Global Health Analysis & Mapping of Gaps

Building a comprehensive understanding of socio-economic and human rights factors to disease outbreaks, drawing upon and partnering with communities most affected by diseases.

Focus areas:
Pandemic preparedness
Access to medicines, diagnostics, and vaccines
Assessments on health systems deficits

Related projects:

Researching barriers to diagnostics access in Madagascar

This rapid assessment found a complex diagnostics environment marked by high out-of-pocket spending for diagnostics relative to income, relatively long distances to get to primary healthcare centres, doctors prescribing antibiotics with incomplete diagnostics regimens or no diagnostics at all, poor clinical practices on diagnostics (such as use of inaccurate terminology), and insufficient data about stockouts. We noted that because rapid malaria tests are provided for free, doctors offer these more regularly, but upon a negative result are unable to recommend additional tests because of the cost barrier. We also found that rural communities overwhelmingly wanted more accessible and affordable testing – and perceived that people they knew were dying from ‘unknown diseases’.

Urgent reforms are needed. Based on our research, we proposed the following:

  • Universal health coverage for diagnostics | Tests that are fully funded by the state, and made available in all public health facilities.
  • Better clinical practice around diagnostics | Including accurate and respectful communication of confirmed diagnoses to patients and avoiding prescription of antibiotics if diagnostics regimens are incomplete.
  • Trained & salaried community health workers bringing rapid tests to communities | Poor road infrastructure means that a 5.5km trek to the nearest primary healthcare centre is a deterrent for access to tests.
  • Facilities with point-of-care testing closer to rural communities | As aforementioned, there is poor road infrastructure and travelling to healthcare centres often takes an entire day, with many taking time off from informal jobs and losing a days’ income.

Increasing access to COVID-19 and MPOX diagnostics

While there has been much publicised about the inequities in access to COVID-19 vaccines, dubbed in some outlets as ‘vaccine apartheid’ due to the overwhelming disparity in access between HICs and LMICs, relatively little has been written about diagnostics apartheid and the massive gaps in access faced by people living in and from LMICs. Furthermore, in MPOX, several countries have faced MPOX outbreaks for decades such as DRC, Central African Republic, and Nigeria, but continue to have less testing than HICs that only recently have had outbreaks.

Supported by the rawing upon the expertise of key actors in the diagnostics space, including the WHO, FIND, Global Access Diagnostics, Nigeria CDC, and Africa CDC, we unpacked what barriers to affordability and accessibility existed through both pandemics, and what needs to be done to ensure equity in diagnostics in future pandemics.

Key recommendations include:

  • To establish robust multiyear integrated diagnostics country strategies in view of the upcoming 2023 WHO diagnostics resolution. These should include, inter alia, planning for income protection for those in the informal sector for future pandemics, local production, regional collaboration on regulatory processes, and community-led advocacy, demand creation, expertise on quantification and forecasting, and testing literacy.
  • To establish/strengthen regional regulatory processes to ensure rapid, optimal, and equitable access to diagnostics in communities.
  • To emphasise technology transfer as an essential component of pandemic aid, including through investments on local production of pandemic tools in The World Bank Pandemic Fund and other related aid.
  • To build income protection funds as a crucial measure in diagnostics uptake strategies and in pandemic planning strategies, and to prioritise those in the informal sector.
  • To invest in and place priority on advocacy and community-led demand creation in LMICs earlier in pandemics, to ensure equitable uptake, affordability, and rights-based approaches in access to pandemic tools.
  • Rights-based testing approaches. This may require a shift in philosophies from prioritising PCR at all costs (which may restrict availability only to those close to laboratories and health facilities) to a pragmatic balance between PCR access and rapid antigen tests to ensure widespread access and self-empowerment in communities about their own healthcare – or investments in new handheld/point-of-care PCR platforms.

Mapping COVID-19 access gaps from 14 countries and territories

This August 2022 report by Matahari Global, with the support of the International Treatment Preparedness Coalition and the People’s Vaccine Alliance, assesses progress on access to COVID-19 tools across 14 countries: Bangladesh, Democratic Republic of the Congo, Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Perú, Senegal, Somalia (and de facto state Somaliland), Uganda and Ukraine.

Matahari collaborated with local partners in DRC, Madagascar, and Nigeria to obtain insights from rural and semi-rural areas on their levels of access to COVID-19 tools, and conducted interviews with key informants in all other countries. The report found, inter alia, that:

  1. there were numerous structural barriers to accessing vaccines, including proximity to vaccination centers and a distrust of government;
  2. that there was no free access to COVID-19 rapid self-tests across all countries;
  3. that community health workers were essential to the response but were largely unpaid;
  4. there was poor oxygen plant maintenance planning by governments; and
  5. Clinicians and health workers in rural areas in Haiti, Madagascar, and Nigeria reported never having heard of novel antivirals for COVID-19 nor the brand name “Paxlovid” – pointing to the need for communications infrastructure and organisation.