{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:27:32Z","timestamp":1753892852983,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The emergence of the COVID-19 has disrupted the health and socioeconomic sectors, particularly in resource-poor settings such as Guinea. Like many sub-Saharan countries, Guinea is facing shortcomings related to its fragile health system and is further affected by the passage of the Ebola virus disease. The pandemic has worsened the socio-economic situation of the poorest people, leading to their exclusion from health care. To promote access to care for the most vulnerable populations, a system was set up to provide care for these people who are victims of health marginalization to promote their access to care. This study aimed to analyze access to health services by vulnerable populations during the COVID-19 pandemic in Guinea through the establishment of a health indigent fund (HIF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a qualitative study to assess the project implementation process. A total of 73 in-depth individual interviews were conducted with beneficiaries, health workers, community health workers and members of the HIF management committee, and a few informal observations and conversions were also conducted in the project intervention areas. The data collected were transcribed and coded using the deductive and inductive approaches with the Nvivo software before applying the thematic analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,987 indigents were identified, of which 1,005 were cared for and 64 referred to all 38 intervention health facilities within the framework of the HIF. All participants appreciated the project's social action to promote access to equitable and quality health care for this population excluded from health care services. In addition, the project has generated waves of compassion and solidarity toward these \u201cdestitute\u201d people whose main barrier to accessing health care remains extreme poverty. A state of poverty that leads some to sell their assets (food or animal reserves) or to go into debt to ensure access to care for their children, considered the most at risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The HIF can be seen as an honest attempt to provide better access to health care for the most vulnerable groups. Some challenges need to be addressed including the current system of acquiring funds before the attempt can be considered scalable.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.1018060","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T10:12:02Z","timestamp":1668679922000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ensuring continuity of care during the COVID-19 pandemic in Guinea: Process evaluation of a health indigent fund"],"prefix":"10.3389","volume":"10","author":[{"given":"Lansana","family":"Barry","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariama","family":"Kouyat\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdoulaye","family":"Sow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willem Van","family":"De Put","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"De Maesschalck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bienvenu Salim","family":"Camara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norohaingo","family":"Adrianaivo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Delamou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"journal-title":"Comptes Nationaux de la Sant\u00e9, 2002","year":"2002","key":"B1"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1472-6963-15-S3-S6","article-title":"From institutionalization of user fees to their abolition in West Africa: a story of pilot projects and public policies","volume":"15","author":"Ridde","year":"2015","journal-title":"BMC Health Serv Res."},{"key":"B3","unstructured":"UNCTAD\/PRESS\/PR\/2021\/0462021"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e0245751","DOI":"10.1371\/journal.pone.0245751","article-title":"Psychosocial impacts of COVID-19 in the Guinean population. An online cross-sectional survey","volume":"16","author":"Tour\u00e9","year":"2021","journal-title":"PLoS ONE."},{"key":"B5","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"425","DOI":"10.3917\/spub.153.0425","article-title":"Arbitrage d'une controverse de politique de sant\u00e9: application d'une d\u00e9marche d\u00e9lib\u00e9rative au Financement bas\u00e9 sur la Performance en Afrique subsaharienne","volume":"27","author":"Manitu","year":"2015","journal-title":"Sant\u00e9 Publique"},{"key":"B7","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1164\/rccm.201506-1064OC","article-title":"Evaluating risk factors for pediatric post-extubation upper airway obstruction using a physiology-based tool","volume":"193","author":"Khemani","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"volume-title":"Comment am\u00e9liorer l'acc\u00e8s aux soins de r\u00e9adaptation pour Les plus pauvres? Evaluation de 3 Fonds d'Equit\u00e9 mis en oeuvre par Handicap International.","year":"2009","author":"Gerbier","key":"B8"},{"key":"B9","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1093\/heapol\/czh003","article-title":"Access to health care for all? User fees plus a Health Equity Fund in Sotnikum, Cambodia","volume":"19","author":"Hardeman","year":"2004","journal-title":"Health Policy Plan."},{"key":"B10","unstructured":"MURIGA en Guin\u00e9e: une exp\u00e9rience de mutualisation des risques li\u00e9s \u00e0 la grossesse et \u00e0 l'accouchement12963\n            NdiayeP\n            KabaS\n            KouroumaM\n            BarryAN\n            BarryA\n            CrielB\n          \n            RichardF\n            WitterS\n            De BrouwereV\n          R\u00e9duire les barri\u00e8res financi\u00e8res aux soins obst\u00e9tricaux dans les pays \u00e0 faibles resources.2008"},{"key":"B11","first-page":"260","volume-title":"Une assurance maladie \u00e0 grande \u00e9chelle pour le secteur informel en Afrique subsaharienne: six ans d'exp\u00e9rience au S\u00e9n\u00e9gal rural 2012\u20132017.","author":"Bossyns","year":"2018"},{"key":"B12","doi-asserted-by":"crossref","first-page":"250","DOI":"10.5040\/9781350222618.ch-014","article-title":"Extending social protection in health through SSE: possibilities and challenges in West Africa","volume-title":"Social and Solidarity Economy: Beyond the Fringe","author":"Fonteneau","year":"2015"},{"key":"B13","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/j.1365-3156.2009.02262.x","article-title":"Community health insurance in sub-Saharan Africa : what operational difficulties hamper its successful development?","volume":"14","author":"Flessa","year":"2009","journal-title":"Trop Med Int Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1093\/heapol\/czaa174","article-title":"Does community-based health insurance improve access to care in sub-Saharan Africa? A rapid review","volume":"36","author":"Artignan","year":"2021","journal-title":"Health Policy Plann."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1016\/S0277-9536(02)00495-1","article-title":"Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?","volume":"57","author":"Criel","year":"2003","journal-title":"Soc Sci Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/heapol\/czaa151","article-title":"Health equity funds as the pathway to universal coverage in Cambodia: care seeking and financial risk protection","volume":"36","author":"Jithitikulchai","year":"2001","journal-title":"Health Policy Plann."},{"key":"B17","unstructured":"CrielB\n            B\u00e2AS\n            KaneF\n            NoirhommeM\n            WaelkensM-P\n          Une Exp\u00e9rience de Protection Sociale en Sant\u00e9 Pour les Plus D\u00e9munis : le Fonds d'indigence de Dar-Na\u00efm en Mauritanie2010"},{"key":"B18","unstructured":"ThomeJ-M\n            PholsenaS\n          ThailandEconomic and Social Commission for AsiaPromoting Sustainable Strategies to Improve Access to Health Care in the Asian and Pacific Region"},{"key":"B19","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1080\/17441690600658792","article-title":"NGO management and health care financing approaches in the Eastern Democratic Republic of the Congo","volume":"1","author":"Dijkzeul","year":"2006","journal-title":"Glob Public Health."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0077382","article-title":"Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo","volume":"8","author":"Gerstl","year":"2013","journal-title":"PloS ONE"},{"journal-title":"Rapport Mondial de Suivi 2017 : La Couverture-Sant\u00e9 Universelle","year":"2017","key":"B21"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1016\/s0277-9536(02)00495-1","article-title":"Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?","volume":"57","author":"Criel","year":"2003","journal-title":"Soc Sci Med."},{"key":"B23","first-page":"1","author":"Noirhomme","year":"2009","journal-title":"Am\u00e9liorer l'acc\u00e8s aux soins des plus pauvres?: le cas des fonds d'\u00e9quit\u00e9."},{"key":"B24","doi-asserted-by":"publisher","first-page":"198","DOI":"10.11604\/pamj.2021.38.198.27115","article-title":"Challenges in healthcare financing for surgery in sub-Saharan Africa","volume":"38","author":"Okoroh","year":"2021","journal-title":"Pan Afr Med J."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1018060\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T10:12:07Z","timestamp":1668679927000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1018060\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,17]]},"references-count":24,"alternative-id":["10.3389\/fpubh.2022.1018060"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.1018060","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2022,11,17]]},"article-number":"1018060"}}