; conflict settings; COVID-19; Palestine
8 References Extensive references
9 Pages 14
10 Methods Policy analysis by public health scholars from the MENA region and local Palestinian researchers

 Video Case Studies

  1. India
1. Organization Jashodhara Das Gupta -Independent Researcher on Gender, Health and Rights.
2. Title Community Health Workers and Covid-19: Testimony of an ‘ASHA’ (Community Health Workers) from India
3 Authors Jashodhara Das Gupta
4. Publication Status Not published
5 Theme Community Health Workers (CHWs) and Covid-19
6. Sub-Theme

Or 50 word summary

 Video testimony of a Community health Worker from India on the increased workload in Covid pandemic, lack of adequate and timely and the poor behavior and lack of acknowledgement from the hospital staff.
7 Key Words India, Community Health Workers, COVID-19
8 References NA
9 Time 10.5 minutes
10 Methods Video Testimony of an ASHA (Community Health Worker) from India
  1. Congo (3 videos)
1. Organization Viva Salud
2. Title Three video interviews with different Civil Society members in Congo on-

i. Covid and Access to Water

ii. Covid and Comités de Santé Populaires

iii. Covid and Poverty and Gender
3 Authors Viva Salud
4. Publication Status Uploaded on Viva Salud YouTube channel
5 Theme Equity and the Covid-19 Health Systems Response
6. Sub-Theme

Or 50 word summary

 i. Covid and Access to water– Civil society members talk about their work with the communities which had no/irregular access to water in their work area and consequences it would have for hand washing practice prescribed for Covid.

ii. Covid and Comités de santé populaires– Civil Society members’ continued work with communities in Covid, reinvention of their information campaigns and the role of/collaboration with of local district authorities in reaching out to people.

iii. Covid and Poverty and Gender– In a lockdown like situation after Covid, it is difficult for girls and women, as bread earners and helpers to not go out in the market and forego their earnings. Civil Society members talked about their work with women/girls, eventually reaching out to district authorities asking them to pay more attention to women/girls as they are more exposed to pandemic.   

7 Key Words Covid-19, Water, Gender, poverty, Civil Society, Health Information Campaign
8 References NA
9 Time i. Covid and Access to Water- 3:18 mints

ii. Covid and Comités de santé populaires- 2:34 mints

iii. Covid and Poverty and Gender- 4:03 mints
10 Methods Small video interviews with Civil Society members working with communities.

 

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