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Boundary Crossing: Meaningfully Engaging Religious Traditions and Religious Institutions in Public Health. RELIGIONS 2019. [DOI: 10.3390/rel10070412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interest in religion and spirituality continues to grow among public health practitioners, researchers, and scholars. While there have been several recent landmark publications and efforts to understand the intersections of religion, spirituality, and public health, work remains to be done. In this commentary, we outline three challenges that impede more substantive engagement with religion and spirituality from the public health perspective; namely, the controversial aspects of religion, the perception of religion as a private matter, and limited academic space for coursework around religion and spirituality within public health training. We then describe a series of recommendations that might foster better scholarship and praxis at the crossroads of public health, religion, and spirituality: forming interdisciplinary teams, engaging a wider body of literature, building relationships with faith-inspired colleagues and communities, and considering the goals and ends of communities we serve. We remain hopeful that through ongoing dialogue and academic humility, work exploring the features of religion, spirituality, and public health will yield richer understanding of our shared humanity and the features that give rise to life.
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Ooms G, Kruja K. The integration of the global HIV/AIDS response into universal health coverage: desirable, perhaps possible, but far from easy. Global Health 2019; 15:41. [PMID: 31215446 PMCID: PMC6582556 DOI: 10.1186/s12992-019-0487-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The international community's health focus is shifting from achieving disease-specific targets towards aiming for universal health coverage. Integrating the global HIV/AIDS response into universal health coverage may be inevitable to secure its achievements in the long run, and for expanding these achievements beyond addressing a single disease. However, this integration comes at a time when international financial support for the global HIV/AIDS response is declining, while political support for universal health coverage is not translated into financial support. To assess the risks, challenges and opportunities of the integration of the global HIV/AIDS response into national universal health coverage plans, we carried out assessments in Indonesia, Kenya, Uganda and Ukraine, based on key informant interviews with civil society, policy-makers and development partners, as well as on a review of grey and academic literature. RESULTS In the absence of international financial support, governments are turning towards national health insurance schemes to finance universal health coverage, making access to healthcare contingent on regular financial contributions. It is not clear how AIDS treatment will be fit in. While the global HIV/AIDS response accords special attention to exclusion due to sexual orientation and gender identity, sex work or drug use, efforts to achieve universal health coverage focus on exclusion due to poverty, gender and geographical inequalities. Policies aiming for universal health coverage try to include private healthcare providers in the health system, which could create a sustainable framework for civil society organisations providing HIV/AIDS-related services. While the global HIV/AIDS response insisted on the inclusion of civil society in decision-making policies, that is not (yet) the case for policies aiming for universal health coverage. DISCUSSION While there are many obstacles to successful integration of the global HIV/AIDS response into universal health coverage policies, integration seems inevitable and is happening. Successful integration will require expanding the principle of 'shared responsibility' which emerged with the global HIV/AIDS response to universal health coverage, rather than relying solely on domestic efforts for universal health coverage. The preference for national health insurance as the best way to achieve universal health coverage should be reconsidered. An alliance between HIV/AIDS advocates and proponents of universal health coverage requires mutual condemnation of discrimination based on sexual orientation and gender identity, sex work or drug use, as well as addressing of exclusion based on poverty and other factors. The fulfilment of the promise to include civil society in decision-making processes about universal health coverage is long overdue.
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Affiliation(s)
- Gorik Ooms
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH UK
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Sund GC. Team Effort Needed for Development and Implementation of the Anesthesia Training Framework. Anesth Analg 2019; 128:e131-e132. [DOI: 10.1213/ane.0000000000004169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Strategies for engaging men in HIV services. Lancet HIV 2019; 6:e191-e200. [PMID: 30777726 DOI: 10.1016/s2352-3018(19)30032-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022]
Abstract
The importance of men in the global HIV response is increasingly recognised. In most settings, men are less engaged in HIV services and have worse health outcomes than women. The multiple gender, social, economic, political, and institutional factors behind these patterns are well documented. More recently, researchers have been reporting evidence on strategies aimed at improving the engagement of men in HIV services. Several promising approaches exist, including community-based outreach programmes, gender-transformative interventions to shift gender norms and practices, and the development of more responsive, male-friendly health services. Challenges remain, however, in terms of cost and sustainability, intersecting inequalities like race and class, and the difficulty of changing community-level gender norms. Future research should focus on developing theory-informed interventions and evaluations, on improving the understanding of specific subpopulations of men, and on broadening the evidence base beyond the few countries that produce most research in this field.
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Ntambue AM, Malonga FK, Dramaix-Wilmet M, Ilunga TM, Musau AN, Matungulu CM, Cowgill KD, Donnen P. Commercialization of obstetric and neonatal care in the Democratic Republic of the Congo: A study of the variability in user fees in Lubumbashi, 2014. PLoS One 2018; 13:e0205082. [PMID: 30304060 PMCID: PMC6179261 DOI: 10.1371/journal.pone.0205082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/19/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, insufficient state financing of the health system produced weak progress toward targets of Millennium Development Goals 4 and 5. In Lubumbashi, almost all women pay out-of-pocket for obstetric and neonatal care. As no standard pricing system has been implemented, there is great variation in payments related to childbirth between health facilities and even within the same facility. This work investigates the determinants of this variation. METHODS We conducted a cross-sectional study including women from admission through discharge at 92 maternity wards in Lubumbashi in March 2014. The women's payments were collected and validated by triangulating interviews of new mothers and nurses with document review. We studied payments related to delivery from the perspective of women delivering. The total was the sum of the payments linked to seeking and accessing care and transport of the woman and companion. The determinants were assessed by multilevel regression. RESULTS Median payments for delivery varied by type: for an uncomplicated vaginal delivery, US$45 (range, US$17-260); for a complicated vaginal delivery US$60 (US$16-304); and for a Cesarean section, US$338 (US$163-782). Vaginal delivery was more expensive at health centers than in general referral hospitals or polyclinics. Cesarean sections done in corporate polyclinics and hospitals were more expensive than those done in the general referral hospitals. Referral of delivering women, use of more highly trained personnel, and a longer stay in the maternity unit contributed to higher expenses. A vaginal delivery in the private sector was more cost-effective than in the public sector. CONCLUSION To guarantee universal coverage of high-quality care, we suggest that the government and funders in DRC support health insurance and risk pool initiatives, and introduce and institutionalize free mother and infant care.
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Affiliation(s)
- Abel Mukengeshayi Ntambue
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Françoise Kaj Malonga
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Michèle Dramaix-Wilmet
- Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
| | - Tabitha Mpoyi Ilunga
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Angel Nkola Musau
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Charles Matungulu Matungulu
- Unité d’Epidémiologie et de Santé de la mère, du nouveau-né et de l’enfant, École de Santé Publique, Université de Lubumbashi, Lubumbashi, RDC
| | - Karen D. Cowgill
- School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, and Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Philippe Donnen
- Centre de recherche en Epidémiologie, Biostatistiques et recherche clinique, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
- Centre de Recherche en Politiques et systèmes de santé-Santé internationale, École de Santé Publique Université Libre de Bruxelles, Brussels, Belgium
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Grieve A, Olivier J. Towards universal health coverage: a mixed-method study mapping the development of the faith-based non-profit sector in the Ghanaian health system. Int J Equity Health 2018; 17:97. [PMID: 30286758 PMCID: PMC6172851 DOI: 10.1186/s12939-018-0810-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Faith-based non-profit (FBNP) providers have had a long-standing role as non-state, non-profit providers in the Ghanaian health system. They have historically been considered to be important in addressing the inequitable geographical distribution of health services and towards the achievement of universal health coverage (UHC), but in changing contexts, this contribution is being questioned. However, any assessment of contribution is hampered by the lack of basic information about their comparative presence and coverage in the Ghanaian health system. In response, since the 1950s, there have been repeated calls for the 'mapping' of faith-based health assets. METHODS A historically-focused mixed-methods study was conducted, collecting qualitative and quantitative data and combining geospatial mapping with varied documentary resources (secondary and primary, current and archival). Geospatial maps were developed, providing a visual representation of changes in the spatial footprint of the Ghanaian FBNP health sector. RESULTS The geospatial maps show that FBNPs were originally located in rural remote areas of the country but that this service footprint has evolved over time, in line with changing social, political and economic contexts. CONCLUSION FBNPs have had a long-standing role in the provision of health services and remain a valuable asset within national health systems in Ghana and sub-Saharan Africa more broadly. Collaboration between the public sector and such non-state providers, drawing on the comparative strengths and resources of FBNPs and focusing on whole system strengthening, is essential for the achievement of UHC.
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Affiliation(s)
- Annabel Grieve
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Beogo I, Darboe A, Adesanya OA, Rojas BM. Choosing between nurse-led and medical doctor-led from private for-profit versus non-for-profit health facilities: A household survey in urban Burkina Faso. PLoS One 2018; 13:e0200233. [PMID: 30044796 PMCID: PMC6059411 DOI: 10.1371/journal.pone.0200233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background Providers’ qualification (Medical doctor [MD] or nurse); type of care facility ownership (for-profit [FP] or not-for-profit [NFP]) may all influence individuals’ healthcare-seeking behavior and therefore merits empirical assessment to provide valuable evidence-informed policy orientation in the present context of private health system development. Previous studies have not examined these factors in combination, especially within the urban context of sub-Sahara Africa, where the private sector is rapidly growing. This study aims to explore factors associated with urban residents’ preferences between private MD-led and private nurse-led outpatient care and how these factors vary by type of private health facility ownership (FP and NFP) and levels of disease severity (severe and non-severe cases). Methods A cross-sectional household survey was conducted in July-November 2011 on a random final sample of 2064 adults (646 households). We used a face-to-face interview to capture participants’ choice of provider and their associated factors. A multivariable logistic regression was applied. Results For severe conditions, participants, almost equally sought FP and NFP facilities, only 36.4% preferred nurses compared to MDs, while for non-severe cases 53.2% preferred FP facilities and only 29.2% patronized nurses. For non-severe conditions, university educated were more likely to use MDs-led FP compared to nurse-led FP facilities (Odds Ratio [OR] = 4.66, 95% confidence interval [CI] = 2.62–8.30) and MD-led FP over MD-led NFP facilities (OR = 1.03, 95%CI = 1.01–1.04), for severe health conditions. Having insurance predicted MD-led FP preference over nurse-led FP. Furthermore, insurance predicted the preference for MD-led FP over MD-led NFP facilities. Employment did not distinguish participants’ choice of provider. Conclusion The findings suggest that, at different levels, MDs and nurses from FP and NFP facilities importantly contribute to health services delivery regardless of the severity of health conditions. The results offer some valuable evidence for policy orientation in the current rising tide of the private system, including workforce development, and practitioners' role definition. We suggested that health insurance mechanism would reinforce the private health services utilization and could enhance progress towards the attainment of Sustainable Development Goals.
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Affiliation(s)
- Idrissa Beogo
- Centre de recherche en gestion des services de santé, FSA-ULaval-CHU de Québec UL–IUCPQ-UL, Pavillon Palasis-Prince, Université Laval, Québec (Qc), Canada
- École Nationale de Santé Publique, Ouagadougou, Ouagadougou, Burkina Faso
- * E-mail:
| | - Amadou Darboe
- The University of Melbourne, School of Population and Global Health, Parkville, Victoria, Australia
| | - Oluwafunmilade A. Adesanya
- Institute of Public Health, International Health Program, National Yang Ming University, Beitou District, Taipei, Taiwan
| | - Bomar Mendez Rojas
- Institute of Public Health, International Health Program, National Yang Ming University, Beitou District, Taipei, Taiwan
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Timmins F, Pujol N. The Role of Healthcare Chaplains in Resuscitation: A Rapid Literature Review. JOURNAL OF RELIGION AND HEALTH 2018; 57:1183-1195. [PMID: 29569111 DOI: 10.1007/s10943-018-0604-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Spirituality is becoming of increasing importance in the international healthcare context. While patients' spirituality or faith is often overlooked, there is a growing awareness that understanding, addressing and supporting patients' spiritual and faith needs can influence healthcare outcomes. This review aims to illuminate this role and highlight healthcare chaplains' potential in relation to the provision of pastoral support for families during and after patient resuscitation, and the dearth of interdisciplinary education in this field. A rapid structured review was undertaken using four databases-PubMed, CINAHL, PsycINFO and ATLA. Primary research studies published during the 10-year period 2007-2017 written in English addressing the chaplain's role or perceived role in resuscitation were included. An initial search using key terms yielded 18 relevant citations. This reduced to 11 once duplicates were removed. Ultimately five relevant primary research studies were included in the final analysis. This review found few studies that directly explored the topic. Certainly many view the chaplain as a key member of the resuscitation team, although this role has not been fully explored. Chaplains likely have a key role in supporting families during decisions about 'not for resuscitation' and in supporting families during and after resuscitation procedures. Chaplains are key personnel, already employed in many healthcare organisations, who are in a pivotal position to contribute to future developments of spiritual and pastoral care provision and support. Their role at the end of life, despite well described and supported, has received little empirical support. There is an emerging role for chaplains in healthcare ethics, supporting end-of-life decisions and supporting family witnessed resuscitation where relevant. Their role needs to be more clearly understood by medical staff, and chaplain's input into undergraduate medical education programmes is becoming vital.
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Affiliation(s)
- Fiona Timmins
- School of Nursing and Midwifery Studies, Trinity College Dublin, 24 D'Olier St., Dublin 2, Ireland.
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Walker JA, Hashim Y, Oranye N. Impact of Muslim opinion leaders' training of healthcare providers on the uptake of MNCH services in Northern Nigeria. Glob Public Health 2018; 14:200-213. [PMID: 29764294 DOI: 10.1080/17441692.2018.1473889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Expanding access to maternal, newborn and child health (MNCH) services in traditional societies is a public health challenge, often complicated by cultural and religious beliefs about what is permitted or not permitted within a faith group. This is particularly true in the Muslim majority North of Nigeria, where deep suspicions of Western public health programmes, coupled with failing and underfunded health system, have led to the emergence of a new generation of Muslim Opinion Leaders (MOLs) with counter-narratives against family planning, immunisation and nutrition programmes. This paper reports on an innovative project implemented under the Saving Lives at Birth global partnership programme, where conservative MOLs transformed as champions were engaged as health communicators to train health providers on correct religious precepts related to MNCH. A matched subject type of study design was used to compare healthcare providers' performance in control and intervention health facilities. The result indicates a significant difference both in perception and in practices between healthcare providers in intervention and control facilities, with respect to MNCH uptake. This paper highlights the need for renewed focus on engaging faith leaders and organisations in health communication and service delivery and presents a model of sustainable engagement of champions in MNCH.
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Affiliation(s)
| | - Yahaya Hashim
- a Development Research and Projects Centre , Kano , Nigeria
| | - Nelson Oranye
- b College of Rehabilitation Sciences , University of Manitoba , Winnipeg , Canada
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Saadi A, Okeng'o K, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, Parker RA, Wibecan L, Iyer G, Onesmo PM, Kapina BN, Regenhardt RW, Mateen FJ. Post-stroke social networks, depressive symptoms, and disability in Tanzania: A prospective study. Int J Stroke 2018; 13:840-848. [PMID: 29676225 DOI: 10.1177/1747493018772788] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence suggests that social networks improve functional recovery after stroke, but this work has not been extended to low- and middle-income countries (LMICs). Post-stroke depression interferes with functional outcome but is understudied in LMICs. Aims To determine the relationships between social networks, disability, and depressive symptoms in patients surviving 90-days post-stroke in Dar es Salaam, Tanzania. Methods Participants ≥ 18 years, admitted ≤ 14 days of stroke onset, were enrolled. Disability was measured using the modified Rankin Scale, social networks by the Berkman-Syme social network index, and depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9) by telephone interview at 90 days. A Kruskal-Wallis test or Spearman's correlation coefficient was used to assess the associations between social networks, depressive symptoms, and disability. Results Of 176 participants, 43% (n = 75) died, with an additional 11% (n = 20) lost to follow-up by 90 days. Among 81 survivors, 94% (n = 76, 57% male, average age 54 years) had complete information on all scales (mean and median follow-up time of 101 and 88 days). Thirty percent (n = 23, 41.9%, 95% confidence interval 20.2) had at least mild depressive symptoms (PHQ-9 ≥ 5 points). Nearly two-thirds (n = 46, 61%) reported ≥ 3 close friends. A higher social network index score was associated with fewer depressive symptoms (p < 0.0001) and showed a trend towards significance with lower disability (p = 0.061). Higher depressive symptom burden was correlated with higher disability (r = 0.52, p < 0.0001). Conclusion Post-stroke social isolation is associated with more depressive symptoms in Tanzania. Understanding social networks and the associated mechanisms of recovery in stroke is especially relevant in the context of limited resources.
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Affiliation(s)
- Altaf Saadi
- 1 National Clinical Scholars Program, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Sara J Grundy
- 3 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ai Xu
- 4 Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A Parker
- 4 Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,5 Harvard Medical School, Boston, USA
| | - Leah Wibecan
- 6 Massachusetts General Hospital, Boston, MA, USA
| | - Geetha Iyer
- 7 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Robert W Regenhardt
- 8 Partners Neurology Residency, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Farrah J Mateen
- 5 Harvard Medical School, Boston, USA.,6 Massachusetts General Hospital, Boston, MA, USA
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Håkansson M, Oguttu M, Gemzell-Danielsson K, Makenzius M. Human rights versus societal norms: a mixed methods study among healthcare providers on social stigma related to adolescent abortion and contraceptive use in Kisumu, Kenya. BMJ Glob Health 2018. [PMID: 29527357 PMCID: PMC5841529 DOI: 10.1136/bmjgh-2017-000608] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Adolescent pregnancy represents a serious public health issue in sub-Saharan Africa, and stigmatising attitudes are contributing factors. This study investigates stigmatising attitudes related to adolescent pregnancy, abortion and contraceptive use among healthcare providers working with postabortion care (PAC) in a low-resource setting in Kenya. Methods A mixed methods approach in a convergent design was utilised to capture attitudes related to abortion and contraceptive use among 86 (f=62; m=19) PAC providers in Kisumu, Kenya. Two Likert-scale questionnaires were used: the 18-item Stigmatising Attitudes, Beliefs and Actions Scale (SABAS) and the 7-item Contraceptive Use Stigma Scale (CUSS). 74 PAC providers responded to the SABAS, 44 to the CUSS and 12 participated in two focus group discussions. Descriptive statistics, psychometric tests of instruments and qualitative content analysis were conducted and reported in accordance with Consolidated Criteria for Reporting Qualitative Research. Results Cronbach's α coefficients for the total instrument was 0.88 (SABAS) and 0.84 (CUSS). The majority, 92% (68/74) agreed that a woman who has had an abortion should be treated equally to everyone else, 27% (20/74) considered abortion a sin and 30% (22/74) believed she will make abortion a habit. Contraceptive use among adolescent women was associated with promiscuity (39%; 17/44), hence contraceptives should only be available to married women (36%; 16/44), and 20% (9/44) believed that contraceptive use causes infertility. The providers encouraged women's autonomy and their rights to sexual and reproductive health; however, unclear regulations reinforce religious and cultural beliefs, which hampers implementation of evidence-based contraceptive counselling. Conclusion Stigmatising attitudes towards young women in need of abortion and contraception is common among PAC providers. Their work is characterised by a conflict between human rights and societal norms, thus highlighting the need for interventions targeting PAC providers to reduce stigma and misconceptions related to abortion and contraception among adolescent women.
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Affiliation(s)
- Miranda Håkansson
- Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Monica Oguttu
- Kisumu Medical and Education Trust (KMET), Kisumu, Kenya
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marlene Makenzius
- Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
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Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities. Int J Hyg Environ Health 2018; 221:409-422. [PMID: 29352706 DOI: 10.1016/j.ijheh.2018.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 11/22/2022]
Abstract
Safe environmental conditions and the availability of standard precaution items are important to prevent and treat infection in health care facilities (HCFs) and to achieve Sustainable Development Goal (SDG) targets for health and water, sanitation, and hygiene. Baseline coverage estimates for HCFs have yet to be formed for the SDGs; and there is little evidence describing inequalities in coverage. To address this, we produced the first coverage estimates of environmental conditions and standard precaution items in HCFs in low- and middle-income countries (LMICs); and explored factors associated with low coverage. Data from monitoring reports and peer-reviewed literature were systematically compiled; and information on conditions, service levels, and inequalities tabulated. We used logistic regression to identify factors associated with low coverage. Data for 21 indicators of environmental conditions and standard precaution items were compiled from 78 LMICs which were representative of 129,557 HCFs. 50% of HCFs lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, 73% lack sterilization equipment, and 59% lack reliable energy services. Using nationally representative data from six countries, 2% of HCFs provide all four of water, sanitation, hygiene, and waste management services. Statistically significant inequalities in coverage exist between HCFs by: urban-rural setting, managing authority, facility type, and sub-national administrative unit. We identified important, previously undocumented inequalities and environmental health challenges faced by HCFs in LMICs. The information and analyses provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.
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Agyepong IA, Sewankambo N, Binagwaho A, Coll-Seck AM, Corrah T, Ezeh A, Fekadu A, Kilonzo N, Lamptey P, Masiye F, Mayosi B, Mboup S, Muyembe JJ, Pate M, Sidibe M, Simons B, Tlou S, Gheorghe A, Legido-Quigley H, McManus J, Ng E, O'Leary M, Enoch J, Kassebaum N, Piot P. The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa. Lancet 2017; 390:2803-2859. [PMID: 28917958 DOI: 10.1016/s0140-6736(17)31509-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Accra, Ghana; Ghana College of Physicians and Surgeons, Public Health Faculty, Accra, Ghana
| | | | | | | | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nduku Kilonzo
- National AIDS Control Council, Ministry of Health, Nairobi, Kenya
| | - Peter Lamptey
- FHI360, Durham, NC, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | | | | | | | | | - Sheila Tlou
- Regional Support Team for Eastern and Southern Africa, UNAIDS, Johannesburg, South Africa
| | - Adrian Gheorghe
- London School of Hygiene & Tropical Medicine, London, UK; Oxford Policy Management, Oxford, UK
| | - Helena Legido-Quigley
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Edmond Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jamie Enoch
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK.
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Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the 'Black Box' of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091007. [PMID: 28869518 PMCID: PMC5615544 DOI: 10.3390/ijerph14091007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/25/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023]
Abstract
Increased attention on "complexity" in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: "success to the successful", "growth and underinvestment", and "supervision conundrum". The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.
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Porter JD, Bresick G. Is it just religious practice? Exploring patients' reasons for choosing a faith-based primary health clinic over their local public sector primary health clinic. Afr J Prim Health Care Fam Med 2017; 9:e1-e9. [PMID: 28697620 PMCID: PMC5506500 DOI: 10.4102/phcfm.v9i1.1219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 02/10/2017] [Accepted: 11/26/2016] [Indexed: 11/14/2022] Open
Abstract
Background Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in sub-Saharan Africa, but there is limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. Aim The primary objective was to determine and explore the reasons for patient choice of a faith-based primary care clinic over their local public sector primary care clinic, and secondarily to determine to what extent these reasons were influenced by demography. Setting The study was conducted at Jubilee Health Centre (JHC), a faith-based primary care clinic attached to Jubilee Community Church in Cape Town, South Africa. Methods Focus groups, using the nominal group technique, were conducted with JHC patients and used to generate ranked reasons for attending the clinic. These were collated into the top 15 reasons and incorporated into a quantitative questionnaire which was administered to adult patients attending JHC. Results A total of 164 patients were surveyed (a response rate of 92.4%) of which 68.3% were female and 57.9% from the Democratic Republic of the Congo (DRC). Of patients surveyed, 98.2% chose to attend JHC because ‘the staff treat me with respect’, 96.3% because ‘the staff are friendly’ and 96.3% because ‘the staff take time to listen to me’. The reason ‘it is a Christian clinic’ was chosen by 70.1% of patients. ‘The staff speak my home language’ was given as a reason by 61.1% of DRC patients and 37.1% of South African patients. ‘The clinic is close to me’ was chosen by 66.6% of Muslims and 40.8% of Christians. Conclusion Patients chose to attend JHC (a faith-based primary care clinic) because of the quality of care received. They emphasised the staff–patient relationship and patient-centredness rather than the clinic’s religious practices (prayer with patients). These findings may be important in informing efforts to improve public sector primary care.
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Timmins F, Caldeira S, Murphy M, Pujol N, Sheaf G, Weathers E, Whelan J, Flanagan B. The Role of the Healthcare Chaplain: A Literature Review. J Health Care Chaplain 2017. [DOI: 10.1080/08854726.2017.1338048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fiona Timmins
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Sílvia Caldeira
- Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Maryanne Murphy
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Greg Sheaf
- Library of Trinity College Dublin, Dublin, Ireland
| | | | - Jacqueline Whelan
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Barden-O'Fallon J. Availability of family planning services and quality of counseling by faith-based organizations: a three country comparative analysis. Reprod Health 2017; 14:57. [PMID: 28482905 PMCID: PMC5423000 DOI: 10.1186/s12978-017-0317-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background Faith-based organizations (FBOs) have a long history of providing health services in developing countries and are important contributors to healthcare systems. Support for the wellbeing of women, children, and families is evidenced through active participation in the field of family planning (FP). However, there is little quantitative evidence on the availability or quality of FP services by FBOs. Methods The descriptive analysis uses facility-level data collected through recent Service Provision Assessments in Malawi (2013–14), Kenya (2010), and Haiti (2012) to examine 11 indicators of FP service and method availability and nine indicators of comprehensive and quality counseling. The indicators include measures of FP service provision, method mix, method stock, the provision of accurate information, and the discussion of reproductive intentions, client’s questions/concerns, prevention of sexually transmitted infections, and return visits, among others. Pearson’s Chi-square test is used to assess the selected indicators by managing authority (FBO, public, and other private sector) to determine statistical equivalence. Results Results show that FBOs are less likely to offer FP services than other managing authorities (p < 0.05). For example, 69% of FBOs in Kenya offer FP services compared to 97% of public facilities and 83% of other private facilities. Offering long-acting or permanent methods in faith-based facilities is especially low (43% in Malawi, 29% in Kenya and 39% in Haiti). There were few statistically significant differences between the managing authorities in comprehensive and quality counseling indicators. Interestingly, Haitian FBOs often perform as well or better than public sector health facilities on counseling indicators, such as discussion of a return visit (79% of FBO providers vs. 68% of public sector providers) and discussion of client concerns/questions (52% vs. 49%, respectively). Conclusions Results from this analysis indicate that there is room for improvement in the availability of FP services by FBOs in these countries. Quality of counseling should be improved by all managing authorities in the three countries, as indicated by low overall coverage for practices such as ensuring confidentiality (22% in Malawi, 47% in Kenya and 12% in Haiti), discussion of sexually transmitted infections (18%, 25%, 17%, respectively), and providing services to youth (53%, 27%, 32%, respectively).
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Affiliation(s)
- Janine Barden-O'Fallon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 400 Meadowmont Village Circle, 3rd Floor, Chapel Hill, NC, 27517, USA.
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Spies L, Garner SL, Faucher M, Hastings-Tolsma M, Riley C, Millenbruch J, Prater L, Conroy S. A model for upscaling global partnerships and building nurse and midwifery capacity. Int Nurs Rev 2017; 64:331-344. [DOI: 10.1111/inr.12349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L.A. Spies
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - S. L. Garner
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - M.A. Faucher
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - M. Hastings-Tolsma
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
- University of Johannesburg; Johannesburg South Africa
| | - C. Riley
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - J. Millenbruch
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - L. Prater
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - S.F. Conroy
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
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Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, Gyansa-Lutterodt M, Jing S, Luiza VL, Mbindyo RM, Möller H, Moucheraud C, Pécoul B, Rägo L, Rashidian A, Ross-Degnan D, Stephens PN, Teerawattananon Y, 't Hoen EFM, Wagner AK, Yadav P, Reich MR. Essential medicines for universal health coverage. Lancet 2017; 389:403-476. [PMID: 27832874 PMCID: PMC7159295 DOI: 10.1016/s0140-6736(16)31599-9] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Veronika J Wirtz
- Department of Global Health/Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
| | - Hans V Hogerzeil
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Andrew L Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | | | | | | | - Sun Jing
- Peking Union Medical College School of Public Health, Beijing, China
| | - Vera L Luiza
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Helene Möller
- United Nations Children's Fund, Supply Division, Copenhagen, Denmark
| | - Corrina Moucheraud
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Bernard Pécoul
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Lembit Rägo
- Regulation of Medicines and other Health Technologies, Geneva, Switzerland
| | - Arash Rashidian
- Department of Information, Evidence and Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Dennis Ross-Degnan
- Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; Harvard Medical School, Boston, MA, USA; Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Thai Ministry of Public Health Nonthaburi, Thailand
| | - Ellen F M 't Hoen
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Anita K Wagner
- Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt; Harvard Medical School, Boston, MA, USA
| | - Prashant Yadav
- William Davidson Institute at the University of Michigan, Ann Arbor, MI, USA
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White MC. Pro: Pure service delivery is still needed in global surgery missions. Can J Anaesth 2016; 64:347-352. [DOI: 10.1007/s12630-016-0807-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022] Open
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Verkuyl DAA. Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it. Contracept Reprod Med 2016; 1:23. [PMID: 29201412 PMCID: PMC5693528 DOI: 10.1186/s40834-016-0034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the increased prevalence of reversible contraception, global unintended pregnancy rates are stable. Mistakes, method failures, side effects, alcohol, stock-outs, fears, costs, delays, myths, religious interference, doctors with other priorities, traditions and lack of health professionals may all factor in. Yet these unintended pregnancies - nearly a hundred million annually - cause much individual suffering, and in the long run, can aggravate conflicts, poverty, forced emigration and climate change. Presently, non-poor women postpone childbearing because of longer educational trajectories and careers. Sterilisations are therefore less often regretted or coerced. For poor-resourced women with a completed family, an unwanted pregnancy often has serious consequences, including crossing the (extreme) poverty line in the wrong direction, choosing an unsafe abortion, or even death. Caesarean sections (CSs), which currently stand at around 23 million annually, are increasing. On an "intention-never-to-become-pregnant-again" analysis, choosing a partial, and even more so a total bilateral tubectomy to be implemented during an - anyway performed - CS is by far the most reliable and safe contraceptive choice compared to meaning to start female or male sterilisation or any other contraceptive method later, and it reduces the chance of a future ovarian carcinoma substantially. CSs make subsequent pregnancies more dangerous. Simultaneously, they provide convenient, potentially cost-free opportunities for voluntary permanent contraception (PC): particularly important if there is no guaranteed future access to reliable contraception, safe abortion and well-supervised labour. PARTIAL SOLUTION Millions of women are within reach of attaining freedom from the "tyranny of excessive fertility" when they have a CS. Therefore, any woman who might conceivably be of the firm opinion that her family will be (over) completed after delivery should antenatally have "what if you have a CS" counselling to assess whether she would like a tubectomy/ligation. Yet many are not provided with this option: leading to frequent regret, more often than having been giving that choice would. CONCLUSION Withholding antenatal counselling about the option of PC for in case the delivery might become a CS is very prevalent, yet often more medically risky, and morally questionable than when, even in labour, a doctor sometimes decides in the absence of earlier counselling, considering numerous factors, to provide the choice to undergo a concurrent sterilisation if s/he is convinced that would be in the patient's best interest.
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Affiliation(s)
- Douwe A. A. Verkuyl
- Leinweberlaan 16, 3971 KZ Driebergen, The Netherlands
- CASAklinieken, Leiden, The Netherlands
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72
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Yang JD, Mohamed EA, Aziz AOA, Shousha HI, Hashem MB, Nabeel MM, Abdelmaksoud AH, Elbaz TM, Afihene MY, Duduyemi BM, Ayawin JP, Gyedu A, Lohouès-Kouacou MJ, Ndam AWN, Moustafa EF, Hassany SM, Moussa AM, Ugiagbe RA, Omuemu CE, Anthony R, Palmer D, Nyanga AF, Malu AO, Obekpa S, Abdo AE, Siddig AI, Mudawi HMY, Okonkwo U, Kooffreh-Ada M, Awuku YA, Nartey YA, Abbew ET, Awuku NA, Otegbayo JA, Akande KO, Desalegn HM, Omonisi AE, Ajayi AO, Okeke EN, Duguru MJ, Davwar PM, Okorie MC, Mustapha S, Debes JD, Ocama P, Lesi OA, Odeghe E, Bello R, Onyekwere C, Ekere F, Igetei R, Mah'moud MA, Addissie B, Ali HM, Gores GJ, Topazian MD, Roberts LR. Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium. Lancet Gastroenterol Hepatol 2016; 2:103-111. [PMID: 28403980 DOI: 10.1016/s2468-1253(16)30161-3] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of patients with hepatocellular carcinoma in Africa. METHODS We did a multicentre, multicountry, retrospective observational cohort study, inviting investigators from the African Network for Gastrointestinal and Liver Diseases to participate in the consortium to develop hepatocellular carcinoma research databases and biospecimen repositories. Participating institutions were from Cameroon, Egypt, Ethiopia, Ghana, Ivory Coast, Nigeria, Sudan, Tanzania, and Uganda. Clinical information-demographic characteristics, cause of disease, liver-related blood tests, tumour characteristics, treatments, last follow-up date, and survival status-for patients diagnosed with hepatocellular carcinoma between Aug 1, 2006, and April 1, 2016, were extracted from medical records by participating investigators. Because patients from Egypt showed differences in characteristics compared with patients from the other countries, we divided patients into two groups for analysis; Egypt versus other African countries. We undertook a multifactorial analysis using the Cox proportional hazards model to identify factors affecting survival (assessed from the time of diagnosis to last known follow-up or death). FINDINGS We obtained information for 2566 patients at 21 tertiary referral centres (two in Egypt, nine in Nigeria, four in Ghana, and one each in the Ivory Coast, Cameroon, Sudan, Ethiopia, Tanzania, and Uganda). 1251 patients were from Egypt and 1315 were from the other African countries (491 from Ghana, 363 from Nigeria, 277 from Ivory Coast, 59 from Cameroon, 51 from Sudan, 33 from Ethiopia, 21 from Tanzania, and 20 from Uganda). The median age at which hepatocellular carcinoma was diagnosed significantly later in Egypt than the other African countries (58 years [IQR 53-63] vs 46 years [36-58]; p<0·0001). Hepatitis C virus was the leading cause of hepatocellular carcinoma in Egypt (1054 [84%] of 1251 patients), and hepatitis B virus was the leading cause in the other African countries (597 [55%] of 1082 patients). Substantially fewer patients received treatment specifically for hepatocellular carcinoma in the other African countries than in Egypt (43 [3%] of 1315 vs 956 [76%] of 1251; p<0·0001). Among patients with survival information (605 [48%] of 1251 in Egypt and 583 [44%] of 1315 in other African countries), median survival was shorter in the other African countries than in Egypt (2·5 months [95% CI 2·0-3·1] vs 10·9 months [9·6-12·0]; p<0·0001). Factors independently associated with poor survival were: being from an African countries other than Egypt (hazard ratio [HR] 1·59 [95% CI 1·13-2·20]; p=0·01), hepatic encephalopathy (2·81 [1·72-4·42]; p=0·0004), diameter of the largest tumour (1·07 per cm increase [1·04-1·11]; p<0·0001), log α-fetoprotein (1·10 per unit increase [1·02-1·20]; p=0·0188), Eastern Cooperative Oncology Group performance status 3-4 (2·92 [2·13-3·93]; p<0·0001) and no treatment (1·79 [1·44-2·22]; p<0·0001). INTERPRETATION Characteristics of hepatocellular carcinoma differ between Egypt and other African countries. The proportion of patients receiving specific treatment in other African countries was low and their outcomes were extremely poor. Urgent efforts are needed to develop health policy strategies to decrease the burden of hepatocellular carcinoma in Africa. FUNDING None.
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Affiliation(s)
- Ju Dong Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Essa A Mohamed
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ashraf O Abdel Aziz
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Hend I Shousha
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mohamed B Hashem
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mohamed M Nabeel
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Ahmed H Abdelmaksoud
- Department of Diagnostic and Interventional Radiology, University of Cairo, Cairo, Egypt
| | - Tamer M Elbaz
- Endemic Medicine and Hepatogastroenterology Department, University of Cairo, Cairo, Egypt
| | - Mary Y Afihene
- Department of Internal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Babatunde M Duduyemi
- Department of Pathology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joshua P Ayawin
- Department of Internal Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Marie-Jeanne Lohouès-Kouacou
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - Antonin W Ndjitoyap Ndam
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - Ehab F Moustafa
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Sahar M Hassany
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Abdelmajeed M Moussa
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut Governorate, Egypt
| | - Rose A Ugiagbe
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Casimir E Omuemu
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Richard Anthony
- Department of Internal Medicine, Effia Nkwanta Regional Hospital, Sekondi, Ghana
| | - Dennis Palmer
- Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon
| | - Albert F Nyanga
- Department of Internal Medicine, Mbingo Baptist Hospital, Bamenda, Cameroon
| | - Abraham O Malu
- Department of Medicine, Benue State University Teaching Hospital, Benue, Nigeria
| | - Solomon Obekpa
- Department of Medicine, Benue State University Teaching Hospital, Benue, Nigeria
| | | | | | - Hatim M Y Mudawi
- Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
| | - Uchenna Okonkwo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Mbang Kooffreh-Ada
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Yaw A Awuku
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Yvonne A Nartey
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Elizabeth T Abbew
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | - Nana A Awuku
- Department of Internal Medicine, School of Medical Sciences, Cape Coast, Ghana
| | | | | | - Hailemichael M Desalegn
- Department of Internal Medicine, St. Paul's Hospital Millenium Medical College, Addis Ababa, Ethiopia
| | - Abidemi E Omonisi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Akande O Ajayi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Edith N Okeke
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Mary J Duguru
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Pantong M Davwar
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Michael C Okorie
- Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Shettima Mustapha
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Jose D Debes
- Department of Medicine, University of Minnesota, MN, USA; Department of Medicine, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Ponsiano Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olufunmilayo A Lesi
- Division of Gastroenterology and Hepatology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emuobor Odeghe
- Division of Gastroenterology and Hepatology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ruth Bello
- Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | - Charles Onyekwere
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Francis Ekere
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufina Igetei
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Benyam Addissie
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Hawa M Ali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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Hallfors DD, Iritani BJ, Zhang L, Hartman S, Luseno WK, Mpofu E, Rusakaniko S. 'I thought if I marry the prophet I would not die': The significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe. SAHARA J 2016; 13:178-187. [PMID: 27762160 PMCID: PMC5642446 DOI: 10.1080/17290376.2016.1245627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This study examines the association between religious affiliation and reasons for marriage, perceived church attitudes, and reproductive health-seeking behaviors, including HIV testing, among young women in eastern rural Zimbabwe. The sample comprised women (N = 35) who had married by 2012 while participating in a larger randomized controlled trial (RCT) to test the effects of school support on HIV-related risk. The RCT sample was identified in 2007 as all female sixth graders in 25 rural eastern Zimbabwe primary schools whose parents, one or both, had died (N = 328). In our previous RCT analyses, we found that participants who affiliated with an Apostolic church were more than four times more likely to marry than those from non-Apostolic churches and that control group participants were twice as likely to marry as those in the intervention group. Other studies had found that marriage greatly increased the odds of HIV infection among adolescent women. Given the link between Apostolic affiliation and marriage, we conducted semi-structured interviews to explore type of marriage, reasons for marrying, church affiliation and attitudes, family planning, HIV testing, schooling, and family life. We were interested in differences, as perceived by our sample of young married women congregants, among Apostolic sects and other denominations in their attitudes about marriage and health-seeking behaviors. We were also interested in the influence of church affiliation on intervention participants' decision to marry, since they had comprehensive school support and education is highly valued in Zimbabwe, but costly and often out of financial reach. Interviews were conducted from October 2012 through November 2013; data were analyzed using a general inductive approach. We found that pressure or perceived deception for coitus or marriage was reported only by intervention participants affiliated with Apostolic denominations. Other reasons for marriage were similar between Apostolic and non-Apostolic adherents, as well as intervention and control conditions. All participants believed HIV testing was important, but while all non-Apostolic denominations encouraged HIV testing and clinic/hospital care, there was considerable heterogeneity in attitudes among Apostolics, with ultraconservative denominations most likely to proscribe non-religious health care. We conclude that some, but not all, Apostolic-affiliated women are afforded discretion in their health-seeking behaviors. Since HIV screening and treatment depend on access to clinic/hospital care, continued public health efforts to engage Apostolic leaders is needed, along with monitoring of progress in access and outcomes.
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Affiliation(s)
- Denise Dion Hallfors
- PhD Senior Research Scientist, is affiliated to Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC27514, USA
| | - Bonita J. Iritani
- MS, MA Associate Research Scientist, is affiliated to Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC27514, USA
| | - Lei Zhang
- PhD Associate Research Scientist, is affiliated to Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC27514, USA
| | - Shane Hartman
- BA Research Associate, is affiliated to Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC27514USA
| | - Winnie K. Luseno
- PhD Research Scientist, is affiliated to Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Suite 200, Chapel Hill, NC27514, USA
| | - Elias Mpofu
- PhD, DEd Professor of Rehabilitation Counseling, is affiliated to Department of Rehabilitation Counseling, Faculty of Health Sciences, University of Sydney, Australia
- PhD, DEd Professor of Rehabilitation Counseling, is affiliated to Department of Research and Innovation, Central University of Technology, Bloemfontein, South Africa
| | - Simbarashe Rusakaniko
- PhD Professor and Chairman, is affiliated to Department of Community Medicine, University of Zimbabwe, PO Box A 178, Avondale, Harare, Zimbabwe
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Palmer JJ, Gilbert A, Choy M, Blanchet K. Circumventing 'free care' and 'shouting louder': using a health systems approach to study eye health system sustainability in government and mission facilities of north-west Tanzania. Health Res Policy Syst 2016; 14:68. [PMID: 27612454 PMCID: PMC5017067 DOI: 10.1186/s12961-016-0137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. Methods In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. Results Practitioners in this region felt eye care was systemically neglected by government and therefore was ‘all under the NGOs’, but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain ‘sustainability funds’ to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for ‘free care’. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. Conclusions Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs’ investments are important, not only in terms of the population health outcomes achieved by teams they support, but also in the diversity of organisational models they contribute to in the wider eye health system, which facilitates innovation. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0137-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer J Palmer
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.,Centre of African Studies, School of Political and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alice Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Michelle Choy
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom
| | - Karl Blanchet
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, United Kingdom.
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Bischoff A. Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study. Glob Health Action 2016; 9:29404. [PMID: 27238652 PMCID: PMC4884679 DOI: 10.3402/gha.v9.29404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. Design This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. Conclusions This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly stick to original plans that might not be working; 4) Be realistic and do not romanticise. Embarking on such a project was a timely response to the Tanzanian's government call for strengthening Primary Health Care and for rapidly accelerating the training of nurses able to work in rural areas.
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Affiliation(s)
- Alexander Bischoff
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.,School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland; ;
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Time for full inclusion of community actions in the response to AIDS. J Int AIDS Soc 2016; 19:20712. [PMID: 27083149 PMCID: PMC4833769 DOI: 10.7448/ias.19.1.20712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Community action, including activism, advocacy and service delivery, has been crucially important in the global response to AIDS from the beginning of the epidemic and remains one of its defining features. This indispensable contribution has been increasingly acknowledged in strategic planning documents from UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, the World Bank, the World Health Organization and other organizations. A growing body of literature demonstrates that community-based services can have measurable impact, serve populations that are not accessing public health services and reach people at scale. Discussion Recognition of the powerful potential role of community has not translated into full incorporation of community responses in programme planning or financing, and communities are still not fully understood as true assets within overall systems for health. The diverse community contributions remain seriously underappreciated and under-resourced in national responses. Conclusions It is time for a paradigm shift in how we think about, plan and finance community-based responses to HIV in order to achieve improved impact and move toward ending the epidemic. We must utilize the unique strengths of communities in creating resilient and sustainable systems for health. There are several priorities for immediate attention, including agreement on the need to nurture truly comprehensive systems for health that include public, private and community activities; re-examination of donor and national funding processes to ensure community is strategically included; improvement of data systems to capture the full spectrum of health services; and improved accountability frameworks for overall health systems. Health planning and financing approaches run by governments and donors should institutionalize consideration of how public, community and private health services can strategically contribute to meeting service needs and accomplishing public health targets.
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Spillman ID. Faith-based health care. Lancet 2016; 387:429. [PMID: 26869563 DOI: 10.1016/s0140-6736(16)00168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tomkins A, Duff J, Fitzgibbon A, Karam A, Mills EJ, Munnings K, Smith S, Seshadri SR, Steinberg A, Vitillo R, Yugi P. Controversies in faith and health care. Lancet 2015; 386:1776-85. [PMID: 26159392 DOI: 10.1016/s0140-6736(15)60252-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care.
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Affiliation(s)
- Andrew Tomkins
- Institute for Global Health, Institute of Child Health, UCL, London, UK.
| | - Jean Duff
- Partnership for Faith and Development, USA
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Abstract
The sharpening focus on global health and the growing recognition of the capacities and scope of faith-based groups for improving community health outcomes suggest an intentional and systematic approach to forging strong, sustained partnerships between public sector agencies and faith-based organisations. Drawing from both development and faith perspectives, this Series paper examines trends that could ground powerful, more sustainable partnerships and identifies new opportunities for collaboration based on respective strengths and existing models. This paper concludes with five areas of recommendations for more effective collaboration to achieve health goals.
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Affiliation(s)
- Jean F Duff
- Partnership for Faith and Development, Washington, DC, USA.
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Haakenstad A, Johnson E, Graves C, Olivier J, Duff J, Dieleman JL. Estimating the development assistance for health provided to faith-based organizations, 1990-2013. PLoS One 2015; 10:e0128389. [PMID: 26042731 PMCID: PMC4456102 DOI: 10.1371/journal.pone.0128389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 04/26/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations. MATERIAL AND METHODS Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs. RESULTS In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund's contributions to NGOs. In 2011, the Gates Foundation's contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs. CONCLUSION Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.
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Affiliation(s)
- Annie Haakenstad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Elizabeth Johnson
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Casey Graves
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Jill Olivier
- University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
| | - Jean Duff
- Joint Learning Initiative on Faith and Local Communities, Washington, DC, United States of America
| | - Joseph L. Dieleman
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
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