301
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Ballard M, Montgomery P. Systematic review of interventions for improving the performance of community health workers in low-income and middle-income countries. BMJ Open 2017; 7:e014216. [PMID: 29074507 PMCID: PMC5665298 DOI: 10.1136/bmjopen-2016-014216] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To systematically review and critically appraise the evidence for the effects of interventions to improve the performance of community health workers (CHWs) for community-based primary healthcare in low- and middle-income countries. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS 19 electronic databases were searched with a highly sensitive prespecified strategy and the grey literature examined, completed July 2016. Randomised controlled trials evaluating interventions to improve CHW performance in low- and middle-income countries were included and appraised for risk of bias. Outcomes were biological and behavioural patient outcomes (primary), use of health services, quality of care provided by CHWs and CHW retention (secondary). RESULTS Two reviewers screened 8082 records; 14 evaluations were included. Due to heterogeneity and lack of clear outcome data, no meta-analysis was conducted. Results were presented in a narrative summary. The review found one study showing no effect on the biological outcomes of interest, though these moderate quality data may not be indicative of all biological outcomes. It also found moderate quality evidence of the efficacy of performance improvement interventions for (1) improving behavioural outcomes for patients, (2) improving use of services by increasing the absolute number of patients who access services and, perhaps, better identifying those who would benefit from such services and (3) improving CHW quality of care in terms of upstream measures like completion of prescribed activities and downstream measures like adherence to treatment protocols. Nearly half of studies were compound interventions, making it difficult to isolate the effects of individual performance improvement intervention components, though four specific strategies pertaining to recruitment, supervision, incentivisation and equipment were identified. CONCLUSIONS Variations in recruitment, supervision, incentivisation and equipment may improve CHW performance. Practitioners should, however, assess the relevance and feasibility of these strategies in their health setting prior to implementation. Component selection experiments on a greater range of interventions to improve performance ought to be conducted.
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Affiliation(s)
- Madeleine Ballard
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK
| | - Paul Montgomery
- Department of Social Policy and Social Work, University of Birmingham, Birmingham, UK
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302
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Jabot F, Kane H. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2017; 29:451-452. [PMID: 29034660 DOI: 10.3917/spub.174.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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303
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Kurth AE. Planetary Health and the Role of Nursing: A Call to Action. J Nurs Scholarsh 2017; 49:598-605. [PMID: 28960761 DOI: 10.1111/jnu.12343] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To discuss the drivers of planetary health, responses, and the role of nursing in making health systems more resilient in an era of increasing stresses. As health providers, scientists, educators, and leaders, nurses have an obligation to prepare for climate change and other impacts of ecosystem strain on human health. DESIGN AND METHODS Review of literature relevant to a planetary health framework. FINDINGS Population displacement, new disease patterns and health needs, stresses on air quality, food production and water systems, and equity concerns, as well as the generation of sustainable energy, are all intimately related to health. CONCLUSIONS Nurses are key to achieving the sustainable development goals that, like the planetary health framework, focus on environmental sustainability and human well-being. Nurses contribute to resilient health systems, as trusted leaders and providers of health care, and as advocates and change makers impacting the world. CLINICAL RELEVANCE It is critical that nurses and other health professionals consider the multiple effects of ecosystem strain on human health, and anticipate population health and health system planning and response.
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Affiliation(s)
- Ann E Kurth
- Dean and Linda Koch Lorimer Professor, Yale University School of Nursing, West Haven, CT, USA
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304
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Olu O. Resilient Health System As Conceptual Framework for Strengthening Public Health Disaster Risk Management: An African Viewpoint. Front Public Health 2017; 5:263. [PMID: 29034230 PMCID: PMC5625001 DOI: 10.3389/fpubh.2017.00263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/14/2017] [Indexed: 11/13/2022] Open
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305
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Chang AY, Ogbuoji O, Atun R, Verguet S. Dynamic modeling approaches to characterize the functioning of health systems: A systematic review of the literature. Soc Sci Med 2017; 194:160-167. [PMID: 29100141 DOI: 10.1016/j.socscimed.2017.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/05/2017] [Accepted: 09/05/2017] [Indexed: 12/14/2022]
Abstract
Universal Health Coverage (UHC) is one of the targets for the United Nations Sustainable Development Goal 3. The impetus for UHC has led to an increased demand for time-sensitive tools to enhance our knowledge of how health systems function and to evaluate impact of system interventions. We define the field of "health system modeling" (HSM) as an area of research where dynamic mathematical models can be designed in order to describe, predict, and quantitatively capture the functioning of health systems. HSM can be used to explore the dynamic relationships among different system components, including organizational design, financing and other resources (such as investments in resources and supply chain management systems) - what we call "inputs" - on access, coverage, and quality of care - what we call "outputs", toward improved health system "outcomes", namely increased levels and fairer distributions of population health and financial risk protection. We undertook a systematic review to identify the existing approaches used in HSM. We identified "systems thinking" - a conceptual and qualitative description of the critical interactions within a health system - as an important underlying precursor to HSM, and collated a critical collection of such articles. We then reviewed and categorized articles from two schools of thoughts: "system dynamics" (SD)" and "susceptible-infected-recovered-plus" (SIR+). SD emphasizes the notion of accumulations of stocks in the system, inflows and outflows, and causal feedback structure to predict intended and unintended consequences of policy interventions. The SIR + models link a typical disease transmission model with another that captures certain aspects of the system that impact the outcomes of the main model. These existing methods provide critical insights in informing the design of HSM, and provide a departure point to extend this research agenda. We highlight the opportunity to advance modeling methods to further understand the dynamics between health system inputs and outputs.
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Affiliation(s)
- Angela Y Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Osondu Ogbuoji
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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306
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Leslie HH, Spiegelman D, Zhou X, Kruk ME. Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ 2017; 95:738-748. [PMID: 29147054 PMCID: PMC5677617 DOI: 10.2471/blt.17.191916] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Methods Using existing data from service provision assessments of the health systems of the 10 study countries, we calculated a service readiness index for each of 8443 health facilities. This index represents the percentage availability of 50 items that the World Health Organization considers essential for providing health care. For our analysis we used 37–49 of the items on the list. We used linear regression to assess the independent explanatory power of four national and four facility-level characteristics on reported service readiness. Findings The mean values for the service readiness index were 77% for the 636 hospitals and 52% for the 7807 health centres/clinics. Deficiencies in medications and diagnostic capacity were particularly common. The readiness index varied more between hospitals and health centres/clinics in the same country than between them. There was weak correlation between national factors related to health financing and the readiness index. Conclusion Most health facilities in our study countries were insufficiently equipped to provide basic clinical care. If countries are to bolster health-system capacity towards achieving universal coverage, more attention needs to be given to within-country inequities.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America (USA)
| | - Donna Spiegelman
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Xin Zhou
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America (USA)
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307
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Amanat N, Hosseini SH, Khankeh HR, Aminizadeh M, Nakhaee M, Farzinnia B. Health Services Vulnerability During the Ebola Outbreak: A Qualitative Report. HEALTH IN EMERGENCIES & DISASTERS QUARTERLY 2017. [DOI: 10.29252/nrip.hdq.2.4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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308
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Grépin KA, Pinkstaff CB, Shroff ZC, Ghaffar A. Donor funding health policy and systems research in low- and middle-income countries: how much, from where and to whom. Health Res Policy Syst 2017; 15:68. [PMID: 28854946 PMCID: PMC5577666 DOI: 10.1186/s12961-017-0224-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for sufficient and reliable funding to support health policy and systems research (HPSR) in low- and middle-income countries (LMICs) has been widely recognised. Currently, most resources to support such activities come from traditional development assistance for health (DAH) donors; however, few studies have examined the levels, trends, sources and national recipients of such support - a gap this research seeks to address. METHOD Using OECD's Creditor Reporting System database, we classified donor funding commitments using a keyword analysis of the project-level descriptions of donor supported projects to estimate total funding available for HPSR-related activities annually from bilateral and multilateral donors, as well as the Bill and Melinda Gates Foundation, to LMICs over the period 2000-2014. RESULTS Total commitments to HPSR-related activities have greatly increased since 2000, peaked in 2010, and have held steady since 2011. Over the entire study period (2000-2014), donors committed a total of $4 billion in funding for HPSR-related activities or an average of $266 million a year. Over the last 5 years (2010-2014), donors committed an average of $434 million a year to HPSR-related activities. Funding for HPSR is heavily concentrated, with more than 93% coming from just 10 donors and only represents approximately 2% of all donor funding for health and population projects. Countries in the sub-Saharan African region are the major recipients of HPSR funding. CONCLUSION Funding for HPSR-related activities has generally increased over the study period; however, donor support to such activities represents only a small proportion of total DAH and has not grown in recent years. Donors should consider increasing the proportion of funds they allocate to support HPSR activities in order to further build the evidence base on how to build stronger health systems.
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Affiliation(s)
- Karen Ann Grépin
- Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada.
| | | | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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309
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Russo G, Bloom G, McCoy D. Universal health coverage, economic slowdown and system resilience: Africa's policy dilemma. BMJ Glob Health 2017; 2:e000400. [PMID: 29082020 PMCID: PMC5656116 DOI: 10.1136/bmjgh-2017-000400] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Giuliano Russo
- Centre for Primary Care and Public Health, Queen Mary University of London, London, The United Kingdom
| | - Gerald Bloom
- Institute of Development Studies, The University of Sussex, Brighton, The United Kingdom
| | - David McCoy
- Centre for Primary Care and Public Health, Queen Mary University of London, London, The United Kingdom
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310
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Garattini C, Raffle J, Aisyah DN, Sartain F, Kozlakidis Z. Big Data Analytics, Infectious Diseases and Associated Ethical Impacts. PHILOSOPHY & TECHNOLOGY 2017; 32:69-85. [PMID: 31024785 PMCID: PMC6451937 DOI: 10.1007/s13347-017-0278-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/02/2017] [Indexed: 12/16/2022]
Abstract
The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes in the information accumulation models. These are discussed by comparing the traditional and new models of data accumulation. Big data analytics is fast becoming a crucial component for the modelling of transmission-aiding infection control measures and policies-emergency response analyses required during local or international outbreaks. However, the application of big data analytics in infectious diseases is coupled with a number of ethical impacts. Four key areas are discussed in this paper: (i) automation and algorithmic reliance impacting freedom of choice, (ii) big data analytics complexity impacting informed consent, (iii) reliance on profiling impacting individual and group identities and justice/fair access and (iv) increased surveillance and population intervention capabilities impacting behavioural norms and practices. Furthermore, the extension of big data analytics to include information derived from personal devices, such as mobile phones and wearables as part of infectious disease frameworks in the near future and their potential ethical impacts are discussed. Considered together, the need for a constructive and transparent inclusion of ethical questioning in this rapidly evolving field becomes an increasing necessity in order to provide a moral foundation for the societal acceptance and responsible development of the technological advancement.
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Affiliation(s)
- Chiara Garattini
- Anthropology and UX Research, Health and Life Sciences, Intel, London, UK
| | - Jade Raffle
- Division of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, WC1E 6BT UK
| | - Dewi N Aisyah
- Department of Infectious Disease Informatics, University College London, Farr Institute of Health Informatics Research, 222 Euston Road, London, NW1 2DA UK
| | | | - Zisis Kozlakidis
- Division of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, WC1E 6BT UK
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311
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Diaconu K, Chen YF, Cummins C, Jimenez Moyao G, Manaseki-Holland S, Lilford R. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review. Global Health 2017; 13:59. [PMID: 28821280 PMCID: PMC5563028 DOI: 10.1186/s12992-017-0280-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/27/2017] [Indexed: 05/29/2023] Open
Abstract
Background Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue. We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries. We explore the factors/evidence-base proposed for consideration within such methods and identify prioritization criteria. Results We included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured in the meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipment costs (including maintenance) and health needs are the dominant issues considered. Extracted data suggest that procurement officials should prioritize devices with low- and middle-income country appropriate technical specifications – i.e. devices and equipment that can be used given available human resources, infrastructure and maintenance capacity. Conclusion Suboptimal device use is directly linked to incomplete costing and inadequate consideration of maintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and careful consideration of device servicing are of crucial importance. Electronic supplementary material The online version of this article (doi:10.1186/s12992-017-0280-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Diaconu
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK. .,Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
| | - Carole Cummins
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK.
| | - Gabriela Jimenez Moyao
- Medicins Sans Frontieres, Artsen Zonder Grenzen, Rue de l'Arbre Benit 46, 1050, Bruxelles, Belgium
| | - Semira Manaseki-Holland
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK
| | - Richard Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
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312
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Gilson L, Barasa E, Nxumalo N, Cleary S, Goudge J, Molyneux S, Tsofa B, Lehmann U. Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health 2017; 2:e000224. [PMID: 29081995 PMCID: PMC5656138 DOI: 10.1136/bmjgh-2016-000224] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/25/2017] [Accepted: 03/28/2017] [Indexed: 11/05/2022] Open
Abstract
Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding.
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Affiliation(s)
- Lucy Gilson
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Center for Geographical Medicine, KEMRI-Wellcome Trust Programme, Nairobi, Kenya
| | - Nonhlanhla Nxumalo
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Cleary
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jane Goudge
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Sassy Molyneux
- Center for Geographical Medicine, KEMRI-Wellcome Trust Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Center for Geographical Medicine, KEMRI-Wellcome Trust Programme, Nairobi, Kenya
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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313
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Silvestri DM, Blevins M, Wallston KA, Afzal AR, Alam N, Andrews B, Derbew M, Kaur S, Mipando M, Mkony CA, Mwachaka PM, Ranjit N, Vermund SH. Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa. Am J Trop Med Hyg 2017; 96:1512-1520. [PMID: 28719284 PMCID: PMC5462594 DOI: 10.4269/ajtmh.16-0756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/21/2017] [Indexed: 11/07/2022] Open
Abstract
AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.
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Affiliation(s)
| | - Meridith Blevins
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kenneth A. Wallston
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Arfan R. Afzal
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nazmul Alam
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Ben Andrews
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Miliard Derbew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Simran Kaur
- Department of Physiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | | | - Charles A. Mkony
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Nirju Ranjit
- Department of Anatomy, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Sten H. Vermund
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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314
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Hafner T, Walkowiak H, Lee D, Aboagye-Nyame F. Defining pharmaceutical systems strengthening: concepts to enable measurement. Health Policy Plan 2017; 32:572-584. [PMID: 28025324 PMCID: PMC5400040 DOI: 10.1093/heapol/czw153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/14/2022] Open
Abstract
Pharmaceutical products are indispensable for improving health outcomes. An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information. This work adds clarity to the concept of pharmaceutical systems and their strengthening by proposing holistic definitions on the basis of systems thinking. It provides a practical starting point for measuring the progress of pharmaceutical systems strengthening.
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Affiliation(s)
| | - Helena Walkowiak
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA 22203, USA
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315
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Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, Secci F, Wong E, Basu L, Taylor C, Bayona J, Wang H, Lagomarsino G, Hirschhorn LR. Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries. J Gen Intern Med 2017; 32:566-571. [PMID: 27943038 PMCID: PMC5400754 DOI: 10.1007/s11606-016-3898-5] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/29/2022]
Abstract
Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators ("Vital Signs"). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.
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Affiliation(s)
- Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Third Floor East, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Third Floor East, Boston, MA, 02215, USA
| | | | | | | | | | | | - Ethan Wong
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lopa Basu
- World Health Organization, Geneva, Switzerland
| | | | | | - Hong Wang
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Lisa R Hirschhorn
- Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, Third Floor East, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
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316
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Claeson M. The Global Financing Facility-towards a new way of financing for development. Lancet 2017; 389:1588-1592. [PMID: 28443542 DOI: 10.1016/s0140-6736(17)31000-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mariam Claeson
- Global Financing Facility, World Bank, Washington, DC 20433, USA.
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317
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Haldane V, Ong SE, Chuah FLH, Legido-Quigley H. Health systems resilience: meaningful construct or catchphrase? Lancet 2017; 389:1513. [PMID: 28422019 PMCID: PMC7133569 DOI: 10.1016/s0140-6736(17)30946-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 12/03/2022]
Affiliation(s)
- Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549
| | - Suan-Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549
| | - Fiona Leh-Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
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318
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Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, Kluge H, Lin V, Menabde N, Mirza Z, Siddiqi S, Travis P. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ 2017; 95:537-539. [PMID: 28670019 PMCID: PMC5487973 DOI: 10.2471/blt.16.187476] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Marie Paule Kieny
- Health Systems and Innovation, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Henk Bekedam
- India Country Office, World Health Organization, New Delhi, India
| | - Delanyo Dovlo
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - James Fitzgerald
- Pan American Health Organization, Washington, United States of America (USA)
| | - Jarno Habicht
- Kyrgyzstan Country Office, World Health Organization, Bishkek, Kyrgyzstan
| | - Graham Harrison
- Malaysia Country Office, World Health Organization, Kuala Lumpur, Malaysia
| | - Hans Kluge
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Vivian Lin
- Regional Office for Western Pacific, World Health Organization, Manila, Philippines
| | - Natela Menabde
- World Health Organization Office at the United Nations, World Health Organization, New York, USA
| | - Zafar Mirza
- India Country Office, World Health Organization, New Delhi, India
| | - Sameen Siddiqi
- Islamic Republic of Iran Country Office, World Health Organization, Tehran, Islamic Republic of Iran
| | - Phyllida Travis
- Regional Office for South-East Asia, World Health Organization, New Delhi, India
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319
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Bain LE, Ebuenyi ID. An Urgent Call for the Renaissance of the World Health Organization: Needed Now More than Ever Before. Front Public Health 2017; 5:43. [PMID: 28344970 PMCID: PMC5344893 DOI: 10.3389/fpubh.2017.00043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luchuo Engelbert Bain
- Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit , Amsterdam , Netherlands
| | - Ikenna Desmond Ebuenyi
- Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit , Amsterdam , Netherlands
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320
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Bennett B, Cohen IG, Davies SE, Gostin LO, Hill PS, Mankad A, Phelan AL. Future-proofing global health: Governance of priorities. Glob Public Health 2017; 13:519-527. [PMID: 28271746 DOI: 10.1080/17441692.2017.1296172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.
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Affiliation(s)
- Belinda Bennett
- a Australian Centre for Health Law Research , Queensland University of Technology , Brisbane , Australia
| | - I Glenn Cohen
- b Petrie Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School , Harvard University , Cambridge , MA , USA
| | - Sara E Davies
- c Centre for Governance and Public Policy , Griffith University , Brisbane , Australia
| | - Lawrence O Gostin
- d O'Neill Institute for National and Global Health Law, Georgetown University , Washington , DC , USA
| | - Peter S Hill
- e School of Public Health , University of Queensland , Brisbane , Australia
| | | | - Alexandra L Phelan
- d O'Neill Institute for National and Global Health Law, Georgetown University , Washington , DC , USA
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321
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Rüegg SR, McMahon BJ, Häsler B, Esposito R, Nielsen LR, Ifejika Speranza C, Ehlinger T, Peyre M, Aragrande M, Zinsstag J, Davies P, Mihalca AD, Buttigieg SC, Rushton J, Carmo LP, De Meneghi D, Canali M, Filippitzi ME, Goutard FL, Ilieski V, Milićević D, O'Shea H, Radeski M, Kock R, Staines A, Lindberg A. A Blueprint to Evaluate One Health. Front Public Health 2017; 5:20. [PMID: 28261580 PMCID: PMC5311072 DOI: 10.3389/fpubh.2017.00020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the “Network for Evaluation of One Health,” an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.
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Affiliation(s)
- Simon R Rüegg
- Vetsuisse-Faculty, Section for Veterinary Epidemiology, University of Zurich , Zurich , Switzerland
| | - Barry J McMahon
- UCD School of Agriculture and Food Science, University College Dublin , Dublin , Ireland
| | | | | | | | - Chinwe Ifejika Speranza
- Institute of Geography and Centre for Development and Environment, University of Bern , Bern , Switzerland
| | | | | | - Maurizio Aragrande
- Agriculture and Food Science Department, University of Bologna , Bologna , Italy
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, University of Basel , Basel , Switzerland
| | | | - Andrei Daniel Mihalca
- Department of Parasitology and Parasitic Diseases, University of Agricultural Sciences and Veterinary Medicine , Cluj Napoca , Romania
| | | | - Jonathan Rushton
- Faculty of Health and Life Sciences, University of Liverpool , Liverpool , UK
| | - Luís P Carmo
- Veterinary Public Health Institute, University of Bern , Bern , Switzerland
| | - Daniele De Meneghi
- Department of Veterinary Sciences, University of Turin , Grugliasco-Turin , Italy
| | - Massimo Canali
- Agriculture and Food Science Department, University of Bologna , Bologna , Italy
| | - Maria E Filippitzi
- Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University , Ghent , Belgium
| | | | - Vlatko Ilieski
- Faculty of Veterinary Medicine, Ss Cyril and Methodius University , Skopje , Macedonia
| | | | | | - Miroslav Radeski
- Faculty of Veterinary Medicine, Ss Cyril and Methodius University , Skopje , Macedonia
| | | | - Anthony Staines
- School of Nursing & Human Sciences, Dublin City University , Dublin , Ireland
| | - Ann Lindberg
- National Veterinary Institute , Uppsala , Sweden
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322
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Siekmans K, Sohani S, Boima T, Koffa F, Basil L, Laaziz S. Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia. BMC Public Health 2017; 17:84. [PMID: 28095824 PMCID: PMC5240441 DOI: 10.1186/s12889-016-4012-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/30/2016] [Indexed: 12/03/2022] Open
Abstract
Background Trained community health workers (CHW) enhance access to essential primary health care services in contexts where the health system lacks capacity to adequately deliver them. In Liberia, the Ebola outbreak further disrupted health system function. The objective of this study is to examine the value of a community-based health system in ensuring continued treatment of child illnesses during the outbreak and the role that CHWs had in Ebola prevention activities. Methods A descriptive observational study design used mixed methods to collect data from CHWs (structured survey, n = 60; focus group discussions, n = 16), government health facility workers and project staff. Monthly data on child diarrhea and pneumonia treatment were gathered from CHW case registers and local health facility records. Results Coverage for community-based treatment of child diarrhea and pneumonia continued throughout the outbreak in project areas. A slight decrease in cases treated during the height of the outbreak, from 50 to 28% of registers with at least one treatment per month, was attributed to directives not to touch others, lack of essential medicines and fear of contracting Ebola. In a climate of distrust, where health workers were reluctant to treat patients, sick people were afraid to self-identify and caregivers were afraid to take children to the clinic, CHWs were a trusted source of advice and Ebola prevention education. These findings reaffirm the value of recruiting and training local workers who are trusted by the community and understand the social and cultural complexities of this relationship. “No touch” integrated community case management (iCCM) guidelines distributed at the height of the outbreak gave CHWs renewed confidence in assessing and treating sick children. Conclusions Investments in community-based health service delivery contributed to continued access to lifesaving treatment for child pneumonia and diarrhea during the Ebola outbreak, making communities more resilient when facility-based health services were impacted by the crisis. To maximize the effectiveness of these interventions during a crisis, proactive training of CHWs in infection prevention and “no touch” iCCM guidelines, strengthening drug supply chain management and finding alternative ways to provide supportive supervision when movements are restricted are recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-4012-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kendra Siekmans
- HealthBridge, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada
| | - Salim Sohani
- Canadian Red Cross Society, 170 Metcalfe Street, Ottawa, ON, K2P 2P2, Canada.
| | - Tamba Boima
- Ministry of Health and Social Welfare, P. O. Box 10-9009, 1000, Monrovia, 10, Liberia
| | - Florence Koffa
- Liberia Red Cross Society, 107 Lynch Street, 1000, Monrovia, 20, Liberia
| | - Luay Basil
- Canadian Red Cross Society, 170 Metcalfe Street, Ottawa, ON, K2P 2P2, Canada
| | - Saïd Laaziz
- Canadian Red Cross Society, 170 Metcalfe Street, Ottawa, ON, K2P 2P2, Canada
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323
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Ozawa S, Paina L, Qiu M. Exploring pathways for building trust in vaccination and strengthening health system resilience. BMC Health Serv Res 2016; 16:639. [PMID: 28185595 PMCID: PMC5123384 DOI: 10.1186/s12913-016-1867-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Trust is critical to generate and maintain demand for vaccines in low and middle income countries. However, there is little documentation on how health system insufficiencies affect trust in vaccination and the process of re-building trust once it has been compromised. We reflect on how disruptions to immunizations systems can affect trust in vaccination and can compromise vaccine utilization. We then explore key pathways for overcoming system vulnerabilities in order to restore trust, to strengthen the resilience of health systems and communities, and to promote vaccine utilization. Methods Utilizing secondary data and a review of the literature, we developed a causal loop diagram (CLD) to map the determinants of building trust in immunizations. Using the CLD, we devised three scenarios to illustrate common vulnerabilities that compromise trust and pathways to strengthen trust and utilization of vaccines, specifically looking at weak health systems, harmful communication channels, and role of social capital. Spill-over effects, interactions and other dynamics in the CLD were then examined to assess leverage points to counter these vulnerabilities. Results Trust in vaccination arises from the interactions among experiences with the health system, the various forms of communication and social capital – both external and internal to communities. When experiencing system-wide shocks such as the case in Ebola-affected countries, distrust is reinforced by feedback between the health and immunization systems where distrust often lingers even after systems are restored and spills over beyond vaccination in the broader health system. Vaccine myths or anti-vaccine movements reinforce distrust. Social capital – the collective value of social networks of community members – plays a central role in increasing levels of trust. Conclusions Trust is important, yet underexplored, in the context of vaccine utilization. Using a CLD to illustrate various scenarios helped to explore how common health and vaccine vulnerabilities can reinforce and spill over distrust through vicious, reinforcing feedback. Restoring trust requires a careful balance between eliminating vulnerabilities and strengthening social capital and interactions among communication channels.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Mary Qiu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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324
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Kruk ME, Kujawski S, Moyer CA, Adanu RM, Afsana K, Cohen J, Glassman A, Labrique A, Reddy KS, Yamey G. Next generation maternal health: external shocks and health-system innovations. Lancet 2016; 388:2296-2306. [PMID: 27642020 PMCID: PMC5167371 DOI: 10.1016/s0140-6736(16)31395-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/15/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
In this Series we document the substantial progress in the reduction of maternal mortality and discuss the current state of science in reducing maternal mortality. However, maternal health is also powerfully influenced by the structures and resources of societies, communities, and health systems. We discuss the shocks from outside of the field of maternal health that will influence maternal survival including economic growth in low-income and middle-income countries, urbanisation, and health crises due to disease outbreaks, extreme weather, and conflict. Policy and technological innovations, such as universal health coverage, behavioural economics, mobile health, and the data revolution, are changing health systems and ushering in new approaches to affect the health of mothers. Research and policy will need to reflect the changing maternal health landscape.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, School of Public Health, Harvard T H Chan, Boston, Boston, MA, USA.
| | - Stephanie Kujawski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Cheryl A Moyer
- Department of Learning Health Sciences and Department of Obstetrics and Gynaecology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Kaosar Afsana
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jessica Cohen
- Department of Global Health and Population, School of Public Health, Harvard T H Chan, Boston, Boston, MA, USA
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gavin Yamey
- Duke Global Health Institute, Durham, NC, USA
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325
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McKenzie A, Abdulwahab A, Sokpo E, Mecaskey JW. Creating the Foundation for Health System Resilience in Northern Nigeria. Health Syst Reform 2016; 2:357-366. [PMID: 31514718 DOI: 10.1080/23288604.2016.1242453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract-The experience of a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in four states of Northern Nigeria illustrates how a Complex Adaptive System (CAS) approach to health system strengthening can lead to health systems becoming more resilient. The program worked with the array of political, cultural and social determinants which interact to shape the health system and its functionality. It worked in an environment marked by weak governance with little public accountability and by very limited management capability in inadequately regulated markets. To these conditions of fragility was added the shock from the rapidly deteriorating security situation caused in 2011 by the Boko Haram insurgency and the government's ensuing response. A CAS theory of change provided the basis for the multi-faceted approach that identified critical points of leverage among institutions in social as well as professional systems and helped achieve significant improvements in health service delivery in the RMNCH continuum of care. It also established the foundation for Primary Health Care Under One Roof, which has emerged as a central national strategy in Nigeria for strengthening health sector governance and services under the 2014 Health Act. This article draws on the experience of work undertaken in Northern Nigeria over the course of the last 10 years. A team largely of Nigerian professionals from an array of disciplines worked widely across the health system, addressing issues of governance, finance, institutional management, community systems support, access and accountability, and service delivery-frequently at the same time. This experience provides lessons for efforts elsewhere on how to strengthen health systems during and after emergencies (such as Ebola in West Africa) and in situations affected by conflict.
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Affiliation(s)
- Andrew McKenzie
- Health Partners International , Lewes, UK, and Abuja , Nigeria
| | | | - Emmanuel Sokpo
- Health Partners International , Lewes, UK, and Abuja , Nigeria
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326
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Martineau FP. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis. Int Health 2016; 8:307-9. [PMID: 27620922 PMCID: PMC5039820 DOI: 10.1093/inthealth/ihw029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/25/2016] [Indexed: 12/04/2022] Open
Abstract
The 2014–2016 West African Ebola outbreak demonstrated the extent to which local social and political dynamics shape health system responses to crises such as epidemics. Many post-Ebola health system strengthening programmes are framed around a notion of health system ‘resilience’ that focuses on global rather than local priorities and fails to account for key local social dynamics that shape crisis responses. Post-crisis health system strengthening efforts require a shift towards a more ‘people-centred’ understanding of resilience that attends to the people, relationships and local contexts that constitute health systems and the practices that produce crisis responses.
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Affiliation(s)
- Fred P Martineau
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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327
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Jay J, Buse K, Hart M, Wilson D, Marten R, Kellerman S, Odetoyinbo M, Quick JD, Evans T, Piot P, Dybul M, Binagwaho A. Building from the HIV Response toward Universal Health Coverage. PLoS Med 2016; 13:e1002083. [PMID: 27529809 PMCID: PMC4987004 DOI: 10.1371/journal.pmed.1002083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Jonathan Jay and colleagues draw lessons from the the global HIV response that could help guide the universal health coverage movement.
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Affiliation(s)
- Jonathan Jay
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Marielle Hart
- International HIV/AIDS Alliance/STOP AIDS NOW!, Washington, D.C., United States of America
| | - David Wilson
- World Bank Group, Washington, D.C., United States of America
| | - Robert Marten
- Rockefeller Foundation, New York, New York, United States of America
| | - Scott Kellerman
- Management Sciences for Health, Medford, Massachusetts, United States of America
| | | | - Jonathan D. Quick
- Management Sciences for Health, Medford, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Timothy Evans
- World Bank Group, Washington, D.C., United States of America
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Dybul
- Global Fund to Fight AIDS, TB and Malaria, Geneva, Switzerland
| | - Agnes Binagwaho
- Harvard Medical School, Boston, Massachusetts, United States of America
- Geisel School of Medicine, Hanover, New Hampshire, United States of America
- University of Global Health Equity, Kigali, Rwanda
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328
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Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey. PLoS Med 2016; 13:e1002096. [PMID: 27482706 PMCID: PMC4970816 DOI: 10.1371/journal.pmed.1002096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. METHODS AND FINDINGS We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. CONCLUSIONS We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
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329
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Woodward A, Sondorp E, Witter S, Martineau T. Health systems research in fragile and conflict-affected states: a research agenda-setting exercise. Health Res Policy Syst 2016; 14:51. [PMID: 27439611 PMCID: PMC4955129 DOI: 10.1186/s12961-016-0124-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest amongst donors in investing in the health sectors of fragile and conflict-affected states, although there is limited research evidence and research funding to support this. Agreeing priority areas is therefore critical. This paper describes an 18-month process to develop a consultative research agenda and questions for health systems research, providing reflections on the process as well as its output. METHODS After a scoping review had been conducted, primary data was collected from August 2014 to September 2015. Data was collected using a mixture of methods, including an online survey (n = 61), two face-to-face group sessions (one with 11 participants; one with 17), email consultation (n = 18), a webinar (n = 65), and feedback via LinkedIn. Two steering committees of purposively selected experts guided the research process - a core steering committee (n = 10) and broad steering committee (n = 20). The process moved from developing broad topics and lists of research needs to grouping and honing them down into a smaller, prioritised agenda, with specific research questions associated to each topic. RESULTS An initial list of 146 topics was honed down to 25 research needs through this process, grouped thematically under transition and sustainability, resilience and fragility, gender and equity, accessibility, capacity building, actors and accountability, community, healthcare delivery, health workforce, and health financing. They were not ranked, as all health system areas are interdependent. The research agenda forms a starting point for local contextualisation and is not definitive. CONCLUSIONS A wide range of stakeholders participated in the different stages of this exercise, which produced a useful starting point for health systems research agenda setting in fragile and conflict-affected states. The process of engagement may have been as valuable for building a community of researchers as the product. It is now important to drive forward the research agenda. Without both a higher profile and deeper focus for this area, there is a real risk that fragile and conflict-affected states will continue to fall behind in global health and development goals.
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Affiliation(s)
- Aniek Woodward
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Sophie Witter
- Queen Margaret University, Edinburgh, United Kingdom
| | - Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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330
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Ridde V, Lechat L, Meda IB. Terrorist attack of 15 January 2016 in Ouagadougou: how resilient was Burkina Faso's health system? BMJ Glob Health 2016; 1:e000056. [PMID: 28588927 PMCID: PMC5321324 DOI: 10.1136/bmjgh-2016-000056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 11/03/2022] Open
Abstract
In Africa, health systems are often not very responsive. Their resilience is often tested by health or geopolitical crises. The Ebola epidemic, for instance, exposed the fragility of health systems, and recent terrorist attacks have required countries to respond to urgent situations. Up until 2014, Burkina Faso's health system strongly resisted these pressures and reforms had always been minor. However, since late 2014, Burkina Faso has had to contend with several unprecedented crises. In October 2014, there was a popular insurrection. Then, in September 2015, the Security Regiment of the deposed president attempted a coup d'état. Finally, on 15 January 2016, a terrorist attack occurred in the capital, Ouagadougou. These events involved significant human injury and casualties. In these crises, the Burkinabè health system was sorely tried, testing its responsiveness, resiliency and adaptability. We describe the management of the recent terrorist attack from the standpoint of health system resilience. It would appear that the multiple crises that had occurred within the previous 2 years led to appropriate management of that terrorist attack thanks to the rapid mobilisation of personnel and good communication between centres. For example, the health system had put in place a committee and an emergency response plan, adapted blood bank services and psychology services, and made healthcare free for victims. Nevertheless, the system encountered several challenges, including the development of framework documents for resources (financial, material and human) and their use and coordination in crisis situations.
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Affiliation(s)
- Valéry Ridde
- University of Montreal Public Health Research Institute - (IRSPUM) and University of Montreal School of Public Health (ESPUM), Québec, Canada
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331
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Daniels K, Loewenson R, George A, Howard N, Koleva G, Lewin S, Marchal B, Nambiar D, Paina L, Sacks E, Sheikh K, Tetui M, Theobald S, Topp SM, Zwi AB. Fair publication of qualitative research in health systems: a call by health policy and systems researchers. Int J Equity Health 2016; 15:98. [PMID: 27334117 PMCID: PMC4917954 DOI: 10.1186/s12939-016-0368-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa.
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rene Loewenson
- Training and Research Support Centre, Regional Network for Equity in Health in East and Southern Africa (EQUINET), Harare, East and Southern Africa.
| | - Asha George
- School of Public Health, University of the Western Cape, Western Cape, South Africa
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Natasha Howard
- London School of Hygiene & Tropical Medicine, London, UK
| | - Gergana Koleva
- Patient Experience Researcher and Advocate for Patient and Public Involvement, Sofia, Bulgaria
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Global Health Unit, Knowledge Centre for the Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Ligia Paina
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
- USAID Maternal and Child Survival Program (MCSP)/ICF International, Baltimore, USA
| | - Kabir Sheikh
- Public Health Foundation of India, New Delhi, India
| | - Moses Tetui
- Makerere University School of Public Health, Makerere, Uganda
- Umea International School Of Public Health, Umea University, Umea, Sweden
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Institute of Development Studies, Sussex, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Science, James Cook University, Townsville City, Australia
| | - Anthony B Zwi
- Health Rights and Development, School of Social Sciences, The University of New South Wales, New South Wales, Australia
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332
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Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6264249. [PMID: 27403432 PMCID: PMC4925981 DOI: 10.1155/2016/6264249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
Abstract
Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments (n = 56 facilities) revealed gaps in provider's skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training (n = 51 facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings.
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333
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Johnson O, Youkee D, Brown CS, Lado M, Wurie A, Bash-Taqi D, Hall A, Hanciles E, Kamara I, Kamara C, Kamboz A, Seedat A, Thomas S, Kamara TB, Leather AJM, Kargbo B. Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning. BMJ Glob Health 2016; 1:e000030. [PMID: 28588922 PMCID: PMC5321322 DOI: 10.1136/bmjgh-2016-000030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022] Open
Abstract
The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis.
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Affiliation(s)
- Oliver Johnson
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Daniel Youkee
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Colin S Brown
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK.,Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Marta Lado
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Alie Wurie
- Ministry of Health & Sanitation, Freetown, Sierra Leone
| | | | - Andy Hall
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | | | | | | | - Amardeep Kamboz
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Ahmed Seedat
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Suzanne Thomas
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - T B Kamara
- Connaught Hospital, Freetown, Sierra Leone.,Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
| | - Andrew J M Leather
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | - Brima Kargbo
- Ministry of Health & Sanitation, Freetown, Sierra Leone
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334
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Morse B, Grépin KA, Blair RA, Tsai L. Patterns of demand for non-Ebola health services during and after the Ebola outbreak: panel survey evidence from Monrovia, Liberia. BMJ Glob Health 2016; 1:e000007. [PMID: 28588907 PMCID: PMC5321298 DOI: 10.1136/bmjgh-2015-000007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/09/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction The recent Ebola virus disease (EVD) outbreak was unprecedented in magnitude, duration and geographic scope. Hitherto there have been no population-based estimates of its impact on non-EVD health outcomes and health-seeking behaviour. Methods We use data from a population-based panel survey conducted in the late-crisis period and two postcrisis periods to track trends in (1) the prevalence of adult and child illness, (2) subsequent usage of health services and (3) the determinants thereof. Results The prevalence of child and adult illness remained relatively steady across all periods. Usage of health services for children and adults increased by 77% and 104%, respectively, between the late-crisis period and the postcrisis periods. In the late-crisis period, (1) socioeconomic factors weakly predict usage, (2) distrust in government strongly predicts usage, (3) direct exposure to the EVD outbreak, as measured by witnessing dead bodies or knowing Ebola victims, negatively predicts trust and usage and (4) exposure to government-organised community outreach predicts higher trust and usage. These patterns do not obtain in the post-crisis period. Interpretation Supply-side and socioeconomic factors are insufficient to account for lower health-seeking behaviour during the crisis. Rather, it appears that distrust and negative EVD-related experiences reduced demand during the outbreak. The absence of these patterns outside the crisis period suggests that the rebound after the crisis reflects recovery of demand. Policymakers should anticipate the importance of demand-side factors, including fear and trust, on usage of health services during health crises.
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Affiliation(s)
- Ben Morse
- Political Science Department, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Karen A Grépin
- Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Robert A Blair
- Department of Political Science and Watson Institute for International and Public Affairs, Brown University, Providence, Rhode Island, USA
| | - Lily Tsai
- Political Science Department, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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335
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Dare AJ, Lee KC, Bleicher J, Elobu AE, Kamara TB, Liko O, Luboga S, Danlop A, Kune G, Hagander L, Leather AJM, Yamey G. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med 2016; 13:e1002023. [PMID: 27186645 PMCID: PMC4871553 DOI: 10.1371/journal.pmed.1002023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. METHODS AND FINDINGS We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. CONCLUSIONS National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial support from regional and international partners is also important.
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Affiliation(s)
- Anna J. Dare
- King’s Centre for Global Health, King’s College London and King’s Health Partners, London, United Kingdom
| | - Katherine C. Lee
- Global Health Group, Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Josh Bleicher
- Global Health Group, Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Alex E. Elobu
- Department of Surgery, Mulago Hospital, Kampala, Uganda
| | - Thaim B. Kamara
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Osborne Liko
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Samuel Luboga
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Akule Danlop
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Gabriel Kune
- Department of Surgery, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lars Hagander
- Department of Clinical Sciences–Lund, Lund University, Lund, Sweden
| | - Andrew J. M. Leather
- King’s Centre for Global Health, King’s College London and King’s Health Partners, London, United Kingdom
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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336
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Wong ZY, Alrasheedy AA, Hassali MA, Saleem F. Generic medicines in the Malaysian health care system: Opportunities and challenges. Res Social Adm Pharm 2016; 12:807-10. [PMID: 27157864 DOI: 10.1016/j.sapharm.2016.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Zhi Yen Wong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | | | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Fahad Saleem
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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337
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Jefee-Bahloul H, Bajbouj M, Alabdullah J, Hassan G, Barkil-Oteo A. Mental health in Europe's Syrian refugee crisis. Lancet Psychiatry 2016; 3:315-7. [PMID: 26868309 DOI: 10.1016/s2215-0366(16)00014-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Hussam Jefee-Bahloul
- University of Massachusetts Medical School, Worcester, MA, USA; Yale School of Medicine, New Haven, CT 06511, USA
| | | | | | - Ghayda Hassan
- University of Quebec in Montreal, Montreal, QC, Canada
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338
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Froeschl G, Ntinginya NE, Sangare A, Lawala P, Mangu C, Dobler G, Heinrich N, Flach B, Nsojo A, Lennemann T. Integrating Local, National, and International Stakeholders in Outbreak Preparedness in Developing Countries: Conclusions from a Conference in Mbeya, Tanzania. Health Secur 2016; 14:29-34. [PMID: 26836445 DOI: 10.1089/hs.2015.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A conference called "Outbreaks in Tanzania-Are We Prepared?" was held in Mbeya, Tanzania, on September 14 and 15, 2015, accompanied by a training workshop on infection prevention and control for local stakeholders from September 16 to 18, 2015. The objective of the conference was to revisit past disease epidemics and to reflect on the current status of surveillance and outbreak preparedness in Tanzania, including an overview of agents relevant to biosecurity. The conference brought together national authorities of Tanzania, regional public health representatives, people from research and academic institutions, and international stakeholders. Key findings of the event were: (1) although national frameworks for surveillance and preparedness exist, their implementation presents challenges, and local health structures need support in implementation; (2) the ability to identify and properly manage infectious diseases of public health concern is crucial in empowering the local health workforce to contribute to surveillance measures, which in turn allows for realistic risk assessments and management algorithms; and (3) in settings of limited resources, research activities acquire an additional responsibility toward national surveillance and capacity building and should be integrated into national epidemic preparedness plans. This event was the first of its kind in Tanzania, facilitating direct discussion among regional, zonal, national, and international stakeholders on surveillance and outbreak preparedness. The conference's conclusions are relevant to strengthening health systems in other low- and middle-income countries.
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339
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Kutzin J, Sparkes SP. Health systems strengthening, universal health coverage, health security and resilience. Bull World Health Organ 2016; 94:2. [PMID: 26769987 PMCID: PMC4709803 DOI: 10.2471/blt.15.165050] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joseph Kutzin
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Susan P Sparkes
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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340
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Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, Horton R, Mace GM, Marten R, Myers SS, Nishtar S, Osofsky SA, Pattanayak SK, Pongsiri MJ, Romanelli C, Soucat A, Vega J, Yach D. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. Lancet 2015; 386:1973-2028. [PMID: 26188744 DOI: 10.1016/s0140-6736(15)60901-1] [Citation(s) in RCA: 977] [Impact Index Per Article: 108.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sarah Whitmee
- Centre for Biodiversity and Environment Research, University College London, London, UK.
| | - Andy Haines
- London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Anthony G Capon
- International Institute for Global Health, United Nations University, Federal Territory of Kuala Lumpur, Malaysia
| | | | - Alex Ezeh
- African Population and Health Research Center, Nairobi, Kenya
| | - Howard Frumkin
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Peng Gong
- Center for Earth System Science, Tsinghua University, Beijing, China
| | - Peter Head
- The Ecological Sequestration Trust, London, UK
| | | | - Georgina M Mace
- Centre for Biodiversity and Environment Research, University College London, London, UK
| | - Robert Marten
- London School of Hygiene & Tropical Medicine, London, UK; The Rockefeller Foundation, New York, NY, USA
| | - Samuel S Myers
- Center for the Environment, Harvard University, Cambridge, MA, USA; Harvard T.H. Chan School of Public Health, Islamabad, Pakistan
| | | | | | - Subhrendu K Pattanayak
- Sanford School of Public Policy and Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | | | | | - Jeanette Vega
- The National Chilean Public Health Insurance Agency, Santiago, Chile
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341
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Kirigia JM, Muthuri RDK, Nabyonga-Orem J, Kirigia DG. Counting the cost of child mortality in the World Health Organization African region. BMC Public Health 2015; 15:1103. [PMID: 26545350 PMCID: PMC4636778 DOI: 10.1186/s12889-015-2465-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/31/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all the basic needs for a healthy population. The specific objective of this study was to estimate expected/future productivity losses from child deaths in the WHO African Region in 2013 for use in advocacy for increased investments in child health services and other basic services that address children's welfare. METHODS A cost-of-illness method was used to estimate future non-health GDP losses related to child deaths. Future non-health GDP losses were discounted at 3 %. The analysis was undertaken with the countries categorized under three income groups: Group 1 consisted of nine high and upper middle income countries, Group 2 of 13 lower middle income countries, and Group 3 of 25 low income countries. One-way sensitivity analysis at 5 % and 10 % discount rates assessed the impact of the expected non-health GDP loss. RESULTS The discounted value of future non-health GDP loss due to the deaths of children under 5 years old in 2013 will be in the order of Int$ 150.3 billion. Approximately 27.3 % of the loss will be borne by Group 1 countries, 47.1 % by Group 2 and 25.7 % by Group 3. The average non-health GDP lost per child death will be Int$ 174 310 for Group 1, Int$ 57 584 for Group 2 and Int$ 25 508 for Group 3. CONCLUSIONS It is estimated that the African Region will incur a loss of approximately 6 % of its non-health GDP from the future years of life lost among the 2 976 000 child deaths that occurred in 2013. Therefore, countries and development partners should in solidarity sustainably provide the resources essential to build resilient national health systems and systems to address the determinants of health and meet the other basic needs such as for clothing, education, food, shelter, sanitation and clean water to end preventable child morbidity and mortality.
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Affiliation(s)
- Joses M Kirigia
- Research, Publications and Library Services Programme, Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo.
| | | | - Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo.
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Kirigia JM, Masiye F, Kirigia DG, Akweongo P. Indirect costs associated with deaths from the Ebola virus disease in West Africa. Infect Dis Poverty 2015; 4:45. [PMID: 26510633 PMCID: PMC4625462 DOI: 10.1186/s40249-015-0079-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/09/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND By 28 June 2015, there were a total of 11,234 deaths from the Ebola virus disease (EVD) in five West African countries (Guinea, Liberia, Mali, Nigeria and Sierra Leone). The objective of this study was to estimate the future productivity losses associated with EVD deaths in these West African countries, in order to encourage increased investments in national health systems. METHODS A cost-of-illness method was employed to calculate future non-health (NH) gross domestic product (GDP) (NHGDP) losses associated with EVD deaths. The future non-health GDP loss (NHGDPLoss) was discounted at 3 %. Separate analyses were done for three different age groups (< =14 years, 15-44 years and = >45 years) for the five countries (Guinea, Liberia, Mali, Nigeria, and Sierra Leone) affected by EVD. We also conducted a one-way sensitivity analysis at 5 and 10 % discount rates to gauge their impacts on expected NHGDPLoss. RESULTS The discounted value of future NHGDPLoss due to the 11,234 deaths associated with EVD was estimated to be Int$ (international dollars) 155,663,244. About 27.86 % of the loss would be borne by Guinea, 34.84 % by Liberia, 0.10 % by Mali, 0.24 % by Nigeria and 36.96 % by Sierra Leone. About 27.27 % of the loss is attributed to those aged under 14 years, 66.27 % to those aged 15-44 years and 6.46 % to those aged over 45 years. The average NHGDPLoss per EVD death was estimated to be Int$ 17,473 for Guinea, Int$ 11,283 for Liberia, Int$ 25,126 for Mali, Int$ 47,364 for Nigeria and Int$ 14,633 for Sierra Leone. CONCLUSION In spite of alluded limitations, the estimates of human and economic losses reported in this paper, in addition to those projected by the World Bank, show that EVD imposes a significant economic burden on the affected West African countries. That heavy burden, coupled with human rights and global security concerns, underscores the urgent need for increased domestic and external investments to enable Guinea, Liberia and Sierra Leone (and other vulnerable African countries) to develop resilient health systems, including core capacities to detect, assess, notify, verify and report events, and to respond to public health risks and emergencies.
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Affiliation(s)
- Joses Muthuri Kirigia
- Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo.
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia.
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Ager AK, Lembani M, Mohammed A, Mohammed Ashir G, Abdulwahab A, de Pinho H, Delobelle P, Zarowsky C. Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building. Confl Health 2015; 9:30. [PMID: 26442129 PMCID: PMC4593224 DOI: 10.1186/s13031-015-0056-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation. Methods Structured interviews were conducted with 39 stakeholders from three local government areas selected to represent the diversity of conflict experience across the state: Damaturu, Fune and Nguru, and with four officers of the PRRINN-MNCH program providing technical assistance for primary care development in the state. A group model building session was convened with 11 senior stakeholders, which used participatory scripts to review thematic analysis of interviews and develop a preliminary systems model linking identified variables. Results Population migration and transport restrictions have substantially impacted access to health provision. The human resource for health capability of the state has been severely diminished through the outward migration of (especially non-indigenous) health workers and the suspension of programmes providing external technical assistance. The political will of the Yobe State government to strengthen health provision — through lifting a moratorium on recruitment and providing incentives for retention and support of staff — has supported a recovery of health systems functioning. Policies of free-drug provision and decentralized drug supply appear to have been protective of the operation of the health system. Community resources and cohesion have been significant assets in combatting the impacts of the insurgency on service utilization and quality. Staff commitment and motivation — particularly amongst staff indigenous to the state — has protected health care quality and enabled flexibility of human resource deployment. Conclusions A systems analysis using participatory group model building provided a mechanism to identify key pathways of threat and adaptation with regard to health service functioning. Generalizable systems characteristics supportive of resilience are suggested, and linked to wider discussion of the role of factors such as diversity, self-regulation and integration.
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Affiliation(s)
- Alastair K Ager
- Mailman School of Public Health, Columbia University, New York, NY USA ; Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Martina Lembani
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | | | - Helen de Pinho
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Christina Zarowsky
- School of Public Health, University of the Western Cape, Cape Town, South Africa ; University of Montreal Hospital Research Centre, School of Public Health, University of Montreal, Montreal, QC Canada
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Phillips JF, Sheff M, Boyer CB. The Astronomy of Africa's Health Systems Literature During the MDG Era: Where Are the Systems Clusters? GLOBAL HEALTH, SCIENCE AND PRACTICE 2015; 3:482-502. [PMID: 26374806 PMCID: PMC4570019 DOI: 10.9745/ghsp-d-15-00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 07/15/2015] [Indexed: 11/03/2022]
Abstract
Growing international concern about the need for improved health systems in Africa has catalyzed an expansion of the health systems literature. This review applies a bibliometric procedure to analyze the acceleration of scientific writing on this theme. We focus on research published during the Millennium Development Goal (MDG) era between 1990 and 2014, reporting findings from a systematic review of a database comprised of 17,655 articles about health systems themes from sub-Saharan African countries or subregions. Using bibliometric tools for co-word textual analysis, we analyzed the incidence and associations of keywords and phrases to generate and visualize topical foci on health systems as clusters of themes, much in the manner that astronomers represent groupings of stars as galaxies of celestial entities. The association of keywords defines their relative position, with the size of images weighted by the relative frequency of terms. Sets of associated keywords are arrayed as stars that cluster as "galaxies" of concepts in the knowledge universe represented by health systems research from sub-Saharan Africa. Results show that health systems research is dominated by literature on diseases and categorical systems research topics, rather than on systems science that cuts across diseases or specific systemic themes. Systems research is highly developed in South Africa but relatively uncommon elsewhere in the region. "Black holes" are identified by searching for terms in our keyword library related to terms in widely cited reviews of health systems. Results identify several themes that are unexpectedly uncommon in the country-specific health systems literature. This includes research on the processes of achieving systems change, the health impact of systems strengthening, processes that explain the systems determinants of health outcomes, or systematic study of organizational dysfunction and ways to improve system performance. Research quantifying the relationship of governance indicators to health systems strengthening is nearly absent from the literature. Long-term experimental studies and statistically rigorous research on cross-cutting themes of health systems strengthening are rare. Studies of organizational malaise or corruption are virtually absent. Trend analysis shows the emergence of organizational research on specific priority diseases, such as on HIV/AIDS, malaria, and tuberculosis, but portrays a lack of focus on integrated systems research on the general burden of disease. If health systems in Africa are to be strengthened, then organizational change research must be a more concerted focus in the future than has been the case in the past.
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Affiliation(s)
- James F Phillips
- Columbia University, Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, NY, USA
| | - Mallory Sheff
- Columbia University, Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, NY, USA
| | - Christopher B Boyer
- Columbia University, Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, NY, USA
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