Global health initiatives in Africa - governance, priorities, harmonisation and alignment

BACKGROUND

The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Over the last decade, the African Region has realised improvements in health outcomes as a result of interventions implemented by both governments and development partners. However, alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination.

METHOD

Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research.

RESULTS

GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that basically, earmarking and donor conditions drive funding allocations regardless of countries' priorities. Although studies cite the lack of harmonisation of GHI priorities with national strategies, evidence shows improvements in that area over time. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers to include groups such as civil society organisations (CSOs), with both positive and negative implications. GHI strategies such as co-financing by countries as a condition for support have been positive in achieving sustainability of interventions.

CONCLUSIONS

GHI approaches have not changed substantially over the years but there has been evolution in terms of donor funding and conditions. GHIs still largely operate in a vertical manner, bypassing country systems; they compete for the limited human resources; they influence country policies; and they are not always harmonised with other donors. To maximise returns on GHI support, there is need to ensure that their approaches are more comprehensive as opposed to being selective; to improve GHI country level governance and alignment with countries' changing epidemiologic profiles; and to strengthen their involvement of CSOs.

[«Bouge ta santé à Clichy-sous-Bois»: Cross-sectoral Approach to Physical Activity]

Introduction: Based on the ICAPS approach, funded by the Regional Health Agency of Île-de-France and the Mutualité Française Île-de-France, a programme to promote the health benefits of physical activity has been conducted since 2012 in Clichy-sous-Bois, a town with major health inequalities. The objective was to implement intersectoral local projects designed to encourage physical activity among young people.Method: An initial assessment identified the lack of collaboration between sport, social, education and health stakeholders. Seven priority work areas were highlighted: creation of municipal synergy, training of local actors in the implementation of “Physical Activity and Health” joint projects, creation of local courses to identify / inform / advise and guide residents towards adapted physical activities, implementation of programmes combining physical activity and a balanced diet in primary and secondary schools, community centres and municipal school sports.Results: Regular meetings between local partners/actors facilitate the implementation of many projects that meet the expectations/needs of residents and professionals. For example, in a community centre, women and children learned to ride a bike, mediators passed a diploma to supervise groups, outings were organized and the planning authority/department decided to study the feasibility of building cycle paths.Conclusion: The sharing of ideas and local resources constitutes a lever to encourage physical activity and reduces social inequalities in health. A partnership culture between sport, social, education and health structures must be developed in order to integrate physical activity as one of the Local Health Contract’s priorities.

Assessment of health-related activities of non-governmental organizations in Rajasthan, India

Public-private partnerships are being encouraged as a part of the comprehensive development framework. We assessed the work profiles of registered non-governmental organizations (NGO) working on health-related activities in Udaipur district, Rajasthan, India by conducting a 16-item pretested questionnaire study. The questions related to various facets of their activities, their scope and process of evaluation. Of the 66 NGOs selected, most (28 [42%]) were working among the general population and had a partnership with a public entity (43 [65.1%]). The running capital of most NGOs (27 [41%]) was `100 000-2 000 000. Only 25 (38%) had a monitoring system to evaluate their progress. There are immense opportunities for NGOs in the health sector in Udaipur. The need of the hour is to encourage various public and private institutions to work together to achieve excellence in healthcare and service delivery.

Why the AMA is (now) worth joining

The AMA is partnering with several public health-oriented organizations, including the Centers for Disease Control and Prevention, to reach out to individuals with diabetes, cardiovascular disease, and cardiac risk factors to promote primary and secondary prevention strategies at a population level.

Planned approaches to business and school partnerships. Does it make a difference? The business perspective

In many countries, schools are encouraged to link with business to add authenticity to learning. The number of these business-school partnerships has shown a marked increase over the last twenty years. Traditionally researchers investigating these partnerships have focussed on the schools' perspectives (Du, Bhattacharya, & Sen, 2010, pp. 32-33), however this New Zealand research has focused solely on the business perspective of established school partnerships. The study used a mixed methods approach utilising both online survey and semi-structured interviews. Ten out of the forty participating businesses surveyed used a brokering organisation as a way of developing and maintaining these partnerships and some developed rationales to support the partnership. This study investigated the value of using brokering organisations, rationales and designated staff to support business-school partnerships. Findings indicate that brokers and designated staff play a very effective role in enhancing business-school links, and more benefits are perceived when a rationale has been established. It is anticipated that these findings will support the development and success of business-school partnerships.

Delivering a research-enabled multistakeholder partnership for enhanced patient care at a population level: The Northern Ireland Comprehensive Cancer Program

The last 20 years have seen significant advances in cancer care in Northern Ireland, leading to measureable improvements in patient outcomes. Crucial to this transformation has been an ethos that recognizes the primacy role of research in effecting heath care change. The authors' model of a cross‐sectoral partnership that unites patients, scientists, health care professionals, hospital trusts, bioindustry, and government agencies can be truly transformative, empowering tripartite clinical‐academic‐industry efforts that have already yielded significant benefit and will continue to inform strategy and its implementation going forward.

Policy and Practice Model of Public-Private Partnership in Public Hospitals during the New Medical Reform Period

Purpose: Since the beginning of the new health care reform in 2009, the state has illustrated the top design and health care improvement strategy of "encouraging social capital to participate in the reform of public hospitals", in accordance with the program's general objective. All areas have been explored on this matter and the results obtained are very interesting, not to mention the acquisition of significant experience. At present, the existing business models in China are mainly the following: Rebuild-Operate-Transfer (ROT), franchise business model, Build-Own-Operate-Transfer (BOOT) model, mixed ownership model and business insurance model. This paper introduces a variety of alternative models, and provides a simple analysis of the advantages and disadvantages. Moreover, for the reform of public hospitals, the government shares should go into franchise mode or mixed ownership, and all property rights should be transferred to the government to ensure the conservation and proliferation of state-owned assets.

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

[On development of partnership between Rospotrebnadzor research institutions and socially responsible business community for sanitary epidemiologic well-being of population]

The article covers systemic approaches to managing risks for public health, and development of partnership between Rospotrebnadzor institutions and socially responsible business community.

EpiAssist: Service-learning in public health education

BACKGROUND

Although public health degree programs typically require practica and other field experiences, service-learning courses, with a focus on civic engagement and the application of classroom learning in real world settings, can go beyond these requirements and provide benefits to students and community-based practice partners. The goal of this paper is to assess potential benefits of service-learning programs for both graduate-level public health students and state and local public health agency partners.

METHODS

EpiAssist is a new service-learning program developed at the School of Public Health of the Texas A and M University Health Science Center, USA, in January 2015. EpiAssist was integrated into a new course, Methods in Field Epidemiology. The integration of service-learning was guided by a partnership with the Texas A and M Center for Teaching Excellence.

RESULTS

State, regional, and local public health partners requested EpiAssist via email or telephone. A listserv was used to recruit student volunteers to meet requests. 54 of 86 registered EpiAssist students (63%) participated in at least one of ten service-learning and three training activities between January and June, 2015. Service-learning activities included questionnaire development, in-person and telephone data collection, and data analysis. Training topics for students included the Epi Info™ software, community assessment and communicable disease reporting. Students and partner organizations provided generally positive assessments of this service learning program through an online evaluation.

DISCUSSION

Service-learning provides students with enhanced classroom learning through applied public health experience in state, regional and local health departments. These experiences provide both needed surge capacity to public health departments and valuable hands-on field experience to students.

Reaching the unreached: Building resilience through engagement with diverse communities

The Department of Homeland Security Center for Faith-based & Neighborhood Partnerships (DHS Center) is one of 13 federal centres whose mandate is to engage faith-based and community groups with governments in the delivery of human services. Working alongside local jurisdictions, over the past five years, the DHS Center developed the Building Resilience with Diverse Communities (BRDC) engagement process to improve relationships with faith-based and community organisations and to 'reach unreached' populations in emergency preparedness, response, recovery and mitigation. BRDC works to improve community resilience by engaging the 'whole community' through its seven-stage process. The BRDC process has been successfully implemented in Los Angeles, California, Lakewood, New Jersey and in varying degrees in other communities. The initiative demonstrates that emergency management can adapt the BRDC process to effectively integrate faith-based and community groups into their plans and processes, leverage existing resources and, by doing so, increase resilience with some of the hardest to reach and unreached populations in their jurisdictions.

MonDossierMedical.ch - The Personal Health Record for Every Geneva Citizen

MonDossierMedical.ch is a project led by the canton of Geneva, making it possible for every patient to access his own electronic health record (EHR) and to share the medical files with his doctors. It was introduced across the canton in mid-2013, and provided to all patients free of charge. It is based on the first Swiss-wide eHealth-compliant pilot project "e-toile". The canton of Geneva developed "e-toile" as a public-private partnership together with Swiss Post and it was launched in 2011 in some of the canton's municipalities. Back then, Geneva's EHR represented the first Swiss attempt to link all healthcare professionals in the treatment chain. Today, it serves more than 6,000 patients and 400 physicians. This number is growing regularly, as well as the health care institutions (private hospitals, labs) joining the community. The project fits into the national strategy of Switzerland in establishing a national EHR by linking regional implementations like MonDossierMedical.

Medical Director Responsibilities to the ESRD Network

The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years. The Conditions for Coverage require dialysis providers to participate in Network activities, and failure to do so can be the basis for sanctions against the provider. However, the Networks attempt to foster a collegial relationship with dialysis facilities by offering tools, educational activities, and other resources to assist the facilities in meeting the evolving requirements by the Centers for Medicare and Medicaid Services on the basis of national aims and domains for quality improvement in health care that transcend the ESRD program. Because of his/her responsibility for implementing the quality assessment and performance improvement activities in the facility, the medical director has much to gain by actively participating in Network activities, especially those focused on quality, safety, patient grievance, patient engagement, and coordination of care. Membership on Network committees can also foster the professional growth of the medical director through participation in quality improvement activity development and implementation, authorship of articles in peer-reviewed journals, creation of educational tools and presentations, and application of Network-sponsored materials to improve patient outcomes, engagement, and satisfaction in the medical director's facility. The improvement of care of patients on dialysis will be beneficial to the facility in achieving its goals of quality, safety, and financial viability.

[THE ORGANIZATION OF REHABILITATION CARE OF POPULATION USING INNOVATIVE MEDICAL ORGANIZATIONAL TECHNOLOGIES AND PRINCIPLES OF PUBLIC PRIVATE PARTNERSHIP]

The article considers actual problems of actual stage of development of health care related to using innovative approaches to organization and management of rehabilitation care ofpopulation. The rehabilitation is most important direction of medical sector supporting complex of services in closed cycle of rendering medical care to population and significant social economic effects. The capacity and extreme unprofitability of rehabilitation services determine necessity of searching alternative forms of organization of this type of care and financing including mechanisms of public-private partnership. The experience is presented related to involvement of resources of non-public medical organizations for implementing public commitments on rendering qualitative rehabilitation services to population using innovative medical organizational technologies.

Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda

IMPORTANCE

Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD.

OBJECTIVE

We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD.

EVIDENCE REVIEW

Interviews with key personnel and review of administrative records were conducted to obtain qualitative and quantitative data on the recruitment of clinical personnel, procurement of equipment, and program finances. The number of surgical cases completed and the resultant clinical outcomes are reviewed.

FINDINGS

From 2008 to 2013, six annual visits were completed. A total of 128 prosthetic valves have been implanted in 86 complex patients in New York Heart Association (NYHA) class III or IV heart failure, with excellent clinical outcomes (5 % 30-day mortality). Postoperative complications included a cerebrovascular accident (n = 1) and hemorrhage, requiring reoperation (n = 2). All procedures were performed with participation of local personnel.

CONCLUSIONS AND RELEVANCE

This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.

["MonDossierMedical.ch": an efficient tool for sharing medical data between patients and doctors]

"MonDossierMedical.ch" is a project led by the canton of Geneva, making it possible for every patient to access his own electronic health record (EHR) and to share the medical files with his doctors. It was introduced across the canton in mid-2013, and provided to all patients free of charge. it is based on the first Swiss-wide e-health-compliant pilot project "e-toile". The canton of Geneva developed "e-toile" as a public-private partnership together with Swiss Post and it was launched in 2009 in some of the canton's municipalities. Back then, Geneva's EHR represented the first Swiss attempt to link all healthcare professionals in the treatment chain. Today, it serves more than 4,600 patients and 380 physicians. This number is growing regularly, as well as the health care institutions (physicians, private hospitals, labs) joining the community. Added value tools, such as a shared care plan and a shared medication list will make the platform even more attractive.