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Shawar YR, Djellouli N, Akter K, Payne W, Kinney M, Mwaba K, Seruwagi G, English M, Marchant T, Shiffman J, Colbourn T. Factors shaping network emergence: A cross-country comparison of quality of care networks in Bangladesh, Ethiopia, Malawi, and Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001839. [PMID: 39042649 PMCID: PMC11265678 DOI: 10.1371/journal.pgph.0001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2024] [Indexed: 07/25/2024]
Abstract
The Quality-of-Care Network (QCN) was conceptualized by the World Health Organization (WHO) and other global partners to facilitate learning on and improve quality of care for maternal and newborn health within and across low and middle-income countries. However, there was significant variance in the speed and extent to which QCN formed in the involved countries. This paper investigates the factors that shaped QCN's differential emergence in Bangladesh, Ethiopia, Malawi, and Uganda. Drawing on network scholarship, we conducted a replicated case study of the four country cases and triangulated several sources of data, including a document review, observations of national-level and district level meetings, and key informant interviews in each country and at the global level. Thematic coding was performed in NVivo 12. We find that QCN emerged most quickly and robustly in Bangladesh, followed by Ethiopia, then Uganda, and slowest and with least institutionalization in Malawi. Factors connected to the policy environment and network features explained variance in network emergence. With respect to the policy environment, pre-existing resources and initiatives dedicated to maternal and newborn health and quality improvement, strong data and health system capacity, and national commitment to advancing on synergistic goals were crucial drivers to QCN's emergence. With respect to the features of the network itself, the embedding of QCN leadership in powerful agencies with pre-existing coordination structures and trusting relationships with key stakeholders, inclusive network membership, and effective individual national and local leadership were also crucial in explaining QCN's speed and quality of emergence across countries. Studying QCN emergence provides critical insights as to why well-intentioned top-down global health networks may not materialize in some country contexts and have relatively quick uptake in others, and has implications for a network's perceived legitimacy and ultimate effectiveness in producing stated objectives.
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Affiliation(s)
- Yusra Ribhi Shawar
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
- School of Advanced International Studies, John Hopkins University, Washington, District of Columbia, United States of America
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Will Payne
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Jeremy Shiffman
- Department of International Health, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
- School of Advanced International Studies, John Hopkins University, Washington, District of Columbia, United States of America
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
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Parashar R, Nanda S, Smith SL, Shroff Z, Shawar YR, Hamunakwadi DL, Shiffman J. Comparing priority received by global health issues: a measurement framework applied to tuberculosis, malaria, diarrhoeal diseases and dengue fever. BMJ Glob Health 2024; 9:e014884. [PMID: 38977402 PMCID: PMC11256119 DOI: 10.1136/bmjgh-2023-014884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION The relative priority received by issues in global health agendas is subjected to impressionistic claims in the absence of objective methods of assessment of priority. To build an approach for conducting structured assessments of comparative priority health issues receive, we expand the public arenas model (2021) and offer a framework for future assessments of health issue priority in global and national health agendas. METHODS We aimed to develop a more comprehensive set of measures for conducting multiyear priority comparisons of health issues in six agenda-setting arenas by identifying possible measures and data sources, selecting indicators based on feasibility and comparability of measures and gathering the data on selected indicators. We applied these measures to four communicable diseases-tuberculosis (TB), malaria, diarrhoeal diseases and dengue fever-given their differing impressionistic claims of priority. Where possible, we analysed the annual and/or 5-year trends from 2000 through 2022. RESULTS We observed that TB and malaria received the highest priority for most periods in the past two decades in most arenas. However, a stagnation in development funding for these two conditions over the last 8-10 years may have fuelled the neglect claims. Despite having a higher disease burden, diarrhoea has been slipping in global priority with reduced spending, fewer clinical trials and stagnating publications. Dengue remains a low-priority condition but has witnessed a sharp rise in attention from the pharmaceutical industry. DISCUSSIONS We expanded the arenas model by including a transnational arena (international representation) and additional measurements for various arenas. This analysis presents an approach to enable comparative trend analysis of the markers of agenda status over a multiyear period. More such analyses can bring much-desired objectivity in understanding how attention to global or national health issues changes over time in different arenas, potentiating a more equitable allocation of resources.
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Affiliation(s)
- Rakesh Parashar
- Health Systems and Policy, Independent Consultant, New Delhi, Delhi, India
- Global Business School of Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Sharmishtha Nanda
- Independent Consultant, Delhi, India
- International Center for Research on Women Asia Regional Office, New Delhi, India
| | - Stephanie L Smith
- School of Public and International Affairs, Virginia Tech, Arlington, Texas, USA
| | - Zubin Shroff
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Yusra R Shawar
- International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jeremy Shiffman
- International Health, Johns Hopkins University, Baltimore, Maryland, USA
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Nthumba PM. Global Surgery: The Challenges and Strategies to Win a War That Must Be Won. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5953. [PMID: 38962157 PMCID: PMC11221857 DOI: 10.1097/gox.0000000000005953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
Background Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author. Methods The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline. Results A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground. Conclusions Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
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Affiliation(s)
- Peter M. Nthumba
- From Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, Kijabe, Kenya
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Nthumba PM, Odhiambo M, Pusic A, Kamau S, Rohde C, Onyango O, Gosman A, Vyas R, Nthumba MN. The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5903. [PMID: 38881962 PMCID: PMC11177832 DOI: 10.1097/gox.0000000000005903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/01/2024] [Indexed: 06/18/2024]
Abstract
Background Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future. Methods The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills. Results Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists. Conclusions In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.
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Affiliation(s)
- Peter M Nthumba
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Moses Odhiambo
- From the Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- EACH Research, University of Nairobi, Nairobi, Kenya
| | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Stephen Kamau
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christine Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, N.Y
| | - Onesmus Onyango
- EACH Research, University of Nairobi, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Amanda Gosman
- Department of Plastic Surgery, UC San Diego School of Medicine, Calif
| | - Raj Vyas
- Department of Plastic Surgery, UC Irvine, School of Medicine, Irvine, Calif
| | - Michelle N Nthumba
- EACH Research, University of Nairobi, Nairobi, Kenya
- African Women's Studies Centre, University of Nairobi, Nairobi, Kenya
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Elnakib S, Jackson C, Lalani U, Shawar YR, Bennett S. How integration of refugees into national health systems became a global priority: a qualitative policy analysis. Confl Health 2024; 18:31. [PMID: 38622721 PMCID: PMC11017473 DOI: 10.1186/s13031-024-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Despite a long history of political discourse around refugee integration, it wasn't until 2016 that this issue emerged as a global political priority. Limited research has examined the evolution of policies of global actors around health service provision to refugees and how refugee integration into health systems came onto the global agenda. This study seeks to fill this gap. METHODS Drawing on a document review of 20 peer-reviewed articles, 46 global policies and reports, and 18 semi-structured interviews with actors representing various bilateral, multilateral and non-governmental organizations involved with refugee health policy and funding, we analyze factors that have shaped the global policy priority of integration. We use the Shiffman and Smith Policy Framework on determinants of political priority to organize our findings. RESULTS Several important factors generated global priority for refugee integration into national health systems. Employing the above-mentioned framework, actor power increased due to network expansion through collaborations between humanitarian and development actors. Ideas took hold through the framing of integration as a human rights and responsibility sharing. While political context was influenced through several global movements, it was ultimately the influx of Syrian refugees into Europe and the increasing securitization of the refugee crisis that led to key policies, and critically, global funding to support integration within refugee hosting nations. Finally, issue characteristics, namely the magnitude of the global refugee crisis, its protractedness and the increasing urbanicity of refugee inflows, led integration to emerge as a manageable solution. CONCLUSION The past decade has seen a substantial reframing of refugee integration, along with increased financing sources and increased collaboration, explains this shift towards their integration into health systems. However, despite the emergence of integration as a global political priority, the extent to which efforts around integration have translated into action at the national level remains uncertain.
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Affiliation(s)
- Shatha Elnakib
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Caitlin Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yusra Ribhi Shawar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Washington, DC, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Gomes Z, Lee GS, Mesfin S, Rocha R, Vervoort D. Viral cardiovascular surgical diseases: global burdens, challenges and opportunities. Future Cardiol 2024; 20:229-239. [PMID: 39049768 DOI: 10.1080/14796678.2024.2348382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/24/2024] [Indexed: 07/27/2024] Open
Abstract
Globally, more than one billion people are vulnerable to neglected tropical diseases, many of which have viral origins and cardiovascular implications. Access to cardiovascular care is limited in countries where these conditions are endemic. Six billion people lack access to safe, timely and affordable cardiac surgical care, whereby over 100 countries and territories lack a single cardiac surgeon. Moreover, while clinically unique, the surgical consequences of neglected cardiovascular diseases with viral origins have been poorly described in the current literature. This review provides an overview of the global burden of viral cardiovascular disease, describes access to cardiac surgical care in regions where these conditions are endemic, and further highlights surgical consequences and considerations to manage patients requiring cardiac surgical care.
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Affiliation(s)
- Zoya Gomes
- Faculty of Medicine, Dalhousie University, Halifax, Nova B3H 4R2, Scotia, B3H 4R2, Canada
| | - Grace S Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, M5S 1A1, Ontario, M5S 1A1, Canada
| | - Samuel Mesfin
- College of Health Sciences, Addis Ababa University, Addis NBH1, Ababa, NBH1, Ethiopia
| | - Rodolfo Rocha
- Division of Cardiac Surgery, University of Toronto, Toronto, M5S 1A1, Ontario, M5S 1A1, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, M5S 1A1, Ontario, M5S 1A1, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, M5T 3M6, M5T 3M6, Ontario,Canada
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Vervoort D, Elfaki LA, Servito M, Herrera-Morales KY, Kanyepi K. Redefining global cardiac surgery through an intersectionality lens. MEDICAL HUMANITIES 2024; 50:109-115. [PMID: 38388185 DOI: 10.1136/medhum-2023-012801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of cardiovascular disease and disparities in access to care vary widely based on sociodemographic characteristics, including but not limited to geography, sex, gender, race, ethnicity, indigeneity, socioeconomic status and age. To date, the majority of cardiovascular, global health and global surgical research has lacked intersectionality lenses and methodologies to better understand access to care at the intersection of multiple identities and traditions. As such, global (cardiac) surgical definitions and health system interventions have been rooted in reductionism, focusing, at most, on singular sociodemographic characteristics. In this article, we evaluate barriers in global access to cardiac surgery based on existing intersectionality themes and literature. We further examine intersectionality methodologies to study access to cardiovascular care and cardiac surgery and seek to redefine the definition of 'global cardiac surgery' through an intersectionality lens.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lina A Elfaki
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Ezekannagha O, Drimie S, Von Fintel D, Maziya-Dixon B, Mbhenyane X. A Qualitative Exploratory Study of the Political Commitment for Nutrition Programming: A Case Study of Anambra and Kebbi States of Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:175. [PMID: 38397666 PMCID: PMC10888008 DOI: 10.3390/ijerph21020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
In Nigeria, varying levels of malnutrition across states present a critical challenge to public health, demanding tailored policy responses. This paper delves into the specific issues and dynamics influencing nutrition programs in the country. Advocating for nutrition-sensitive actions requires analyzing context-specific political commitment. This article presents a case study on two Nigerian states with varying malnutrition profiles to explore the political economy of nutrition. The study used stakeholder analysis, in-depth interviews, and semi-structured interviews through workshops, incorporating the Political Commitment Rapid Assessment Tool. The objective was to measure political commitment, the window of opportunity for action, and stakeholder analysis. The results showed that despite having a significant child malnutrition problem, Kebbi State received a high political commitment to nutrition, with proportions ranging from 0.67 to 1 in each of the six domains measured. On the other hand, Anambra State, where malnutrition was less severe, had varying commitment levels. Institutional commitment was marginally high (0.67), expressed commitment was high (0.71), and budgetary commitment was lower at 0.33. Kebbi had better support for programs dependent on foreign donors than Anambra. Both states need to use media to increase awareness about nutrition issues. When the nutrition situation is severe, foreign donors' influence grows. In conclusion, there are opportunities for strategic framing and advocacy of the nutrition profile of the states. Local state media can be effective, and institutional coordination committees that include various sectors already facilitate commitment to nutrition actions. However, individual, uncoordinated sectoral action can counterbalance the benefits of these committees. Further possibilities to generate political commitment for nutrition in the states are available. This study not only offers insights into the effectiveness of political strategies in addressing malnutrition but also lays the groundwork for future research and provides actionable recommendations for government policymaking.
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Affiliation(s)
- Oluchi Ezekannagha
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
- International Institute of Tropical Agriculture, Ibadan 200001, Nigeria
- CGIAR System Organization, c/o Alliance of Bioversity and CIAT, 00153 Rome, Italy
| | - Scott Drimie
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
| | - Dieter Von Fintel
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
| | | | - Xikombiso Mbhenyane
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Tygerberg Campus, Stellenbosch University, Cape Town 8000, South Africa
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Wu D, Low N, Hawkes SJ. Understanding the factors affecting global political priority for controlling sexually transmitted infections: a qualitative policy analysis. BMJ Glob Health 2024; 9:e014237. [PMID: 38262682 PMCID: PMC10823925 DOI: 10.1136/bmjgh-2023-014237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are a significant public health challenge, but there is a perceived lack of political priority in addressing STIs as a global health issue. Our study aimed to understand the determinants of global political priority for STIs since the 1980s and to discern implications for future prioritisation. METHODS Through semistructured interviews from July 2021 to February 2022, we engaged 20 key stakeholders (8 women, 12 men) from academia, United Nations agencies, international non-governmental organisations, philanthropic organisations and national public health agencies. A published policy framework was employed for thematic analysis, and findings triangulated with relevant literature and policy documents. We examined issue characteristics, prevailing ideas, actor power dynamics and political contexts. RESULTS A contrast in perspectives before and after the year 2000 emerged. STI control was high on the global health agenda during the late 1980s and 1990s, as a means to control HIV. A strong policy community agreed on evidence about the high burden of STIs and that STI management could reduce the incidence of HIV. The level of importance decreased when further research evidence did not find an impact of STI control interventions on HIV incidence. Since 2000, cohesion in the STI community has decreased. New framing for broad STI control has not emerged. Interventions that have been funded, such as human papillomavirus vaccination and congenital syphilis elimination have been framed as cancer control or improving newborn survival, rather than as STI control. CONCLUSION Globally, the perceived decline in STI control priority might stem from discrepancies between investment choices and experts' views on STI priorities. Addressing STIs requires understanding the intertwined nature of politics and empirical evidence in resource allocation. The ascent of universal health coverage presents an opportunity for integrated STI strategies but high-quality care, sustainable funding and strategic coordination are essential.
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Affiliation(s)
- Dadong Wu
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
- Center for World Health Organization Studies, Southern Medical University, Guangzhou, China
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sarah J Hawkes
- Institute for Global Health, University College London, London, UK
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Shapiro LM, Chang J, Fox PM, Kozin S, Chung KC, Dyer GS, Fufa D, Leversedge F, Katarincic J, Kamal R. The Development and Validation of Data Elements and Process Steps for an Electronic Health Record for Hand Surgery Outreach Trips. J Hand Microsurg 2023; 15:358-364. [PMID: 38152677 PMCID: PMC10751199 DOI: 10.1055/s-0042-1749465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips. Methods We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step. Results In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs. Conclusion This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Paige M. Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Scott Kozin
- Department of Orthopaedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - George S.M. Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Duretti Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, United States
| | - Fraser Leversedge
- Department of Orthopaedic Surgery, University of Colorado Anschutz, Aurora, Colorado, United States
| | - Julie Katarincic
- Department of Orthopaedic Surgery, University Orthopedics, Rhode Island, United States
| | - Robin Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
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Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study. Int J Surg 2023; 109:3954-3966. [PMID: 38258997 PMCID: PMC10720814 DOI: 10.1097/js9.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/14/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. METHODS LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January-December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). RESULTS A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. CONCLUSIONS This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.
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Vervoort D, Jin H, Edwin F, Kumar RK, Malik M, Tapaua N, Verstappen A, Hasan BS. Global Access to Comprehensive Care for Paediatric and Congenital Heart Disease. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:453-463. [PMID: 38205434 PMCID: PMC10777200 DOI: 10.1016/j.cjcpc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/05/2023] [Indexed: 01/12/2024]
Abstract
Paediatric and congenital heart disease (PCHD) is common but remains forgotten on the global health agenda. Congenital heart disease is the most frequent major congenital anomaly, affecting approximately 1 in every 100 live births. In high-income countries, most children now live into adulthood, whereas in low- and middle-income countries, over 90% of patients do not get the care they need. Rheumatic heart disease is the most common acquired cardiovascular disease in children and adolescents. While almost completely eradicated in high-income countries, over 30-40 million people live with rheumatic heart disease in low- and middle-income countries. Challenges exist in the care for PCHD and, increasingly, adult congenital heart disease (ACHD) worldwide. In this review, we summarize the current status of PCHD and ACHD care through the health systems lens of workforce, infrastructure, financing, service delivery, information management and technology, and governance. We further highlight gaps in knowledge and opportunities moving forward to improve access to care for all those living with PCHD or ACHD worldwide.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hyerang Jin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Edwin
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- National Cardiothoracic Center, Accra, Ghana
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Mahim Malik
- Department of Cardiac Surgery, Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan
| | - Noah Tapaua
- Department of Surgery, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Amy Verstappen
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, Pennsylvania, USA
| | - Babar S. Hasan
- Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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13
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Jhunjhunwala R, Venkatapuram S. How should we prioritise global surgery? A capabilities approach argument for the place of surgery within every health system. BMJ Glob Health 2023; 8:e013100. [PMID: 37949500 PMCID: PMC10649365 DOI: 10.1136/bmjgh-2023-013100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/30/2023] [Indexed: 11/12/2023] Open
Abstract
In the rapidly evolving landscape of global health issues and policy, surgery has historically been sidelined due to concerns about high cost, complexity and other concerns including quantitatively less surgical disease burden in comparison to infectious disease or other health conditions. Now, in the context of pandemics, climate change, shrinking health budgets and other global health security concerns, the hard-won progress in raising the profile of surgical care is at risk, and a reconceptualisation is needed to maintain its position in global healthcare agendas. We challenge the long-standing ethical frameworks that underlie healthcare priority setting, namely cost-effectiveness analysis and human rights, that have contributed to surgery being sidelined for decades. They incompletely account for improvements to life quality and well-being that are possible through surgical healthcare systems. We argue for the Capabilities Approach as an alternative normative framework because it emphasises the moral importance of supporting every person's abilities to be and to do the things they value. Through this framework, we can produce a more comprehensive conception of healthcare that goes beyond biomedical health, and surgical healthcare would ultimately gain a higher priority in valuation of healthcare and non-healthcare interventions.
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Affiliation(s)
- Rashi Jhunjhunwala
- BIDMC Dept of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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14
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Kebede MA, Tor DSG, Aklilu T, Petros A, Ifeanyichi M, Aderaw E, Bognini MS, Singh D, Emodi R, Hargest R, Friebel R. Identifying critical gaps in research to advance global surgery by 2030: a systematic mapping review. BMC Health Serv Res 2023; 23:946. [PMID: 37667225 PMCID: PMC10478287 DOI: 10.1186/s12913-023-09973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023] Open
Abstract
Progress on surgical system strengthening has been slow due to a disconnect between evidence generation and the information required for effective policymaking. This systematic mapping review sought to assess critical research gaps in the field of global surgery guided by the World Health Organisation Health Systems building block framework, analysis of authorship and funding patterns, and an exploration of emerging research partnership networks. Literature was systematically mapped to identify, screen, and synthesize results of publications in the global surgery field between 2015 and March 2022. We searched four databases and included literature published in seven languages. A social network analysis determined the network attributes of research institutions and their transient relationships in shaping the global surgery research agenda. We identified 2,298 relevant studies out of 92,720 unique articles searched. Research output increased from 453 in 2015-16 to 552 in 2021-22, largely due to literature on Covid-19 impacts on surgery. Sub-Saharan Africa (792/2298) and South Asia (331/2298) were the most studied regions, although high-income countries represented a disproportionate number of first (42%) and last (43%) authors. Service delivery received the most attention, including the surgical burden and quality and safety of services, followed by capacity-building efforts in low- and middle-income countries. Critical research in economics and financing, essential infrastructure and supplies, and surgical leadership necessary to guide policy decisions at the country level were lacking. Global surgical systems remain largely under-researched. Knowledge diffusion requires an emphasis on developing sustainable research partnerships and capacity across low- and middle-income countries. A renewed focus must be given to equipping countries with tools for effective decision-making to enhance investments in high-quality surgical services.
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Affiliation(s)
- Meskerem Aleka Kebede
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK.
| | - Deng Simon Garang Tor
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | | | - Adane Petros
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martilord Ifeanyichi
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Ezekiel Aderaw
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maeve Sophia Bognini
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Darshita Singh
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
| | - Rosemary Emodi
- Royal College of Surgeons of England, Global Affairs, 38-43 Lincoln's Inn Fields, London, UK
| | - Rachel Hargest
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
- Royal College of Surgeons of England, Global Affairs, 38-43 Lincoln's Inn Fields, London, UK
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - Rocco Friebel
- Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, Cowdray House 1.12, Houghton Street, London, WC2A 2AE, UK
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Qin RX, Fowler ZG, Jayaram A, Stankey M, Yoon S, McLeod E, Park KB. The current status of surgical care in the Asia-Pacific region and opportunities for improvement: proceedings. BMC Proc 2023; 17:12. [PMID: 37488551 PMCID: PMC10367230 DOI: 10.1186/s12919-023-00255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
The World Health Assembly resolution 68.15 recognised emergency and essential surgery as a critical component of universal health coverage. The first session of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia-Pacific Region focused on the current status of surgical care and opportunities for improvement. During this session, Ministries of Health and World Health Organization (WHO) Regional Directors shared country- and regional-level progress in surgical system strengthening. The WHO Western Pacific Regional Office (WPRO) has developed an Action Framework for Safe and Affordable Surgery, whilst the WHO South-East Asia Regional Office (SEARO) highlighted their efforts in emergency obstetric care, workforce strengthening, and blood safety. Numerous countries have begun developing and implementing National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs). Participants agreed surgical system strengthening is an integral component of universal health coverage, pandemic preparedness, and overall health system resilience. Participants discussed common challenges, such as the COVID-19 pandemic, climate change, workforce capacity building, and improving access for hard-to-reach populations. They generated and shared common solutions, including strengthening surgical care capacity in first-level hospitals, anaesthesia task-shifting, remote training, and integrating surgical care with public health, preventive care, and emergency preparedness. Moving forward, participants committed to developing and implementing NSOAPs and agreed on the need to raise political awareness, build a broad-based movement, and form intersectoral collaborations.
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Affiliation(s)
- Rennie X Qin
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Zachary G Fowler
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Anusha Jayaram
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Makela Stankey
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Keck School of Medicine at the University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Sangchul Yoon
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, South Korea
| | - Elizabeth McLeod
- Department of Neonatal and Paediatric Surgery, Royal Children's Hospital, 50 Flemington Rd, Melbourne, VIC, 3052, Australia
| | - Kee B Park
- The Program in Global Surgery and Social Change, the, Department of Global Health and Social Medicine , Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
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16
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Jumbam DT, Reddy CL, Meara JG, Makasa EM, Atun R. A Financing Strategy to Expand Surgical Health Care. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2100295. [PMID: 37348937 PMCID: PMC10285720 DOI: 10.9745/ghsp-d-21-00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 03/28/2023] [Indexed: 06/24/2023]
Abstract
Despite an evolving need to provide surgical health care globally, few health systems, particularly in low-income and middle-income countries (LMICs), can sufficiently provide such care. The vast majority of the world's people-an estimated 5 billion-are unable to access safe and affordable surgical health care when they need it. This is a significant concern for global public health because the demand for these services is rising with the epidemiological and demographic transitions occurring worldwide. A principal driver of weak surgical health care services is a lack of adequate health system financing for surgical health care. This article examines the financing of surgical health care by analyzing global trends in health system financing, approaches to expand fiscal space for health, and empirical perspectives on the design, introduction, and scale-up of policies to improve surgical systems. We describe a surgical health care financing strategy, together with broader political and economic considerations, to provide policy recommendations to fund the expansion of surgical health care and an essential surgical package as part of universal health coverage in LMICs.
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Affiliation(s)
- Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Che L Reddy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Emmanuel M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Rifat Atun
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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17
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Canick J, Petrucci B, Patterson R, Saunders J, Htoo Thaw M, Omosule I, Denton A, Xu MJ, Chadha S, Young G, Siafa L, Mortel O, Shamshad A, Reddy A, McCalla M, Prasad K, Yang HH, Pan DR, Shah J, Smith E, Alkire B, Ibekwe T, Waterworth C. An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans. Health Policy Plan 2023; 38:719-725. [PMID: 37130061 PMCID: PMC10274565 DOI: 10.1093/heapol/czad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023] Open
Abstract
Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.
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Affiliation(s)
- Julia Canick
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Rolvix Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - James Saunders
- Division of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766 , USA
| | | | - Ikeoluwa Omosule
- Department of Otorhinolaryngology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Alexa Denton
- Department of Otolaryngology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Mary Jue Xu
- Department of Otolaryngology—Head and Neck Surgery, UCSF, San Francisco , CA 94143, USA
| | - Shelly Chadha
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Gabrielle Young
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lyna Siafa
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
| | - Olivier Mortel
- Hôpital de l'Université d'état d'Haïti, Port-au-Prince, Haiti
| | - Alizeh Shamshad
- Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ashwin Reddy
- Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Monet McCalla
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, USA
| | - Kavita Prasad
- Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Debbie R Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Jaffer Shah
- Weill Cornell Medicine, New York, NY 10021, USA
| | - Emily Smith
- Duke Global Health Institute, Durham, NC 27710, USA
- Department of Surgery, Duke University, Durham, NC 27710, USA
| | - Blake Alkire
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Titus Ibekwe
- Department of Otorhinolaryngology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Chris Waterworth
- Disability Inclusion for Health and Development, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Audiology and Speech Pathology, University of Melbourne Faculty of Medicine, Dentistry, & Health Sciences, Carlton, VIC, Australia
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18
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Yohannes K, Målqvist M, Bradby H, Berhane Y, Herzig van Wees S. Addressing the needs of Ethiopia's street homeless women of reproductive age in the health and social protection policy: a qualitative study. Int J Equity Health 2023; 22:80. [PMID: 37143037 PMCID: PMC10159225 DOI: 10.1186/s12939-023-01874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Globally, homelessness is a growing concern, and homeless women of reproductive age are particularly vulnerable to adverse physical, mental, and reproductive health conditions, including violence. Although Ethiopia has many homeless individuals, the topic has received little attention in the policy arena. Therefore, we aimed to understand the reason for the lack of attention, with particular emphasis on women of reproductive age. METHODS This is a qualitative study; 34 participants from governmental and non-governmental organisations responsible for addressing homeless individuals' needs participated in in-depth interviews. A deductive analysis of the interview materials was applied using Shiffman and Smith's political prioritisation framework. RESULTS Several factors contributed to the underrepresentation of homeless women's health and well-being needs in the policy context. Although many governmental and non-governmental organisations contributed to the homeless-focused programme, there was little collaboration and no unifying leadership. Moreover, there was insufficient advocacy and mobilisation to pressure national leaders. Concerning ideas, there was no consensus regarding the definition of and solution to homeless women's health and social protection issues. Regarding political contexts and issue characteristics, a lack of a well-established structure, a paucity of information on the number of homeless women and the severity of their health situations relative to other problems, and the lack of clear indicators prevented this issue from gaining political priority. CONCLUSIONS To prioritise the health and well-being of homeless women, the government should form a unifying collaboration and a governance structure that addresses the unmet needs of these women. It is imperative to divide responsibilities and explicitly include homeless people and services targeted for them in the national health and social protection implementation documents. Further, generating consensus on framing the problems and solutions and establishing indicators for assessing the situation is vital.
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Affiliation(s)
- Kalkidan Yohannes
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- WOMHER- Women's Mental Health During the Reproductive Lifespan, Interdisciplinary Research Center, Uppsala University, Uppsala, Sweden.
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
| | - Mats Målqvist
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sibylle Herzig van Wees
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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20
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Li W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Cheng B, Dai J, Fu N, Li L, Liu S, Sun H. Specialty preferences of studying-abroad medical students from low- and middle-income countries. BMC MEDICAL EDUCATION 2023; 23:158. [PMID: 36922811 PMCID: PMC10015544 DOI: 10.1186/s12909-023-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study explored the specialty preferences of China-educated international medical students (IMSs), who are mainly from low- and middle-income countries (LMICs) and constitute a potential medical workforce both for their home countries and foreign countries, and the influence of migration intentions on their specialty preferences. METHODS A cross-sectional, questionnaire-based survey was conducted at 5 universities in China. The questionnaire link was distributed electronically among the IMSs at the 5 universities via emails. The questionnaire enquired IMSs' demographic information, migration intentions and their specialty preferences. The Chi-square test was applied to determine the influence of the respondent's gender, intention to practise in the home country and intention to practise in a high-income country on their specialty choices. The Chi-square test was also applied to determine the influence of the respondent's gender, year of study and country of origin on their preferences for generalist-orientated or non-generalist orientated specialties. RESULTS Altogether, 452 IMSs returned their responses, yielding a response rate of 64.1%. Approximately half of the IMSs planned to not return to their home country. The most selected specialty was general surgery and the least selected specialty was physical medicine and rehabilitation. No significant differences were evident in most specialty preferences between those who intended to return home and those who intended to stay abroad. Among the IMSs having intentions of returning to their home country, male students tended to choose a generalist-orientated specialty, while female students tended to choose a non-generalist-orientated specialty. CONCLUSION China-educated IMSs could play important roles in the primary care services as well as other shortage specialties both for their home countries or foreign countries. Therefore, it is recommended that governments in these countries plan migration and recruitment policies that cater for these studying-abroad medical students from LMICs, especially in this challenging time during the COVID-19 pandemic.
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Affiliation(s)
- Wen Li
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Robyn M Gillies
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Chang Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Changhao Wu
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Jiayi Chen
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Xiaoning Zhang
- School of Management, Xuzhou Medical University, 221004, Xuzhou, China
| | - Bin Cheng
- School of International Education, Weifang Medical University, 261053, Weifang, China
| | - Jing Dai
- College of International Education, Guilin Medical University, 541199, Guilin, China
| | - Ning Fu
- School of International Education, Shandong First Medical University & Shandong Academy of Medical Sciences, 271016, Tai'an, China
| | - Lin Li
- Language and Literature School, Hebei North University, 075000, Zhangjiakou, China
| | - Shenjun Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China.
| | - Hong Sun
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, China.
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21
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Waithaka D, Gilson L, Barasa E, Tsofa B, Orgill M. Political Prioritisation for Performance-Based Financing at the County Level in Kenya: 2015 to 2018. Int J Health Policy Manag 2023; 12:6909. [PMID: 37579436 PMCID: PMC10125155 DOI: 10.34172/ijhpm.2023.6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Performance based financing was introduced to Kilifi county in Kenya in 2015. This study investigates how and why political and bureaucratic actors at the local level in Kilifi county influenced the extent to which PBF was politically prioritised at the sub-national level. METHODS The study employed a single-case study design. The Shiffman and Smith political priority setting framework with adaptations proposed by Walt and Gilson was applied. Data was collected through document review (n=19) and in-depth interviews (n=8). Framework analysis was used to analyse data and generate findings. RESULTS In the period 2015-2018, the political prioritisation of PBF at the county level in Kilifi was influenced by contextual features including the devolution of power to sub-national actors and rigid public financial management structures. It was further influenced by interpretations of the idea of 'pay-for-performance', its framing as 'additional funding', as well as contestation between actors at the sub national level about key PBF design features. Ultimately PBF ceased at the end of 2018 after donor funding stopped. CONCLUSION Health reformers must be cognisant of the power and interests of national and sub national actors in all phases of the policy process, including both bureaucratic and political actors in health and non-health sectors. This is particularly important in devolved public governance contexts where reforms require sustained attention and budgetary commitment at the sub national level. There is also need for early involvement of critical actors to develop shared understandings of the ideas on which interventions are premised, as well as problems and solutions.
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Affiliation(s)
- Dennis Waithaka
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Health Systems Research Group, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marsha Orgill
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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22
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Muacevic A, Adler JR. The Role and Duty of Global Surgery in Increasing Sustainability and Improving Patient Care in Low and Middle-Income Countries. Cureus 2022; 14:e30023. [PMID: 36381932 PMCID: PMC9637440 DOI: 10.7759/cureus.30023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Global health is one of the most pressing issues facing the 21st century. Surgery is a resource and energy-intensive healthcare activity which produces overwhelming quantities of waste. Using the 5Rs (Reduce, Reuse, Recycle, Rethink, and Research) provides the global surgical community with the pillars of sustainability to develop strategies that are scalable and transferable in both low and middle-income countries and their high-income counterparts. Reducing energy consumption is necessary to achieving net zero emissions in the provision of essential healthcare. Simple, easily transferrable, high-income country (HIC) technologies can greatly reduce energy demands in low-income countries. Reusing appropriately sterilized equipment and reprocessing surgical devices leads to a reduction of costs and a significant reduction of unnecessary potentially hazardous waste. Recycling through official government-facilitated means reduces 'informal recycling' schemes, and the spread of communicable diseases whilst expectantly reducing the release of carcinogens and atmospheric greenhouse gases. Rethinking local surgical innovation and providing an ecosystem that is both ethical and sustainable, is not only beneficial from a medical perspective but allows local financial investment and feeds back into local economies. Finally, research output from low-income countries is minimal compared to the global academic output. Research from low and middle-income countries must equal research from high-income countries, thereby producing fruitful partnerships. With adequate international collaboration and awareness of the lack of necessary surgical interventions in low and middle-income countries (LMICs), global surgery has the potential to reduce the impact of surgical practice on the environment, without compromising patient safety or quality of care.
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23
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Reuter A, Rogge L, Monahan M, Kachapila M, Morton DG, Davies J, Vollmer S. Global economic burden of unmet surgical need for appendicitis. Br J Surg 2022; 109:995-1003. [PMID: 35881506 PMCID: PMC10364778 DOI: 10.1093/bjs/znac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/27/2022] [Accepted: 05/12/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. METHODS Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. RESULTS Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. CONCLUSION For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.
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Affiliation(s)
- Anna Reuter
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Lisa Rogge
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Institute of Economics, Department of Health Economics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Mark Monahan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Mwayi Kachapila
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Dion G Morton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Justine Davies
- Correspondence to: (J.D.) Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK (e-mail: ); (S.V.) Department of Economics & Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073 Göttingen, Germany (e-mail: )
| | - Sebastian Vollmer
- Correspondence to: (J.D.) Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK (e-mail: ); (S.V.) Department of Economics & Centre for Modern Indian Studies (CeMIS), University of Goettingen, Waldweg 26, 37073 Göttingen, Germany (e-mail: )
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24
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Briggs AM, Jordan JE, Sharma S, Young JJ, Chua J, Foster HE, Haq SA, Huckel Schneider C, Jain A, Joshipura M, Kalla AA, Kopansky-Giles D, March L, Reis FJJ, Reyes KAV, Soriano ER, Slater H. Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies. Health Policy Plan 2022; 38:129-149. [PMID: 35876078 PMCID: PMC9923377 DOI: 10.1093/heapol/czac061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care.
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Affiliation(s)
- Andrew M Briggs
- *Corresponding author. Curtin School of Allied Health and enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. E-mail:
| | | | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal,School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, 18 High St Kensington, New South Wales 2052, Australia,Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, New South Wales 2031, Australia
| | | | - Jason Chua
- TBI Network, Faculty of Health and Environmental Sciences, Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland 1010, New Zealand
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom,Paediatric Global Musculoskeletal Task Force, Global Alliance for Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia
| | - Syed Atiqul Haq
- Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh,Asia Pacific League of Associations for Rheumatology (APLAR), 1 Scotts Road #24-10, Shaw Center Singapore 228208, Singapore
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, 17 John Hopkins Drive, Camperdown, New South Wales 2050, Australia
| | - Anil Jain
- Department of Physical Medicine & Rehabilitation, Santokba Durlabhji Memorial Hospital, Bhawani Singh Marg Road, Rambagh Circle 302015, Jaipur, India
| | - Manjul Joshipura
- AO Alliance Foundation, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Deborah Kopansky-Giles
- Global Alliance for Musculoskeletal Health (G-MUSC), Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia,Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, Ontario M2H 3J1, Canada,Department of Family & Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
| | - Lyn March
- Global Alliance for Musculoskeletal Health (G-MUSC), Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia,Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Reserve Rd, St Leonards NSW 2065, Australia,Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia
| | - Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), R. Sen. Furtado, 121/125 - Maracanã, Rio de Janeiro – RJ, 20270-021, Brazil,Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro – RJ, 21044-020, Brazil,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Bd de la Plaine 2, Ixelles 1050, Brussels, Belgium
| | - Katherine Ann V Reyes
- Alliance for Improving Health Outcomes, Inc., West Ave, Quezon City 1104, Philippines,School of Public Health, Pamantasan ng Lungsod ng Maynila, Intramuros, Manila, 1002 Metro, Manila, Philippines
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 CABA, Buenos Aires, Argentina,Pan-American League of Associations for Rheumatology (PANLAR), Wells Fargo Plaza, 333 SE 2nd Avenue Suite 2000 Mia, Florida 33131, United States of America
| | - Helen Slater
- Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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25
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Odland ML, Abdul-Latif AM, Ignatowicz A, Alayande B, Appia Ofori B, Balanikas E, Bekele A, Belli A, Chu K, Ferreira K, Howard A, Nzasabimana P, Owolabi EO, Nyamathe S, Pognaa Kunfah SM, Tabiri S, Yakubu M, Whitaker J, Byiringiro JC, Davies JI. Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa. BMJ Glob Health 2022; 7:bmjgh-2021-008256. [PMID: 35410954 PMCID: PMC9003614 DOI: 10.1136/bmjgh-2021-008256] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework with WHO Building Blocks and Institution of Medicine Quality Outcomes Frameworks to describe barriers to trauma care in three countries in sub-Saharan Africa: Ghana, South Africa and Rwanda. We used a parallel convergent mixed-methods research design, integrating the results to enable a holistic analysis of the barriers to access to quality injury care. Data were collected using surveys of patient experiences of injury care, interviews and focus group discussions with patients and community leaders, and a survey of policy-makers and healthcare leaders on the governance context for injury care. We identified 121 barriers across all three countries. Of these, 31 (25.6%) were shared across countries. More than half (18/31, 58%) were predominantly related to delay 3 (‘Delays to receiving quality care’). The majority of the barriers were captured using just one of the multiple methods, emphasising the need to use multiple methods to identify all barriers. Given there are many barriers to access to quality care for people who have been injured in Rwanda, Ghana and South Africa, but few of these are shared across countries, solutions to overcome these barriers may also be contextually dependent. This suggests the need for rigorous assessments of contexts using multiple data collection methods before developing interventions to improve access to quality care.
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Affiliation(s)
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK .,Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
| | - Abdul-Malik Abdul-Latif
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Volta Regional Health Directorate, Ghana Health Service, Accra, Greater Accra, Ghana
| | | | - Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda.,Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Antonio Belli
- University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Karen Ferreira
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute of Health Research (NIHR) Biomedical Centre, University of Oxford, Headington, Oxford, UK
| | | | - Eyitayo O Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Samukelisiwe Nyamathe
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Stephen Tabiri
- Ghana HUB of NIHR Global Surgery, Tamale, Ghana.,Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana.,Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | - Mustapha Yakubu
- Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana.,School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Jean Claude Byiringiro
- University of Rwanda, Kigali, Rwanda.,Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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26
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Shrestha R, Yadav UN, Shrestha A, Paudel G, Makaju D, Poudel P, Iwashita H, Harada Y, Shrestha A, Karmacharya B, Koju R, Sugishita T, Rawal L. Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal. Front Public Health 2022; 10:763784. [PMID: 35223722 PMCID: PMC8864089 DOI: 10.3389/fpubh.2022.763784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal. Methods This study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes. Results Four key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems. Conclusion This study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.
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Affiliation(s)
- Rabina Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Abha Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
| | - Deepa Makaju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Prakash Poudel
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Hanako Iwashita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Archana Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- *Correspondence: Lal Rawal ;
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27
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Quene TM, Bust L, Louw J, Mwandri M, Chu KM. Global surgery is an essential component of global health. Surgeon 2022; 20:9-15. [PMID: 34922839 PMCID: PMC8695837 DOI: 10.1016/j.surge.2021.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023]
Abstract
Global surgery as an essential component of global health. Global surgery is the study and practice of improving access to timely, quality, and affordable surgical care. It emphasizes horizontal health systems strengthening through addressing a range of health challenges in surgical care that improve health outcomes, particularly in vulnerable populations. Global surgery specifically contributes to achievement of the Sustainable Development Goals 2030 (SDGs) by addressing the elimination of poverty (SDG 1), ensuring good health and well-being (SDG 3), promoting decent work and economic growth (SDG 8), and reducing inequalities (SDGs 5 and 10). Global surgery issues transcend national boundaries and intersect with other global health issues such as migration and the COVID-19 pandemic. These issues are nested in a highly politicised environment, therefore power and politics should be considered when identifying problems and solutions. Despite evidence of its importance, the global surgery network has not generated substantial attention and resources compared to other global health networks. Global surgery can further increase its effectiveness through linking with health systems strengthening agendas, and identifying unified solutions to improve access to quality surgical care in low- and middle-income countries. Global surgery is indispensable in the achievement of health and well-being for all.
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Affiliation(s)
| | | | | | | | - Kathryn M. Chu
- Corresponding author. Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7507, South Africa
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Chipendo PI, Shawar YR, Shiffman J, Razzak JA. Understanding factors impacting global priority of emergency care: a qualitative policy analysis. BMJ Glob Health 2021; 6:e006681. [PMID: 34969680 PMCID: PMC8718415 DOI: 10.1136/bmjgh-2021-006681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/25/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates. METHODS We conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes. RESULTS We identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network's commitment to the issue, the emerging leadership and the existence of policy windows. CONCLUSION To improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies.
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Affiliation(s)
- Portia I Chipendo
- Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Yusra R Shawar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Shiffman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Werbick M, Bari I, Paichadze N, Hyder AA. Firearm violence: a neglected "Global Health" issue. Global Health 2021; 17:120. [PMID: 34641937 PMCID: PMC8506468 DOI: 10.1186/s12992-021-00771-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Populations around the world are facing an increasing burden of firearm violence on mortality and disability. While firearm violence affects every country globally, the burden is significantly higher in many low- and middle-income countries. However, despite overwhelming statistics, there is a lack of research, reporting, and prioritization of firearm violence as a global public health issue, and when attention is given it is focused on high-income countries. This paper discusses the impact of firearm violence, the factors which shape such violence, and how it fits into global public health frameworks in order to illustrate how firearm violence is a global health issue which warrants evidence-based advocacy around the world.
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Affiliation(s)
- Meghan Werbick
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052 USA
| | - Imran Bari
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052 USA
| | - Nino Paichadze
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052 USA
| | - Adnan A. Hyder
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052 USA
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30
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Shlobin NA, Kanmounye US, Ozair A, de Koning R, Zolo Y, Zivkovic I, Niquen-Jimenez M, Affana CK, Jogo L, Abongha GB, Garba DL, Rosseau G. Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery. World Neurosurg 2021; 155:150-159. [PMID: 34464771 DOI: 10.1016/j.wneu.2021.08.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA.
| | - Ulrick Sidney Kanmounye
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; Research Department, Association of Future African Neurosurgeons, Cameroon; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo
| | - Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, India
| | | | - Yvan Zolo
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of Kinsasha Faculty of Medicine, Kinsasha, Democratic Republic of the Congo; Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Irena Zivkovic
- School of Medicine, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Milagros Niquen-Jimenez
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Facultad de Medicina Humana Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Leslie Jogo
- Faculty of Medicine and Biomedical Sciences, University of Ngaoundéré, Garoua, Cameroon
| | | | - Deen L Garba
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Rosseau
- World Federation of Neurosurgical Societies Global Neurosurgery Committee, Nyon, Vaud, Switzerland; Foundation for International Education in Neurological Surgery; G4 Alliance, Chicago, Illinois, USA; Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Abstract
Background: To meet the rising interest in surgical global health, some surgical residency programs offer global health experiences. The level of interest in these programs, however, and their role in residency recruitment and career planning has not been systematically evaluated. Objective: (1) Define interest in global health among Otolaryngology residents in the USA. (2) Assess engagement of Otolaryngology residencies in global health training. (3) Determine barriers to global health training in residency. Methods: A survey questionnaire was developed and sent to all Otolaryngology Residency Program Directors for distribution to all current Otolaryngology residents in the US. Results: A total of 91 complete surveys were collected. A majority of respondents felt that global health was either “very important” or “extremely important” (67%). Two-thirds of respondents had prior global health experience (68%). While 56% of respondents would definitely participate in a global health elective and 78% would likely or definitely participate, only 37% of residency programs offered a global health experience. The availability of a global health elective significantly correlated with residency match choice in respondents with previous global health experience. The three most common barriers to participation were insufficient time, insufficient funding, and lack of program. Conclusion: Participation in bilateral and equitable international electives is a unique experience of personal and professional growth. There is an interest in these opportunities during residency training among Otolaryngology residents that is not reflected in availability within training programs. This suggests the need for development of humanitarian outreach exposure through global health experiences during surgical residency training.
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32
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Kovoor JG, Tivey DR, Ovenden CD, Babidge WJ, Maddern GJ. Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change. BJS Open 2021; 5:6342605. [PMID: 34355242 PMCID: PMC8342932 DOI: 10.1093/bjsopen/zrab048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.
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Affiliation(s)
- J G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - D R Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | - W J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - G J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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33
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Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med 2021; 18:e1003749. [PMID: 34415914 PMCID: PMC8415575 DOI: 10.1371/journal.pmed.1003749] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
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Affiliation(s)
- Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Public Health, Wits University, Johannesburg, South Africa
- * E-mail:
| | - Adrian W. Gelb
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia & Perioperative Care, University of California San Francisco, California, United States of America
| | - Julian Gore-Booth
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
| | - Christina Åkerman
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States of America
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, United States of America
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, The National Hospital, Abuja, Nigeria
- National Surgical, Obstetric and Anaesthesia Planning Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Bruce M. Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Western Cape, South Africa
| | - Geir Sverre Braut
- Research Department of Community Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | | | - Lars Hagander
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Haylock-Loor
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care Medicine, Interventional Pain Unit, Hospital Del Valle, San Pedro Sula, Honduras
| | - Hampus Holmer
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States of America
| | - Sabrina Juran
- Population and Development, United Nations Population Fund, New York, New York, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicolas J. Kassebaum
- Anesthesiology and Pain Medicine, Health Metrics Sciences, Global Health, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Michael S. Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, United States of America
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel M. Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare (WitSSurg), Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Mark W. Newton
- Department of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Tennessee, United States of America
- AIC Kijabe Hospital, Kenya
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, The University of Copenhagen, Copenhagen, Denmark
| | - Teri Reynolds
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Lauri J. Romanzi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anaesthesia and Perioperative Care, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Emi Suzuki
- The World Bank, Washington, DC, United States of America
| | - John E. Varallo
- Department of Safe Surgery, Jhpiego, Baltimore, Maryland, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - David Watters
- University Hospital Geelong, Victoria, Australia
- Faculty of Health, School of Medicine, Deakin University, Victoria, Australia
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Thomas G. Weiser
- Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care Stanford University, Stanford, United States of America
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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Breedt DS, Odland ML, Bakanisi B, Clune E, Makgasa M, Tarpley J, Tarpley M, Munyika A, Sheehama J, Shivera T, Biccard B, Boden R, Chetty S, de Waard L, Duys R, Groeneveld K, Levine S, Mac Quene T, Maswime S, Naidoo M, Naidu P, Peters S, Reddy CL, Verhage S, Muguti G, Nyaguse S, D'Ambruoso L, Chu K, Davies JI. Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach. BMJ Glob Health 2021; 6:bmjgh-2021-005629. [PMID: 34130990 PMCID: PMC8208008 DOI: 10.1136/bmjgh-2021-005629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.
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Affiliation(s)
- Danyca Shadé Breedt
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Balisi Bakanisi
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Edward Clune
- Department of Anaesthesia, University of Botswana, Gaborone, Botswana
| | | | - John Tarpley
- Department of Surgery, University of Botswana, Gabarone, Botswana
| | - Margaret Tarpley
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Akutu Munyika
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Department of Surgery, Onandjokwe Lutheran Hospital, Oniipa, Namibia
| | | | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Regan Boden
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Chetty
- Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rowan Duys
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Kristin Groeneveld
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Priyanka Naidu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shrikant Peters
- Executive Management, Groote Schuur Hospital, Department of Public Health and Familiy Medicine, University of Cape Town, Cape Town, South Africa
| | - Ché L Reddy
- Harvard Medical School, Boston, Massachusetts, USA
| | - Savannah Verhage
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Godfrey Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shingai Nyaguse
- Division of Anaesthesia, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Kathryn Chu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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35
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Briggs AM, Jordan JE, Kopansky-Giles D, Sharma S, March L, Schneider CH, Mishrra S, Young JJ, Slater H. The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants. Glob Health Res Policy 2021; 6:24. [PMID: 34256865 PMCID: PMC8277526 DOI: 10.1186/s41256-021-00201-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. METHODS An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1-4 of the logic model. RESULTS Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. CONCLUSION KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.
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Affiliation(s)
- Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Australia.
| | | | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Lyn March
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
- Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Swatee Mishrra
- Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - James J Young
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, Australia
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36
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Parsons MA. Toward an ethics of global health (de)funding: Thoughts from a maternity hospital project in Kabul, Afghanistan. Glob Public Health 2021; 17:1136-1151. [PMID: 33977857 DOI: 10.1080/17441692.2021.1924821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors - Afghan and internationals - expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation.
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Cossa M, Rose J, Berndtson AE, Noormahomed E, Bickler SW. Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery. World J Surg 2021; 45:1306-1315. [PMID: 33521876 PMCID: PMC8530447 DOI: 10.1007/s00268-020-05925-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique. MATERIAL AND METHODS A prospective cohort of all surgical encounters from Mozambique's National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency. RESULTS Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique's population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province. DISCUSSION Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short- and long-term targets for surgery as a component of health systems strengthening.
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Affiliation(s)
- Matchecane Cossa
- Department of Surgery, Maputo Central Hospital, Eduardo Mondlane University, Maputo, Mozambique
| | - John Rose
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Emilia Noormahomed
- Microbiology Department, Parasitology Laboratory, Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute of Health Education and Research, Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Stephen W Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA
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Torto NM, Brownell KD. Role of food aid and assistance in addressing the double burden of malnutrition in Ghana: a qualitative policy analysis. BMJ Nutr Prev Health 2021; 3:196-204. [PMID: 33521529 PMCID: PMC7841835 DOI: 10.1136/bmjnph-2020-000136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background and aims In many low-income and middle-income countries, the double burden of malnutrition threatens public health and economic progress, urging a re-evaluation of the roles and responsibilities of nutrition actors, both traditional and non-traditional. This study examines the food aid and assistance activities of the United Nations World Food Programme (WFP)-one non-traditional actor in the double burden conversation-and the potential for these activities to reach beyond their traditional mandate on undernutrition to also address overweight and obesity in Ghana. Methods Information on WFP activities in Ghana from 2012 up through its planning into 2023 was extracted from 11 WFP planning, operations and evaluation documents. WFP activities were then judged against the WHO's framework on the determinants of the double burden of malnutrition to determine their potential to address the double burden. Semistructured interviews were also conducted with 17 key informants in the global nutrition landscape to identify challenges that may complicate the role of WFP and other actors in addressing the double burden. Results The analysis demonstrates that WFP activities in Ghana can serve as a platform on which to address the double burden, particularly by targeting the food access, food systems and socioeconomic disadvantage determinants of the double burden. Actors' uncertainty with what role WFP should play in addressing the double burden, insufficient government attention to malnutrition and poor data on overweight and obesity were identified as potential challenges that complicate addressing the double burden. Conclusion The findings suggest that integrating WFP as a partner in the effort to address the double burden in Ghana might help amplify progress. To better address the double burden, WFP might prioritise retrofitting existing activities rather than implementing new interventions.
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Affiliation(s)
- Niisoja M Torto
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Kelly D Brownell
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
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Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics: An International Delphi Study. Ann Surg 2020; 274:1107-1114. [PMID: 33214454 DOI: 10.1097/sla.0000000000004611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to define a globally applicable list of surgical procedures, or "basket", which could represent a health system's capacity to provide surgical care and standardize global surgical measurement. SUMMARY OF BACKGROUND DATA Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, caesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope. METHODS We conducted a three round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (i.e. well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as "extremely" or "very important" by ≥ 50% of respondents in round 3 were included in the final "basket". RESULTS Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing diseases categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified as important for inclusion to assess surgical capacity. CONCLUSIONS This surgical basket could allow a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
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Briggs AM, Shiffman J, Shawar YR, Åkesson K, Ali N, Woolf AD. Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions. Best Pract Res Clin Rheumatol 2020; 34:101549. [PMID: 32713802 PMCID: PMC7377715 DOI: 10.1016/j.berh.2020.101549] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000-2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box 1987, Perth, WA, 6845, Australia.
| | - Jeremy Shiffman
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe St., E8539, Baltimore, MD, 21205, United States.
| | - Yusra Ribhi Shawar
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe St., E8539, Baltimore, MD, 21205, United States.
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Clinical and Molecular Osteoporosis Research Unit, Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
| | - Nuzhat Ali
- Priority and Programmes Division, Health Improvement Directorate, Public Health England, Wellington House, 133- 155 Waterloo Road, Waterloo, SE1 8UG, United Kingdom.
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, TR1 3HD, United Kingdom.
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The global cost of pelvic exenteration: in-hospital perioperative costs. Br J Surg 2020; 107:e470-e471. [PMID: 33460051 DOI: 10.1002/bjs.11924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/03/2023]
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Aya Pastrana N, Beran D, Somerville C, Heller O, Correia JC, Suggs LS. The process of building the priority of neglected tropical diseases: A global policy analysis. PLoS Negl Trop Dis 2020; 14:e0008498. [PMID: 32785262 PMCID: PMC7423089 DOI: 10.1371/journal.pntd.0008498] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
The global burden attributed to Neglected Tropical Diseases (NTDs) is 47.9 million Disability-Adjusted Life Years (DALYs). These diseases predominantly affect disadvantaged populations. Priority for NTDs has grown in recent years, which is observed by their inclusion in the sustainable development goals (SDGs). This study analyzed the process that allowed these diseases to be included on the global health policy agenda. This global policy analysis used the Shiffman and Smith framework to understand the determinants of global health political priority for NTDs. The framework comprises four categories: actor power, ideas, political contexts, and issue characteristics. Global documents and World Health Assembly (WHA) resolutions were examined, key-informant interviews were conducted, and academic publications were reviewed to understand the four categories that comprise the framework. A total of 37 global policy documents, 15 WHA resolutions, and 38 academic publications were examined. Twelve semi-structured interviews were conducted with individuals representing different sectors within the NTD community who have been involved in raising the priority of these diseases. This study found that several factors helped better position NTDs in the global health agenda. These include the leadership of actors that mobilized the global health community, the creation of a label combining these diseases as a group to represent a larger disease burden, the presence of mechanisms aligning the NTD community, and the agreement on ways to present the NTD burden and potential solutions. The process of building the priority of NTDs in the global health agenda shows that several determinants led to positive outcomes, but these diseases continue to have low priority at the global level which requires the implementation of actions to increase their global priority. These include sustaining the commitment of current actors and engaging new ones; increasing the attention given to diseases formerly categorized as "tool-deficient", including zoonotic NTDs; continue leveraging on policy windows and creating favorable policy moments to sustain commitment, as well as setting realistic targets. Findings from this study can help develop strategies to build the momentum and drive actions to implement the goals of the new Roadmap for NTDs in the pathway to universal health coverage (UHC) and sustainable development.
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Affiliation(s)
- Nathaly Aya Pastrana
- BeCHANGE Research Group, Institute for Public Communication, Università della Svizzera italiana, Lugano, Switzerland
- * E-mail: ,
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- Swiss School of Public Health+, Zurich, Switzerland
| | - Claire Somerville
- Gender Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Olivia Heller
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Jorge C. Correia
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - L. Suzanne Suggs
- BeCHANGE Research Group, Institute for Public Communication, Università della Svizzera italiana, Lugano, Switzerland
- Swiss School of Public Health+, Zurich, Switzerland
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Shapiro LM, Park MO, Mariano DJ, Kamal RN. Development of a Needs Assessment Tool to Promote Capacity Building in Hand Surgery Outreach Trips: A Methodological Triangulation Approach. J Hand Surg Am 2020; 45:729-737.e1. [PMID: 32561162 DOI: 10.1016/j.jhsa.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The surgical burden in low- and middle-income countries (LMIC) is immense. Despite the increase in resources invested in surgical outreach trips to LMIC, there is no consistent process for understanding the needs of the site and for preparing the necessary resources to deliver care. Given the importance and lack of a comprehensive and standardized needs assessment tool, we aimed to create a tool that assesses the needs and capacity of a site to inform site selection and expectations and improve quality of care. METHODS We used methodological triangulation, a technique that incorporates multiple and different types of data collection methods to study a phenomenon. We used 2 standardized World Health Organization (WHO) tools to develop a hand surgery-specific needs assessment tool. We then identified missing items and made refinements as a result of field testing at 2 facilities and qualitative analysis of semistructured interviews of hand surgeons with international outreach experience. Interviews were coded and analyzed using conductive content analysis. Key concepts explored included domains and subdomains pertaining to essential considerations prior to a hand surgery outreach trip. RESULTS Current generic needs assessment tools do not capture all necessary domains and subdomains for a hand surgery outreach trip. The WHO tools provide a framework for reference and foundation; field testing and qualitative interviews identified hand surgery-specific items. We developed a tool that includes 7 domains: (1) human resources; (2) physical resources; (3) procedures; (4) cultural and language barriers; (5) safety, quality, and access; (6) regulation and cost; and (7) knowledge transfer and teaching and associated subdomains relevant to hand surgery. CONCLUSIONS A hand surgery-specific standardized needs assessment tool may ensure appropriate resources and personnel are deployed for outreach trips to improve site selection, expectation setting, and quality of care. CLINICAL RELEVANCE A needs assessment tool is a standardized, comprehensive tool to assess the needs and capacity of a new site prior to hand surgery outreach trips to improve site selection, expectation setting, and delivery of high-quality, safe, and effective care in LMIC.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA; Sustainable Global Surgery, Palo Alto, CA
| | - Meewon O Park
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - David J Mariano
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- Sustainable Global Surgery, Palo Alto, CA; VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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Does health securitization affect the role of global surgery? JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:925-930. [PMID: 32837845 PMCID: PMC7391037 DOI: 10.1007/s10389-020-01347-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
Aim More and more frequently outbreaks of infectious diseases force the international community to urgent health action and lead to an increasing security focus on global health. Considering the limiting character of resource allocation, all other medical conditions must compete with the top spot of health security matters, as we currently see with the outbreak of COVID-19. Surgery is an integral part of universal health offering life-saving therapy for a variety of illnesses. Amidst the increasing nexus of infectious diseases and health security and in the view of Public Health Emergencies of International Concern (PHEIC), is there a risk of global surgery falling behind? Subject and Methods While the global undersupply of surgical care is well recorded, contextual explanations are absent. Our research introduces the constructivist concept of securitization according to the Copenhagen School to explain the structural handicap of global surgery and by that presents a structural explanation. We investigate the securitizing potential of surgical diseases in comparison to infectious diseases. Results Surgical conditions are non-contagious without the risk for disease outbreaks, hardly preventable and their treatment is often infrastructurally demanding. These key features mark their low securitizing potential. Additionally, as PHEIC is the only securitizing institution in the realm of health, infectious diseases have a privileged role in health security. Conclusion Surgery substantially lacks securitizing potential in comparison to communicable diseases and by that is structurally given an inferior position in a securitized health order.
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Chu K, Naidu P, Reid S, Hendriks H, Nash J, Lomas V, Coetzee F, Mash R. The role of family physicians in emergency and essential surgical care in the district health system in South Africa. S Afr Fam Pract (2004) 2020; 62:e1-e3. [PMID: 32787383 PMCID: PMC8378209 DOI: 10.4102/safp.v62i1.5117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Margolick J, Yin L, Joharifard S, Afya A, Velez MDLAM, Meza E, Sohani S, Laane C, Ball-Banting E, Joos E. Acute care surgery, trauma and disaster relief: a clinical exchange between the University of British Columbia and the Mexican Red Cross. Can J Surg 2020; 63:E338-E345. [PMID: 32644319 DOI: 10.1503/cjs.004719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Our objective was to establish a sustainable educational partnership and clinical exchange between the trauma services at Vancouver General Hospital (VGH) and the Mexican Red Cross hospital in Mexico City (Hospital Central de la Cruz Roja [HCCR] Polanco). Methods In 2017, a general surgery resident in postgraduate year 4 travelled from VGH to HCCR Polanco for the initial exchange, followed by a trauma fellow. The surgical case volumes in a month at VGH and a month at HCCR Polanco were compared. At the end of the exchange, a 36-item Likert style questionnaire was administered to the Mexican surgeons and residents who interacted with the Canadian resident and fellow during the exchange. Results The most commonly performed procedures on the VGH acute care surgery service were laparoscopic cholecystectomy (35%) and laparoscopic appendectomy (17%). The most commonly performed procedures on the VGH trauma service were chest tube insertions (24%) and tracheostomies (24%). The most commonly performed procedures at HCCR Polanco were surgery for penetrating abdominal trauma (19%) and extremity trauma (13%). The survey results indicated that the costs of travel and accommodation were obstacles to future exchanges. All survey respondents wanted to continue collaborating with Canadians on clinical and research endeavours, felt that hosting Canadian residents was a valuable experience and felt that visiting VGH would also be valuable. Conclusion Canadian surgical trainees gained valuable exposure to operative trauma during the exchange. The mix of operations performed at VGH and HCCR Polanco was vastly different; therefore, the exchange broadened the trainees' surgical experience. There was a unanimously positive response to the exchange among the Mexican survey respondents. This exchange is part of a long-term collaboration between our surgical centres.
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Affiliation(s)
- Joseph Margolick
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Lu Yin
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Shahrzad Joharifard
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Avi Afya
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Maria de Los Angeles Mendoza Velez
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Edgar Meza
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Salim Sohani
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Charlotte Laane
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Elenor Ball-Banting
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
| | - Emilie Joos
- From the Department of Surgery, University of British Columbia, Vancouver, B.C. (Margolick, Yin, Joharifard, Joos); the HCCR Polanco Cruz Roja, Mexico City, Mexico (Afya, Velez, Meza); the Canadian Red Cross, Ottawa, Ont. (Sohani); Trauma Services, Vancouver General Hospital, Vancouver, B.C. (Laane, Joos); the Branch for International Surgical Care, University of British Columbia, Vancouver, B.C. (Ball-Banting, Joos)
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Operative Case Volume Minimums Necessary for Surgical Training Throughout Rural Africa. World J Surg 2020; 44:3245-3258. [DOI: 10.1007/s00268-020-05609-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
BACKGROUND Many global health organisations have adopted formal strategies to integrate gender in their programming. In practice, few prioritise the issue. Institutions with considerable global power therefore largely overlook fundamental drivers of adverse health outcomes: gender inequality and harmful gender norms. We analyse the factors shaping attention to gender in organisations involved in global health governance. METHODS Drawing on scholarship from the fields of organisational behavior and management, sociology, international relations and the policy process, we undertook a thematic analysis of peer-reviewed scholarship and organisational documents. We also conducted 20 semi-structured interviews over Skype with individuals working at the cross-section of gender and health. RESULTS In seeking to reform the policies and practices of global health organisations, gender proponents confront patriarchal organisational cultures, hostile political environments and an issue that is difficult to address as it requires upsetting existing power structures. Proponents also face three linked challenges internal to their own networks. First, there is little cohesion among champions themselves, as they are fragmented into multiple networks. Second, proponents differ on the nature of the problem and solutions, including whether reducing gender inequality or addressing harmful gender norms is the primary goal, the role of men in gender initiatives, which health issues to prioritise, and even the value of proponent cohesion. Third, there are disagreements among proponents on how to convey the problem. Some advance an instrumental case, while others believe that it should be portrayed as a human rights issue and using any other argument undermines that fundamental justification. CONCLUSIONS Prospects for building more gender-responsive global health organisations will depend in part on the ability of proponents to address these disagreements and develop strategies for negotiating difficult organisational cultures and political environments.
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Affiliation(s)
- Yusra Ribhi Shawar
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
| | - Jeremy Shiffman
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
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Shiffman J, Shawar YR. Strengthening accountability of the global health metrics enterprise. Lancet 2020; 395:1452-1456. [PMID: 32305072 PMCID: PMC7162633 DOI: 10.1016/s0140-6736(20)30416-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Jeremy Shiffman
- Bloomberg School of Public Health, Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA.
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health, Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
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Shawar YR, Shiffman J. Generating Global Priority for Addressing Rheumatic Heart Disease: A Qualitative Policy Analysis. J Am Heart Assoc 2020; 9:e014800. [PMID: 32308101 PMCID: PMC7428514 DOI: 10.1161/jaha.119.014800] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/18/2020] [Indexed: 01/24/2023]
Abstract
Background Rheumatic heart disease (RHD) poses a high burden in low-income countries, as well as among indigenous and other socioeconomically disadvantaged populations in high-income countries. Despite its severity and preventability, RHD receives insufficient global attention and resources. We conducted a qualitative policy analysis to investigate the reasons for recent growth but ongoing inadequacy in global priority for addressing RHD. Methods and Results Drawing on social science scholarship, we conducted a thematic analysis, triangulating among peer-reviewed literature, organizational documents, and 20 semistructured interviews with individuals involved in RHD research, clinical practice, and advocacy. The analysis indicates that RHD proponents face 3 linked challenges, all shaped by the nature of the issue. With respect to leadership and governance, the fact that RHD affects mostly poor populations in dispersed regions complicates efforts to coordinate activities among RHD proponents and to engage international organizations and donors. With respect to solution definition, the dearth of data on aspects of clinical management in low-income settings, difficulties preventing and addressing the disease, and the fact that RHD intersects with several disease specialties have fueled proponent disagreements about how best to address the disease. With respect to positioning, a perception that RHD is largely a problem for low-income countries and the ambiguity on its status as a noncommunicable disease have complicated efforts to convince policy makers to act. Conclusions To augment RHD global priority, proponents will need to establish more effective governance mechanisms to facilitate collective action, manage differences surrounding solutions, and identify positionings that resonate with policy makers and funders.
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Affiliation(s)
- Yusra Ribhi Shawar
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMD
- Paul H. Nitze School of Advanced International StudiesJohns Hopkins UniversityWashingtonDC
| | - Jeremy Shiffman
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMD
- Paul H. Nitze School of Advanced International StudiesJohns Hopkins UniversityWashingtonDC
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