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Background: This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality.Objective: The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions – Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadavanatges of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR.Method: An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique,South Africa, Zambia and Zimbabwe.Results: Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more.Conclusion: A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels.

Background Sub-Saharan Africa is the world region with the greatest number of people eligible to receive antiretroviral treatment (ART). Less frequent dispensing of ART and community-based ART-delivery models are potential strategies to reduce the load on overburdened healthcare facilities and reduce the barriers for patients to access treatment. However, no large-scale trials have been conducted investigating patient outcomes or evaluating the cost-effectiveness of extended ART-dispensing intervals within community ART-delivery models. This trial will assess the clinical effectiveness, cost-effectiveness and acceptability of providing ART refills on a 3 vs. a 6-monthly basis within community ART-refill groups (CARGs) for stable patients in Zimbabwe. Methods In this pragmatic, three-arm, parallel, unblinded, cluster-randomized non-inferiority trial, 30 clusters (healthcare facilities and associated CARGs) are allocated using stratified randomization in a 1:1:1 ratio to either (1) ART refills supplied 3-monthly from the health facility (control arm), (2) ART refills supplied 3-monthly within CARGs, or (3) ART refills supplied 6-monthly within CARGs. A CARG consists of 6–12 stable patients who meet in the community to receive ART refills and who provide support to one another. Stable adult ART patients with a baseline viral load < 1000 copies/ml will be invited to participate (1920 participants per arm). The primary outcome is the proportion of participants alive and retained in care 12 months after enrollment. Secondary outcomes (measured at 12 and 24 months) are the proportions achieving virological suppression, average provider cost per participant, provider cost per participant retained, cost per participant retained with virological suppression, and average patient-level costs to access treatment. Qualitative research will assess the acceptability of extended ART-dispensing intervals within CARGs to both providers and patients, and indicators of potential facility-level decongestion due to the interventions will be assessed. Discussion Cost-effective health system models that sustain high levels of patient retention are urgently needed to accommodate the large numbers of stable ART patients in sub-Saharan Africa. This will be the first trial to evaluate extended ART-dispensing intervals within a community-based ART distribution model, and results are intended to inform national and regional policy regarding their potential benefits to both the healthcare system and patients. Trial registration ClinicalTrials.gov, ID: NCT03238846 . Registered on 27 July 2017.

Background : This article provided an analysis of gender inequality, health expenditure and its relationship to maternal mortality. Objective : The objective of this article was to explore gender inequality and its relationship with health expenditure and maternal mortality in sub-Saharan Africa (SSA). A unique analysis was used to correlate the Gender Inequality Index (GII), Health Expenditure and Maternal Mortality Ratio (MMR). The GII captured inequalities across three dimensions - Reproductive health, Women empowerment and Labour force participation between men and women. The GII is a composite index introduced by the UNDP in 2010 and corrects for the disadvantages of the other gender indices. Although the GII incorporates MMR in its calculation, it should not be taken as a substitute for, but rather as complementary to, the MMR. Method : An exploratory and descriptive design to a secondary documentary review using quantitative data and qualitative information was used. The article referred to sub-Saharan Africa, but seven countries were purposively selected for an in-depth analysis based on the availability of data. The countries selected were Angola, Botswana, Malawi, Mozambique, South Africa, Zambia and Zimbabwe. Results : Countries with high gender inequality captured by the gender inequality index were associated with high maternal mortality ratios as compared with countries with lower gender inequality, whilst countries that spend less on health were associated with higher maternal deaths than countries that spend more. Conclusion : A potential relationship exists between gender inequality, health expenditure, and maternal mortality. Gender inequalities are systematic and occur at the macro, societal and household levels. L'inégalité entre les sexes, les dépenses de santé et la mortalité maternelle en Afrique subsaharienne : analyse des données secondaires Contexte : Cet article propose une analyse de l'inégalité entre les sexes et de sa relation aux dépenses de santé et à la mortalité maternelle. Objectif : L'objectif de cet article était d'étudier l'inégalité entre les sexes et sa relation aux dépenses de santé et à la mortalité maternelle en Afrique subsaharienne. Une analyse unique a été utilisée afin de corréler l'indice d'inégalité de genre (IIG), les dépenses de santé et le taux de mortalité maternelle (TMM). L'IIG a permis de déceler des inégalité dans trois domaines: la santé reproductive, l'autonomisation des femmes et les différences de participation à la main-d'oeuvre entre les hommes et les femmes. L'IIG est un indice composite introduit par le PNUD en 2010 et permet de paliers les inconvénients associés aux autres indices relatifs au genre. Bien que l'IIG intègre le TMM dans son calcul, il convient de ne pas le considérer comme un substitut au TMM, mais plutôt comme un complément de celui-ci. Méthode : Une étude exploratoire et descriptive associée à une étude documentaire secondaire utilisant des informations quantitatives et qualitatives a été réalisée. L'article fait référence à l'Afrique subsaharienne, mais sept pays ont volontairement été sélectionnés en fonction de la disponibilité des données afin de procéder à une analyse approfondie. Ces pays sont l'Angola, le Botswana, le Malawi, le Mozambique, l'Afrique du Sud, la Zambie et le Zimbabwe. Résultats : Les pays souffrant d'une forte inégalité entre les sexes, tel qu'indiqué par l'indice d'inégalité de genre, étaient associés à de forts taux de mortalité maternelle, par rapport aux pays présentant une inégalité entre les sexes moindre ; de leur côté, les pays consacrant moins d'argent à la santé étaient associés à des taux de mortalité maternelle supérieurs aux taux rencontrés dans les pays oû les dépenses de santé étaient supérieures. Conclusion : Une relation pourrait exister entre inégalité entre les sexes, dépenses de santé et mortalité maternelle. Les inégalités entre les sexes sont systématiques, et se produisent au niveau macro, de la société et du foyer.