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Chan VF, Yard E, Mashayo E, Mulewa D, Drake L, Omar F. Contextual factors affecting integration of eye health into school health programme in Zanzibar: a qualitative health system research. BMC Health Serv Res 2023; 23:1414. [PMID: 38098051 PMCID: PMC10722834 DOI: 10.1186/s12913-023-10469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Short-term school eye health programmes supported by external funders have sustainability issues. This study aimed to understand the contextual factors affecting integrating eye health into the school health programme. METHODS We elicited responses from 83 respondents, purposefully selected from the Ministry of Health (n = 7), Ministry of Education and Vocational Training (n = 7), hospitals/eye centres (n = 5), master trainers (4) and schools (n = 60) who participated in in-depth interviews. Their responses were analysed and grouped into contextual factors according to the WHO Consolidated Framework for Implementation Research: stakeholders/political, institutional, physical, cultural, delivery system and others. Themes were then generated, and quotations were presented to illustrate the findings. RESULTS The six contextual factors affecting the integration of eye health into the school eye health programme were i) Stakeholders/political (Good ministry coordination, defined departmental roles and resource mobilisation from multiple stakeholders; Good stakeholder synergies and address current gaps); ii) Institutional (Institutional coordination and adequate clinic space; Securing human and financial resources; Strategic advocacy for institutional resources); iii) Physical (Long travel distance to service points); vi) Cultural (low eye health awareness among parents, teachers and children); iv) Delivery system (Practical approach to increase screening coverage using teachers as screeners; Balance teachers' workload, increase screening sensitivity and follow up and; v) Others (Comprehensive training material and effective training delivery; Improved curriculum, teacher selection and supervision and incentives). CONCLUSION Integrated school eye health delivery is generally well-received by stakeholders in Zanzibar, with the caveat that investment is required to address the six contextual factors identified in the study.
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Affiliation(s)
- Ving Fai Chan
- Centre of Public Health, School of Medicine, Dentistry and Biomedical Medicine, Royal Victoria Hospital, Institute of Clinical Sciences, Queen's University of Belfast, Block B, Belfast, BT12 6BA, UK.
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa.
- University of KwaZulu Natal, Durban, South Africa.
| | - Elodie Yard
- Partnership for Child Development, Imperial College London, London, UK
- Oriole Global Health, Nairobi, Kenya
| | - Eden Mashayo
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Damaris Mulewa
- Partnership for Child Development, Imperial College London, London, UK
| | - Lesley Drake
- Partnership for Child Development, Imperial College London, London, UK
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Hendrix N, Kwete X, Bolongaita S, Megiddo I, Memirie ST, Mirkuzie AH, Nonvignon J, Verguet S. Economic evaluations of health system strengthening activities in low-income and middle-income country settings: a methodological systematic review. BMJ Glob Health 2022; 7:bmjgh-2021-007392. [PMID: 35277429 PMCID: PMC8919450 DOI: 10.1136/bmjgh-2021-007392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/29/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Health system strengthening (HSS) activities should accompany disease-targeting interventions in low/middle-income countries (LMICs). Economic evaluations provide information on how these types of investment might best be balanced but can be challenging. We conducted a systematic review to evaluate how researchers address these economic evaluation challenges. Methods We identified studies about economic evaluation of HSS activities in LMICs using a two-stage approach. First, we conducted a broad search to identify areas where economic evaluations of HSS activities were being conducted. Next, we selected specific interventions for more targeted literature review. We extracted study characteristics using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Finally, we summarised authors’ modelling decisions using a framework that examines how models are developed to emphasise generalisability, precision, or realism. Findings Our searches produced 1978 studies, out of which we included 36. Most studies used data from prospective trials and calculated cost-effectiveness directly from these trial inputs, rather than using simulation methods. As a group, these studies primarily emphasised precision and realism over generalisability, meaning that their results were best suited to specific settings. Conclusions The number of included studies was small. Our findings suggest that most economic evaluations of HSS do not leverage methods like sensitivity analyses or inputs from literature review that would produce more generalisable (but potentially less precise) results. More research into how decision-makers would use economic evaluations to define the expansion path to strengthening health systems would allow for conceptualising impactful work on the economic value of HSS.
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Affiliation(s)
- Nathaniel Hendrix
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoxiao Kwete
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Global Health Research and Consulting, Yaozhi, Yangzhou, Jiangsu, China
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemnesh H Mirkuzie
- National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mendis SB, Raymont V, Tabet N. Bilingualism: A Global Public Health Strategy for Healthy Cognitive Aging. Front Neurol 2021; 12:628368. [PMID: 33935937 PMCID: PMC8081826 DOI: 10.3389/fneur.2021.628368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Dementia is a global public health priority which cost global societies $818 billion in 2015 and is disproportionately impacting low and middle-income countries (LMICs). With limited availability of disease modifying drugs to treat Alzheimer's disease (AD), researchers have increasingly focused on preventative strategies which may promote healthy cognitive aging and mitigate the risk of cognitive impairment in aging. Lifelong bilingualism has been presented as both a highly debated and promising cognitive reserve factor which has been associated with better cognitive outcomes in aging. A recent metanalysis has suggested that bilingual individuals present on average 4.05 years later with the clinical features of AD than monolinguals. Bilinguals are also diagnosed with AD ~2.0 years later than monolingual counterparts. In this perspective piece we critically evaluate the findings of this metanalysis and consider the specific implications of these findings to LMICs. Furthermore, we appraise the major epidemiological studies conducted globally on bilingualism and the onset of dementia. We consider how both impactful and robust studies of bilingualism and cognition in older age may be conducted in LMICs. Given the limited expenditure and resources available in LMICs and minimal successes of clinical trials of disease modifying drugs we propose that bilingualism should be positioned as an important and specific public health strategy for maintaining healthy cognitive aging in LMICs. Finally, we reflect upon the scope of implementing bilingualism within the education systems of LMICs and the promotion of bilingualism as a healthy cognitive aging initiative within government policy.
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Affiliation(s)
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Oxford, United Kingdom
| | - Naji Tabet
- Center for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
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Haider M, Jalloh M, Yin J, Diallo A, Puttkammer N, Gueye S, Niang L, Wessells H, McCammon K. The role of international partnerships in improving urethral reconstruction in low- and middle-income countries. World J Urol 2019; 38:3003-3011. [PMID: 31177304 PMCID: PMC7716901 DOI: 10.1007/s00345-019-02819-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To explore the impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low- and middle-income countries. To encourage data collection and outcomes assessments to promote evidence-based and safe surgical care. Methods Qualitative data were collected through observation of a reconstructive surgical workshop held by IVUmed at a host site in Dakar, Senegal. Quantitative data were collected through a retrospective review of 11 years of hospital data to assess surgical outcomes of urethral stricture disease before and after IVUmed started reconstructive workshops at the site. Results In the 11-year study period, 569 patients underwent 774 surgical procedures for urethral strictures. The numbers and types of urethroplasty techniques increased after IVUmed started its workshops. The average number of urethroplasties increased from 10 to 18.75/year. There was a statistically significant improvement in the mean success rate of urethroplasties from 12.7% before to 29% after the workshops. Anastomotic urethroplasty success rates doubled from 16.7 to 35.1%, but this was not statistically significant (p = 0.07). The improved success rate was sustained in cases performed without an IVUmed provider. Conclusions Urethral stricture disease treatment in low- and middle-income countries is fraught with challenges due to complex presentations and limited subspecialty training. Improper preoperative management, lack of specialty instruments, and suboptimal wound care all contribute to poor outcomes. International surgical groups like IVUmed who employ the “teach-the-teacher” model enhance local practitioner expertise and independence leading to long-term improvements in patient outcomes. Tailoring practice guidelines to the local resource framework and encouraging data collection and outcomes assessment are vital components of providing responsible care and should be encouraged. Electronic supplementary material The online version of this article (10.1007/s00345-019-02819-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maahum Haider
- University of Washington, 1959 N.E. Pacific St, Box 356510, Seattle, WA, 98195, USA.
- IVUmed, Salt Lake City, USA.
| | | | - Jiaqi Yin
- University of Washington, 1959 N.E. Pacific St, Box 356510, Seattle, WA, 98195, USA
| | | | - Nancy Puttkammer
- University of Washington, 1959 N.E. Pacific St, Box 356510, Seattle, WA, 98195, USA
| | | | | | - Hunter Wessells
- University of Washington, 1959 N.E. Pacific St, Box 356510, Seattle, WA, 98195, USA
| | - Kurt McCammon
- IVUmed, Salt Lake City, USA
- Eastern Virginia Medical School, Norfolk, USA
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Samuels F, Amaya AB, Balabanova D. Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda. Health Policy Plan 2018; 32:1015-1031. [PMID: 28481996 DOI: 10.1093/heapol/czx037] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. To do this, the article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. At the macro level, governance with effective and committed leaders was found to be vital for achieving positive health outcomes. This was underpinned by clear commitment from donors coupled by a significant increase in funding to the health sector. At the meso level, where policies are operationalized, inter-sectoral partnerships as well as decentralization and task-shifting emerged as critical. At micro (service interface) level, community-centred models and accessible and appropriately trained and incentivized local health providers play a central role in all study countries. The key drivers of progress are multiple, interrelated and transversal in terms of their operation; they are also in a constant state of flux as health systems and contexts develop. Without seeking to offer a blueprint, the study demonstrates that a 'whole-system' approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems.
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Affiliation(s)
- Fiona Samuels
- Social Development Programme, Overseas Development Institute, 203 Blackfriars Road, London SE1 8NJ, UK
| | | | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Perry HB, Sacks E, Schleiff M, Kumapley R, Gupta S, Rassekh BM, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects. J Glob Health 2018; 7:010906. [PMID: 28685044 PMCID: PMC5491945 DOI: 10.7189/jogh.07.010906] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As part of our review of the evidence of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. METHODS We screened 12 166 published reports in PubMed of community-based approaches to improving maternal, neonatal and child health in high-mortality, resource-constrained settings from 1950-2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. RESULTS Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community-level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community-level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator-led participatory women's groups, and (d) health service provision at outreach sites by mobile health teams. CONCLUSIONS The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Paul A Freeman
- Independent consultant, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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Naimoli JF, Saxena S, Hatt LE, Yarrow KM, White TM, Ifafore-Calfee T. Health system strengthening: prospects and threats for its sustainability on the global health policy agenda. Health Policy Plan 2017; 33:85-98. [DOI: 10.1093/heapol/czx147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 11/15/2022] Open
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8
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Mutale W, Ayles H, Bond V, Chintu N, Chilengi R, Mwanamwenge MT, Taylor A, Spicer N, Balabanova D. Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA. J Eval Clin Pract 2017; 23:439-452. [PMID: 26011652 DOI: 10.1111/jep.12354] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. METHODS We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. RESULTS The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. CONCLUSIONS We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences.
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Affiliation(s)
- Wilbroad Mutale
- Department of Community Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Virginia Bond
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Namwinga Chintu
- Centre for Infectious Disease Control in Zambia, Northmead Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Control in Zambia, Northmead Lusaka, Zambia
| | | | - Angela Taylor
- Centre for Infectious Disease Control in Zambia, Northmead Lusaka, Zambia
| | - Neil Spicer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
In today's highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.
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Iwelunmor J, Plange-Rhule J, Airhihenbuwa CO, Ezepue C, Ogedegbe O. A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa. PLoS One 2015; 10:e0130193. [PMID: 26176223 PMCID: PMC4503432 DOI: 10.1371/journal.pone.0130193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/17/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction In sub-Saharan Africa (SSA), an estimated 74.7 million individuals are hypertensive. Reducing the growing burden of hypertension in sub-Saharan Africa will require a variety of strategies one of which is identifying the extent to which actions originating at the health systems level improves optimal management and control. Methods and Results We conducted a narrative synthesis of available papers examining health systems factors influencing optimal hypertension in SSA. Eligible studies included those that analyzed the impact of health systems on hypertension awareness, treatment, control and medication adherence. Twenty-five articles met the inclusion criteria and the narrative synthesis identified the following themes: 1) how physical resources influence mechanisms supportive of optimal hypertension control; 2) the role of human resources with enabling and/or inhibiting hypertension control goals; 3) the availability and/or use of intellectual resources; 4) how health systems financing facilitate and/or compromise access to products necessary for optimal hypertension control. Conclusion The findings highlight the need for further research on the health systems factors that influence management and control of hypertension in the region.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, United States of America
- * E-mail:
| | - Jacob Plange-Rhule
- School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins O. Airhihenbuwa
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States of America
| | - Chizoba Ezepue
- Department of Neurology, Georgia Regents University, Augusta, GA, United States of America
| | - Olugbenga Ogedegbe
- Center for Healthful Behavior Change, Division of General Internal Medicine, Department of Medicine, New York University Langone Medical Center, New York, New York, United States of America
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12
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Weimann E, Stuttaford MC. Consumers' perspectives on national health insurance in South Africa: using a mobile health approach. JMIR Mhealth Uhealth 2014; 2:e49. [PMID: 25351980 PMCID: PMC4259968 DOI: 10.2196/mhealth.3533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. OBJECTIVE This research is based on a survey using Mxit as a mobile phone-based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. METHODS Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. RESULTS Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system's governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. CONCLUSIONS The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.
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Affiliation(s)
- Edda Weimann
- School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Observatory, Cape Town, South Africa.
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13
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Esser DE. Elusive accountabilities in the HIV scale-up: 'ownership' as a functional tautology. Glob Public Health 2014; 9:43-56. [PMID: 24498888 DOI: 10.1080/17441692.2013.879669] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mounting concerns over aid effectiveness have rendered 'ownership' a central concept in the vocabulary of development assistance for health (DAH). The article investigates the application of both 'national ownership' and 'country ownership' in the broader development discourse as well as more specifically in the context of internationally funded HIV/AIDS interventions. Based on comprehensive literature reviews, the research uncovers a multiplicity of definitions, most of which either divert from or plainly contradict the concept's original meaning and intent. During the last 10 years in particular, it appears that both public and private donors have advocated for greater 'ownership' by recipient governments and countries to hedge their own political risk rather than to work towards greater inclusion of the latter in agenda-setting and programming. Such politically driven semantic dynamics suggest that the concept's salience is not merely a discursive reflection of globally skewed power relations in DAH but a deliberate exercise in limiting donors' accountabilities. At the same time, the research also finds evidence that this conceptual contortion frames current global public health scholarship, thus adding further urgency to the need to critically re-evaluate the international political economy of global public health from a discursive perspective.
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Affiliation(s)
- Daniel E Esser
- a School of International Service , American University , Washington , DC , USA
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14
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du Toit R, Faal HB, Etya'ale D, Wiafe B, Mason I, Graham R, Bush S, Mathenge W, Courtright P. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach. BMC Health Serv Res 2013; 13:102. [PMID: 23506686 PMCID: PMC3616885 DOI: 10.1186/1472-6963-13-102] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/02/2013] [Indexed: 12/03/2022] Open
Abstract
Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.
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Kickbusch I, Lister G, Told M, Drager N. The G8/G20 and Global Health Governance: Extended Fragmentation or a New Hub of Coordination. GLOBAL HEALTH DIPLOMACY 2013. [PMCID: PMC7122370 DOI: 10.1007/978-1-4614-5401-4_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This chapter provides an overview of the current position and the possible future of Global Health Governance (GHG)—in terms of the connections and disconnections with the overall architecture of international organizations engaged in global governance. The main focus of this discussion is on the relationship between GHG and leadership summits, including both the “G8” and “G20.” The discussion first notes that while GHG has become a central focus for international diplomacy it has become ever more fragmented as new actors and venues negotiate aspects of global health without apparent reference to a central agency or process. It then briefly reviews the growing role of foundations before focusing on the role of G8 summitry in GHG. The final section and conclusion consider how the G20 could provide a further venue for GHG.
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Affiliation(s)
| | - Graham Lister
- Bulstrode Way, Gerrards Cross 20, Bucks, SL9 7QU United Kingdom
| | - Michaela Told
- Graduate Institute of International and, Global Health Programme, PO Box 136, Geneva, 1211 Switzerland
| | - Nick Drager
- Rue de Lausanne 132, Geneva, 1202 Switzerland
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Jenniskens F, Tiendrebeogo G, Coolen A, Blok L, Kouanda S, Sataru F, Ralisimalala A, Mwapasa V, Kiyombo M, Plummer D. How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS. BMC Public Health 2012; 12:1071. [PMID: 23231820 PMCID: PMC3549279 DOI: 10.1186/1471-2458-12-1071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders' perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. METHODS A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. RESULTS Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics.In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners' lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. CONCLUSIONS Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.
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Affiliation(s)
| | | | - Anne Coolen
- Royal Tropical Institute, Amsterdam, The Netherlands
| | - Lucie Blok
- Royal Tropical Institute, Amsterdam, The Netherlands
| | - Seni Kouanda
- Biomedical and Public health Department, Institute of Research in Health Science (IRSS), Ouagadougou, Burkina Faso
| | | | | | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mbela Kiyombo
- Ecole de Santé Publique, Kinshasa, Democratic Republic of Congo
| | - David Plummer
- James Cook University & Queensland Health, Townsville, Australia
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Car J, Paljärvi T, Car M, Kazeem A, Majeed A, Atun R. Negative health system effects of Global Fund's investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review. JRSM SHORT REPORTS 2012; 3:70. [PMID: 23162683 PMCID: PMC3499959 DOI: 10.1258/shorts.2012.012062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives By using the Global Fund as a case example, we aim to critically evaluate the evidence generated from 2002 to 2009 for potential negative health system effects of Global Health Initiatives (GHI). Design Systematic review of research literature. Setting Developing Countries. Participants All interventions potentially affecting health systems that were funded by the Global Fund. Main outcome measures Negative health system effects of Global Fund investments as reported by study authors. Results We identified 24 studies commenting on adverse effects on health systems arising from Global Fund investments. Sixteen were quantitative studies, six were qualitative and two used both quantitative and qualitative methods, but none explicitly stated that the studies were originally designed to capture or to assess health system effects (positive or negative). Only seemingly anecdotal evidence or authors’ perceptions/interpretations of circumstances could be extracted from the included studies. Conclusions This study shows that much of the currently available evidence generated between 2002 and 2009 on GHIs potential negative health system effects is not of the quality expected or needed to best serve the academic or broader community. The majority of the reviewed research did not fulfil the requirements of rigorous scientific evidence.
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Affiliation(s)
- Josip Car
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College , London W6 8RP , UK
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18
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Haffeld J. Facilitative governance: Transforming global health through complexity theory. Glob Public Health 2012; 7:452-64. [PMID: 22248181 DOI: 10.1080/17441692.2011.649486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hafner T, Shiffman J. The emergence of global attention to health systems strengthening. Health Policy Plan 2012; 28:41-50. [PMID: 22407017 DOI: 10.1093/heapol/czs023] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors.
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Affiliation(s)
- Tamara Hafner
- Department of Public Administration and Policy, American University, Washington, DC 20016, USA.
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Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen JA, Dröschel D, Beck L, Abalos E, El-Jardali F, Gilson L, Oliver S, Wyss K, Tugwell P, Kulier R, Pang T, Haines A. Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development. PLoS Med 2012; 9:e1001185. [PMID: 22412356 PMCID: PMC3295823 DOI: 10.1371/journal.pmed.1001185] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.
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Gruskin S, Ahmed S, Bogecho D, Ferguson L, Hanefeld J, Maccarthy S, Raad Z, Steiner R. Human rights in health systems frameworks: what is there, what is missing and why does it matter? Glob Public Health 2012; 7:337-51. [PMID: 22263700 DOI: 10.1080/17441692.2011.651733] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Global initiatives and recent G8 commitments to health systems strengthening have brought increased attention to factors affecting health system performance. While equity concerns and human rights language appear often in the global health discourse, their inclusion in health systems efforts beyond rhetorical pronouncements is limited. Building on recent work assessing the extent to which features compatible with the right to health are incorporated into national health systems, we examine how health systems frameworks have thus far integrated human rights concepts and human rights-based approaches to health in their conceptualisation. Findings point to the potential value of the inclusion of human rights in these articulations to increase the participation or involvement of clients in health systems, to broaden the concept of equity, to bring attention to laws and policies beyond regulation and to strengthen accountability mechanisms.
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Affiliation(s)
- Sofia Gruskin
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
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22
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Abdullah F, Choo S, Hesse AA, Abantanga F, Sory E, Osen H, Ng J, McCord CW, Cherian M, Fleischer-Djoleto C, Perry H. Assessment of Surgical and Obstetrical Care at 10 District Hospitals in Ghana Using On-Site Interviews. J Surg Res 2011; 171:461-6. [DOI: 10.1016/j.jss.2010.04.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 03/28/2010] [Accepted: 04/12/2010] [Indexed: 11/29/2022]
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Haffeld J, Heggenhougen HK, Lie SO, Røttingen JA, Schei B. The idea of a convention for global health. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:1787-90. [PMID: 21946599 DOI: 10.4045/tidsskr.11.0609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Just Haffeld
- Faculty of Medicine, University of Oslo, Norway.
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Atun R, de Jongh TE, Secci FV, Ohiri K, Adeyi O, Car J. Integration of priority population, health and nutrition interventions into health systems: systematic review. BMC Public Health 2011; 11:780. [PMID: 21985434 PMCID: PMC3204262 DOI: 10.1186/1471-2458-11-780] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 10/10/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. METHODS Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction) and secondary (improved population coverage, access to health services, efficiency, and quality) using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. RESULTS Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. CONCLUSIONS Targeted priority population health interventions we identified led to improved health outcomes, quality of care, patient satisfaction and access to care. Limited evidence with inconsistent findings across varied interventions in different settings means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery.
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Affiliation(s)
- Rifat Atun
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Thyra E de Jongh
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Federica V Secci
- Imperial College Business School, South Kensington Campus, London SW7 2AZ, UK
| | - Kelechi Ohiri
- Human Development Network, The World Bank, 1818 H St., NW, Washington DC, 20433, USA
| | - Olusoji Adeyi
- Human Development Network, The World Bank, 1818 H St., NW, Washington DC, 20433, USA
| | - Josip Car
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP, UK
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Llano R, Kanamori S, Kunii O, Mori R, Takei T, Sasaki H, Nakamura Y, Kurokawa K, Hai Y, Chen L, Takemi K, Shibuya K. Re-invigorating Japan's commitment to global health: challenges and opportunities. Lancet 2011; 378:1255-64. [PMID: 21885096 DOI: 10.1016/s0140-6736(11)61048-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Over the past 50 years, Japan has successfully developed and maintained an increasingly equitable system of universal health coverage in addition to achieving the world's highest life expectancy and one of the lowest infant mortality rates. Against this backdrop, Japan is potentially in a position to become a leading advocate for and supporter of global health. Nevertheless, Japan's engagement with global health has not been outstanding relative to its substantial potential, in part because of government fragmentation, a weak civil society, and lack of transparency and assessment. Japan's development assistance for health, from both governmental and non-governmental sectors, has remained low and Japanese global health leadership has been weak. New challenges arising from changes in governance and global and domestic health needs, including the recent Great East Japan Earthquake, now provide Japan with an opportunity to review past approaches to health policy and develop a new strategy for addressing global and national health. The fragmented functioning of the government with regards to global health policy needs to be reconfigured and should be accompanied by further financial commitment to global health priorities, innovative non-governmental sector initiatives, increased research capacity, and investments in good leadership development as witnessed at the G8 Hokkaido Toyako Summit. Should this strategy development and commitment be achieved, Japan has the potential to make substantial contributions to the health of the world as many countries move toward universal coverage and as Japan itself faces the challenge of maintaining its own health system.
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Affiliation(s)
- Rayden Llano
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan
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26
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Hill PS. Understanding global health governance as a complex adaptive system. Glob Public Health 2011; 6:593-605. [DOI: 10.1080/17441691003762108] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaboru BB. Uncovering the potential of private providers' involvement in health to strengthen comprehensive health systems: a discussion paper. Perspect Public Health 2011; 132:245-52. [PMID: 22991373 DOI: 10.1177/1757913911414770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health systems strengthening (HSS) is being increasingly recognized as a strategic cross-cutting issue in all World Health Organization (WHO) work. Health systems comprise six building blocks: service delivery; medical products, vaccines and technologies; health workforce; health systems financing; health information system; and leadership and governance. Public-private mix (PPM) approaches or partnerships consist of initiatives aimed at increasing collaboration and improving the relationships between public-public, public-private and private-private health providers. An important component of PPM is the clear distribution of tasks between the different providers involved in the provision of health care. In practice, most PPM initiatives are disease-specific and are often related to the health service delivery block mentioned above. Although there is widespread consensus that PPM initiatives are typically of an HSS nature, efforts to make explicit the links between PPM and health systems building blocks are rather uncommon. The present paper aims to identify - in order to facilitate operationalization - potential aspects linking PPM to health systems building blocks, using a few experiences from tuberculosis control and beyond. The paper targets policymakers, donors and health systems scientists and ends with a call for more aware and innovative leadership, for increased support of PPM initiatives covering various building blocks, and for more operational research.
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Affiliation(s)
- Berthollet Bwira Kaboru
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Configuring balanced scorecards for measuring health system performance: evidence from 5 years' evaluation in Afghanistan. PLoS Med 2011; 8:e1001066. [PMID: 21814499 PMCID: PMC3144209 DOI: 10.1371/journal.pmed.1001066] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/14/2011] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. METHODS AND FINDINGS Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0-100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3-84.5, p<0.0001); provider satisfaction (65.4-79.2, p<0.01); capacity for service provision (47.4-76.4, p<0.0001); quality of services (40.5-67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0-52.6). The financial domain also showed improvement until 2007 (84.4-95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. CONCLUSIONS The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary.
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Bosch-Capblanch X, Kelly M, Garner P. Do existing research summaries on health systems match immunisation managers' needs in middle- and low-income countries? Analysis of GAVI health systems strengthening support. BMC Public Health 2011; 11:449. [PMID: 21651793 PMCID: PMC3125377 DOI: 10.1186/1471-2458-11-449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. Our objectives were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers to immunisation. METHODS From 44 health systems strengthening proposals submitted to GAVI in 2007 and 2008, we analysed the topics identified, the coverage of these topics by existing systematic reviews and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. RESULTS Thirty topics were identified and grouped into three thematic areas: health workforce (10 topics); organisation and management (14); and supply, distribution and maintenance (6). We found 51 potentially relevant systematic reviews, although for the topic that appeared most frequently in the proposals ('Health information systems') no review was identified. Thematic and geographic relevance were generally categorised as "high" in 33 (65%) and 25 (49%) reviews, respectively, but few reviews were categorised as "highly relevant for policy" (7 reviews, 14%). With regard to methodological quality, 14 reviews (27%) were categorised as "high".The number of topics that were addressed by at least one high quality systematic review was: seven of the 10 topics in the 'health workforce' thematic area; six of the 14 topics in the area of 'organisation and management'; and none of the topics in the thematic area of 'supply, distribution and maintenance'. Only twelve of the 39 countries with available national surveys referred to them in their proposals. CONCLUSION Relevant, high quality research summaries were found for few of the topics identified by managers. Few proposals used national surveys evidence to identify barriers to vaccination. Researchers generating or adapting evidence about health systems need to be more responsive to managers' needs. Use of available evidence from local or national surveys should be strongly encouraged.
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Labonté R, Mohindra K, Schrecker T. The Growing Impact of Globalization for Health and Public Health Practice. Annu Rev Public Health 2011; 32:263-83. [DOI: 10.1146/annurev-publhealth-031210-101225] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Ted Schrecker
- Institute of Population Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada; , ,
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Choo S, Perry H, Hesse AAJ, Abantanga F, Sory E, Osen H, McCord CW, Abdullah F. Surgical training and experience of medical officers in Ghana's district hospitals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:529-533. [PMID: 21346502 DOI: 10.1097/acm.0b013e31820dc471] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To document the quality of training and experience of those who care for patients undergoing surgery and emergency obstetrical procedures at 10 government district hospitals in Ghana. METHOD A study team composed of Ghanaian and U.S. surgeons visited 10 district hospitals in 10 different regions of Ghana in August 2009. On-site interviews were conducted documenting the formal and informal training and the experience of the medical officers (MOs) performing in surgical facilities in these hospitals. RESULTS Fourteen of the 17 MOs working at these facilities were available for interviews. All 14 had completed two years of housemanship, which is similar to a rotating internship. Only one had obtained any formal surgical training beyond the housemanship, although all were responsible for performing major surgical procedures. The formal training under qualified supervision during the housemanship was limited; the mean number of the most common major surgical procedures performed during training ranged from four to eight, depending on the procedure. CONCLUSIONS Even though formal general surgical residency training in Ghana is well developed, graduates of these programs are not working in the district hospitals surveyed. The majority of surgical services provided at the district hospital are provided by MOs, who would benefit from more comprehensive training and ongoing supervision. To help meet the challenge of a shortage of physicians working at district hospitals, the authors present alternative approaches to care described in the literature that involve nonphysician midlevel health providers.
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Affiliation(s)
- Shelly Choo
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Komatsu R, Lee D, Lusti-Narasimhan M, Martineau T, Vinh-Thomas E, Beer DL, Atun R. Sexual and reproductive health activities in HIV programmes: can we monitor progress? J Epidemiol Community Health 2011; 65:199-204. [PMID: 20630980 PMCID: PMC3034082 DOI: 10.1136/jech.2009.092940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2010] [Indexed: 11/04/2022]
Abstract
BACKGROUND Resource allocation and integration of services have been of interest recently to achieve health-related Millennium Development Goals. This paper analyses the extent to which countries receiving funding in HIV were able to invest in activities in the area of sexual and reproductive health (SRH). METHODS The authors screened the Global Fund grants data with an aggregate investment of US$16 billion in 140 countries to identify indicators revealing typical SRH services. The analysis focused on the 'Top Ten' internationally agreed indicators and used international guidelines and frameworks to define services for SRH and opportunities for 'linkage' between HIV and SRH services. RESULTS As of December 2008, 238 of all HIV grants (n = 252) from 133 countries included 1620 service delivery indicators related to SRH. The budgets amounted to US$9.1 billion with US$5.9 billion committed and US$4 billion disbursed. Services included (1) prevention of mother to child transmission for 445,000 HIV-positive pregnant women, (2) 5.7 million care and support services, (3) 1.2 billion condoms delivered, (4) 4.4 million episodes of sexually transmitted infections treated, (5) 61 million counselling and testing encounters, and (6) 11.6 million behavioural change communication (BCC) outreach services for people at high risk and 64.5 million BCC activities for the general population, including youth. Information on the linkage and integration of SRH-HIV services was limited. CONCLUSION Around 94% of HIV programmes supported SRH-related activities. However, there is a need to systematically capture data on SRH-HIV service integration to understand the benefits of linking these services.
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Affiliation(s)
- Ryuichi Komatsu
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, 1214 Vernier, Geneva, Switzerland.
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Haffeld J, Heggenhougen H, Kiserud T, Lie S. Global helse - fra kaos til koherens. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:1790-2. [DOI: 10.4045/tidsskr.11.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Burdick W, Amaral E, Campos H, Norcini J. A model for linkage between health professions education and health: FAIMER international faculty development initiatives. MEDICAL TEACHER 2011; 33:632-637. [PMID: 21774649 DOI: 10.3109/0142159x.2011.590250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Linking faculty development to improvement of community health is of particular interest to health professions educators and researchers. While individuals and institutions engaged in health professions education have the potential to improve health, limited literature connects capacity building in education with improvements in health. Understanding the mechanism by which faculty development may promote development of socially accountable institutions and improve health can be useful for improving this connection and evaluating program effectiveness.
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Bartram J, Platt J. How health professionals can leverage health gains from improved water, sanitation and hygiene practices. Perspect Public Health 2010; 130:215-21. [PMID: 21086817 DOI: 10.1177/1757913910379193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emerging evidence suggests that widespread failure in coordination and collaboration between the health and WaSH sectors contributes to the substantive disease burden associated with inadequate water, sanitation and hygiene (WaSH). This results in missed opportunities at every level starting with access to water and sanitation and adequate hygiene practices in primary health facilities. This paper describes the application of an established health system functions framework to the WaSH sector and summarizes examples of successful health system action including the roles played by diverse health professionals.
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Affiliation(s)
- Jamie Bartram
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
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Bozorgmehr K. Rethinking the 'global' in global health: a dialectic approach. Global Health 2010; 6:19. [PMID: 21029401 PMCID: PMC2987787 DOI: 10.1186/1744-8603-6-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 10/28/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Current definitions of 'global health' lack specificity about the term 'global'. This debate presents and discusses existing definitions of 'global health' and a common problem inherent therein. It aims to provide a way forward towards an understanding of 'global health' while avoiding redundancy. The attention is concentrated on the dialectics of different concepts of 'global' in their application to malnutrition; HIV, tuberculosis & malaria; and maternal mortality. Further attention is payed to normative objectives attached to 'global health' definitions and to paradoxes involved in attempts to define the field. DISCUSSION The manuscript identifies denotations of 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic'. A fourth concept of 'global' as 'supraterritorial' is presented and defined as 'links between the social determinants of health anywhere in the world'. The rhetorical power of the denotations impacts considerably on the object of 'global health', exemplified in the context of malnutrition; HIV, tuberculosis & malaria; and maternal mortality. The 'global' as 'worldwide', as 'transcending national boundaries' and as 'holistic' house contradictions which can be overcome by the fourth concept of 'global' as 'supraterritorial'. The 'global-local-relationship' inherent in the proposed concept coheres with influential anthropological and sociological views despite the use of different terminology. At the same time, it may be assembled with other views on 'global' or amend apparently conflicting ones. The author argues for detaching normative objectives from 'global health' definitions to avoid so called 'entanglement-problems'. Instead, it is argued that the proposed concept constitutes an un-euphemistical approach to describe the inherently politicised field of 'global health'. SUMMARY While global-as-worldwide and global-as-transcending-national-boundaries are misleading and produce redundancy with public and international health, global-as-supraterritorial provides 'new' objects for research, education and practice while avoiding redundancy. Linked with 'health' as a human right, this concept preserves the rhetorical power of the term 'global health' for more innovative forms of study, research and practice. The dialectic approach reveals that the contradictions involved in the different notions of the term 'global' are only of apparent nature and not exclusive, but have to be seen as complementary to each other if expected to be useful in the final step.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department for International Health Sciences; Institute for Social Medicine, Epidemiology and Health Economics; Charité - University Medical Center, Berlin, Germany.
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Shakarishvili G, Lansang MA, Mitta V, Bornemisza O, Blakley M, Kley N, Burgess C, Atun R. Health systems strengthening: a common classification and framework for investment analysis. Health Policy Plan 2010; 26:316-26. [PMID: 20952397 PMCID: PMC3118911 DOI: 10.1093/heapol/czq053] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Significant scale-up of donors’ investments in health systems strengthening (HSS), and the increased application of harmonization mechanisms for jointly channelling donor resources in countries, necessitate the development of a common framework for tracking donors’ HSS expenditures. Such a framework would make it possible to comparatively analyse donors’ contributions to strengthening specific aspects of countries’ health systems in multi-donor-supported HSS environments. Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses. Building on the analysis of these aspects, the paper proposes a framework for tracking donors’ investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach. Comparative analysis of financial allocations by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for HSS, as an illustrative example of applying the proposed framework in practice, is also presented.
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Affiliation(s)
- George Shakarishvili
- The Global Fund to Fight AIDS, Tuberculosis and Malaria (TGF), Geneva, Switzerland.
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Amico P, Aran C, Avila C. HIV spending as a share of total health expenditure: an analysis of regional variation in a multi-country study. PLoS One 2010; 5:e12997. [PMID: 20885986 PMCID: PMC2945774 DOI: 10.1371/journal.pone.0012997] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. METHODOLOGY/PRINCIPAL FINDINGS A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. CONCLUSIONS/SIGNIFICANCE The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average SSA country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns.
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Affiliation(s)
- Peter Amico
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Christian Aran
- AIDS Financing and Economics Division, UNAIDS, Geneva, Switzerland
| | - Carlos Avila
- AIDS Financing and Economics Division, UNAIDS, Geneva, Switzerland
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Hoffman SJ. The evolution, etiology and eventualities of the global health security regime. Health Policy Plan 2010; 25:510-22. [PMID: 20732860 DOI: 10.1093/heapol/czq037] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours away from affecting many others. METHODS Using regime analysis from political science, the principles, norms, rules and decision-making procedures by which states govern health security are examined in the historical context of their punctuated evolution. This methodology illuminates the catalytic agents of change, distributional consequences and possible future orders that can help to better inform progress in this area. FINDINGS Four periods of global health security governance are identified. The first is characterized by unilateral quarantine regulations (1377-1851), the second by multiple sanitary conferences (1851-92), the third by several international sanitary conventions and international health organizations (1892-1946) and the fourth by the hegemonic leadership of the World Health Organization (1946-????). This final regime, like others before it, is challenged by globalization (e.g. limitations of the new International Health Regulations), changing diplomacy (e.g. proliferation of global health security organizations), new tools (e.g. global health law, human rights and health diplomacy) and shock-activated vulnerabilities (e.g. bioterrorism and avian/swine influenza). This understanding, in turn, allows us to appreciate the impact of this evolving regime on class, race and gender, as well as to consider four possible future configurations of power, including greater authority for the World Health Organization, a concert of powers, developing countries and civil society organizations. CONCLUSIONS This regime analysis allows us to understand the evolution, etiology and eventualities of the global health security regime, which is essential for national and international health policymakers, practitioners and academics to know where and how to act effectively in preparation for tomorrow's challenges.
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Affiliation(s)
- Steven J Hoffman
- Department of Political Science, University of Toronto, 84 Queen's Park, Toronto, Ontario, Canada, M5S 2C5, Canada.
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Choo S, Perry H, Hesse AAJ, Abantanga F, Sory E, Osen H, Fleischer-Djoleto C, Moresky R, McCord CW, Cherian M, Abdullah F. Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 2010; 15:1109-15. [PMID: 20636302 DOI: 10.1111/j.1365-3156.2010.02589.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. METHODS The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. RESULTS Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra-operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. CONCLUSIONS The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications.
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Affiliation(s)
- Shelly Choo
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21205, USA
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Ramanadhan S, Kebede S, Mantopoulos J, Bradley EH. Network-based social capital and capacity-building programs: an example from Ethiopia. HUMAN RESOURCES FOR HEALTH 2010; 8:17. [PMID: 20594321 PMCID: PMC2906407 DOI: 10.1186/1478-4491-8-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/01/2010] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Capacity-building programs are vital for healthcare workforce development in low- and middle-income countries. In addition to increasing human capital, participation in such programs may lead to new professional networks and access to social capital. Although network development and social capital generation were not explicit program goals, we took advantage of a natural experiment and studied the social networks that developed in the first year of an executive-education Master of Hospital and Healthcare Administration (MHA) program in Jimma, Ethiopia. CASE DESCRIPTION We conducted a sociometric network analysis, which included all program participants and supporters (formally affiliated educators and mentors). We studied two networks: the Trainee Network (all 25 trainees) and the Trainee-Supporter Network (25 trainees and 38 supporters). The independent variable of interest was out-degree, the number of program-related connections reported by each respondent. We assessed social capital exchange in terms of resource exchange, both informational and functional. Contingency table analysis for relational data was used to evaluate the relationship between out-degree and informational and functional exchange. DISCUSSION AND EVALUATION Both networks demonstrated growth and inclusion of most or all network members. In the Trainee Network, those with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 123.61, p < 0.01. We did not find a statistically significant relationship between out-degree and functional exchange in this network, chi2(1, N = 23) = 26.11, p > 0.05. In the Trainee-Supporter Network, trainees with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 74.93, p < 0.05. The same pattern held for functional exchange, chi2 (1, N = 23) = 81.31, p < 0.01. CONCLUSIONS We found substantial and productive development of social networks in the first year of a healthcare management capacity-building program. Environmental constraints, such as limited access to information and communication technologies, or challenges with transportation and logistics, may limit the ability of some participants to engage in the networks fully. This work suggests that intentional social network development may be an important opportunity for capacity-building programs as healthcare systems improve their ability to manage resources and tackle emerging problems.
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Affiliation(s)
- Shoba Ramanadhan
- Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney St., LW 703, Boston, MA 02115 USA
| | - Sosena Kebede
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Jeannie Mantopoulos
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Elizabeth H Bradley
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
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National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies. Health Policy 2010; 96:128-33. [PMID: 20176407 DOI: 10.1016/j.healthpol.2010.01.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 01/20/2010] [Accepted: 01/24/2010] [Indexed: 11/22/2022]
Abstract
Integrated Management of Childhood Illness (IMCI) is a pediatric care management strategy that has been shown to improve health care service quality and increase health care cost savings in multi-country evaluations. However, many countries have faced significant training, health system, political, and financial constraints to national implementation and, as a result, have not been able to observe sustained benefits of IMCI. This article reviews the literature for evidence of IMCI health impacts, common implementation constraints, and policy strategies for health system strengthening and successful implementation.
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Goeman L, Galichet B, Porignon DG, Hill PS, Hammami N, Essengue Elouma MS, Kadama PY, Van Lerberghe W. The response to flexibility: country intervention choices in the first four rounds of the GAVI Health Systems Strengthening applications. Health Policy Plan 2010; 25:292-9. [PMID: 20123939 DOI: 10.1093/heapol/czq002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Since December 2005 the GAVI Alliance (GAVI) Health Systems Strengthening (HSS) window has offered predictable funding to developing countries, based on a combined population and economic formula. This is intended to assist them to address system constraints to improved immunization coverage and health care delivery, needed to meet the Millennium Development Goals. The application process invites countries to prioritize specific system constraints not adequately addressed by other donors, and allows them to allocate their eligible funds accordingly. This article presents an analysis of the first four rounds of countries' funding applications. These requested funding for a variety of health system initiatives that reflected country-specific requirements, and were not limited to improving immunization coverage. Analyses identified a dominance of operational-level health service provision activities, and an absence of interventions related to demand and financing. While the proposed activities are only now being implemented, the results of this study provide evidence that the open application process employed by the HSS window has led to a shift in analysis and planning-from the programmatic to the systemic-in the countries whose applications have been approved. However, the proposed responses to identified constraints are dominated by short-term operational responses, rather than more complex, longer term approaches to health system strengthening.
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Affiliation(s)
- Lieve Goeman
- International Health Policy, School of Population Health, University of Queensland, Herston, QLD 4006, Australia
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Haffeld JB, Siem H, Røttingen JA. Examining the global health arena: strengths and weaknesses of a convention approach to global health challenges. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2010; 38:614-628. [PMID: 20880244 DOI: 10.1111/j.1748-720x.2010.00515.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The article comprises a conceptual framework to analyze the strengths and weaknesses of a global health convention. The analyses are inspired by Lawrence Gostin's suggested Framework Convention on Global Health. The analytical model takes a starting-point in events tentatively following a logic sequence: Input (global health funding), Processes (coordination, cooperation, accountability, allocation of aid), Output (definition of basic survival needs), Outcome (access to health services), and Impact (health for all). It then examines to what degree binding international regulations can create order in such a sequence of events. We conclude that a global health convention could be an appropriate instrument to deal with some of the problems of global health. We also show that some of the tasks preceding a convention approach might be to muster international support for supra-national health regulations, negotiate compromises between existing stakeholders in the global health arena, and to utilize WHO as a platform for further discussions on a global health convention.
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Affiliation(s)
- Laurie Garrett
- Council on Foreign Relations, New York City, NY 10065, USA.
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Affiliation(s)
- Julio Frenk
- Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
The Bill & Melinda Gates Foundation is a major contributor to global health; its influence on international health policy and the design of global health programmes and initiatives is profound. Although the foundation's contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. We undertook an analysis of 1094 global health grants awarded between January, 1998, and December, 2007. We found that the total value of these grants was US$8.95 billion, of which $5.82 billion (65%) was shared by only 20 organisations. Nevertheless, a wide range of global health organisations, such as WHO, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, prominent universities, and non-governmental organisations received grants. $3.62 billion (40% of all funding) was given to supranational organisations. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3.27 billion) of funding was allocated to research and development (mainly for vaccines and microbicides), or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.
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Affiliation(s)
- David McCoy
- Centre for International Health and Development, University College London, London, UK.
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