Article Text
Abstract
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.
- health policy
- health systems
- public health
- other infection
- disease
- disorder
- or injury
- qualitative study
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Footnotes
Handling editor Seye Abimbola
Twitter @GodwinYeboah, @shukrifmohamed, @j_p_albuquerque, @GrantTregonning
Contributors SAKSA, MA, KA, PB, Y-FC, NC, FF, FG, BH, PK, RL, AO, NR, JS, SS, SIW, RW and GY conceived and wrote the first draft of the paper. All authors contributed to the interpretation and subsequent revision of the paper. All authors approved the final version of the manuscript.
Funding This research was funded by the National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval All participants provided informed consent to participate before taking part in the study. The NIHR Global Health Research Unit on Improving Health in Slums was granted full ethical approval by the University of Warwick Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2043 AM01), the Ministry of Health, Lagos State Government (LSMH/2695/11/259), Research Ethics Committee of the Oyo State Ministry of Health (AD13/479/657), Amref Health Africa (AMREFESRC P440/2018), the National Bioethics Committee Pakistan (4-87/NBC-298/18/RDC3530) and the Bangladesh Medical Research Council BMRC/NREC/2016-2019/759).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No additional data are available.