Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements
Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements
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DOI：
10.1136/bmjgh-2020-003042
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发表时间：
2020-08-01
影响因子：
8.1
通讯作者：
Yusuf, Rita
中科院分区：
文献类型：
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作者：
Ahmed, Syed A. K. Shifat;Ajisola, Motunrayo;Yusuf, Rita
随着COVID-19的到来，政策制定者迫切需要了解和应对贫民窟社区的健康需求。为控制大流行而实行的封锁会产生健康、社会和经济后果。我们考虑在COVID-19之前和期间为那些在贫民窟社区工作和生活的人提供医疗保健。方法在孟加拉国、肯尼亚、尼日利亚和巴基斯坦的七个贫民窟，我们探讨了利益相关者在两个时期（COVID-19前和COVID-19封锁期间）对非COVID-19条件下医疗保健获取的观点和经验。在2018年3月至2020年5月期间，我们与860名社区领袖、居民、卫生工作者和地方当局代表进行了接触。所有地点的常见疾病包括呼吸道疾病、胃病、水传播疾病、蚊媒疾病和高血压。在COVID前，持份者描述了各种预防、诊断和治疗服务，包括广泛使用的产前和免疫接种计划以及高血压、结核病、艾滋病毒和病媒传播疾病的筛查。在所有地点，药剂师和专利药品供应商是小病治疗和咨询的主要提供者。心理健康服务和处理基于性别的暴力的服务被认为是有限的或不可用的。在COVID-19疫情下，所有地点的医疗服务（包括预防服务）均有所减少。医疗费用增加，而家庭收入减少。居民很难到达医疗机构。害怕被诊断出患有COVID-19，阻碍了寻求医疗保健。缓解措施包括通过电话提供医疗保健，药剂师/药品供应商提供信贷和居民接受慈善或政府支持;这些都是不一致和不充分的。在封锁期间，贫民窟居民寻求非COVID-19医疗保健的能力有所降低。为了鼓励寻求医疗保健，需要就可用的内容以及感染控制是否到位进行明确的沟通。决策者需要确保成本不会上升，从而不公平地使贫民窟社区处于不利地位。应考虑进行远程咨询，以减少面对面接触，并提供心理健康和基于性别的暴力服务。
Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.