1
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Katoue MG, Cerda AA, García LY, Jakovljevic M. Healthcare system development in the Middle East and North Africa region: Challenges, endeavors and prospective opportunities. Front Public Health 2022; 10:1045739. [PMID: 36620278 PMCID: PMC9815436 DOI: 10.3389/fpubh.2022.1045739] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Countries in the Middle East and North Africa (MENA) region have been investing in the development of their health systems through implementing reforms to improve health care delivery for their nations. However, these countries are still facing challenges in providing equitable, high quality healthcare services. There is limited published literature supporting the previous and ongoing attempts that have been made to improve health system performance in MENA countries. Aims This review aims to describe experiences of health system development efforts in the MENA region, highlight progress, identify challenges that need be addressed and future opportunities to achieve responsive and efficient health systems. It also aimed to provide recommendations to further support these health systems toward evolution and performance improvement. Methods A literature review was conducted by searching different databases including PubMed, Scopus, Google Scholar and other electronic resources to identify articles and publications describing health systems development in the MENA region from 1975 to 2022. It also included grey literature, reports and policy and planning documents by international organizations. The identified references were reviewed to extract, analyze, organize and report the findings. Results The review revealed emerging evidence describing governmental initiatives to introduce health system reforms at different levels in the MENA countries. These include initiatives targeting the various elements controlling health system reform: financing, payment, organization, regulation and behavior of providers and consumers. There are several challenges facing the health systems of MENA countries including the rising burden of chronic diseases, inequitable access to health services, deficiency in health workforce, shortage in the use of effective health information systems and leadership challenges. The review identified several key areas that can benefit from further improvement to support health system reforms. These include improving the structure, organization and financing of health systems, health workforce development, effective data management and engagement of key stakeholders to achieve adequate health system reforms. Conclusion The MENA countries have made significant steps to improve the performance of their health systems; yet achieving a comprehensive health reform will require collaboration of various stakeholders including health policy makers, healthcare professionals, and central to the success of the reform, the patients.
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Affiliation(s)
- Maram Gamal Katoue
- Department of Pharmacology and Therapeutics, College of Pharmacy, Kuwait University, Kuwait, Kuwait,*Correspondence: Maram Gamal Katoue
| | - Arcadio A. Cerda
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Leidy Y. García
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg, Russia,Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan,Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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2
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Onambele L, Ortega-Leon W, Guillen-Aguinaga S, Forjaz MJ, Yoseph A, Guillen-Aguinaga L, Alas-Brun R, Arnedo-Pena A, Aguinaga-Ontoso I, Guillen-Grima F. Maternal Mortality in Africa: Regional Trends (2000-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013146. [PMID: 36293727 PMCID: PMC9602585 DOI: 10.3390/ijerph192013146] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. METHODS We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). RESULTS Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. CONCLUSIONS Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.
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Affiliation(s)
- Luc Onambele
- School of Health Sciences, Catholic University of Central Africa, Yaoundé 1110, Cameroon
| | - Wilfrido Ortega-Leon
- Epidemiology and Public Health Program, Department of Surgery, Medical and Social Sciences, University of Alcala de Henares, 28801 Madrid, Spain
| | - Sara Guillen-Aguinaga
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- San Juan Health Center, Primary Health Care, Navarra Health Service, 31006 Pamplona, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, 28029 Madrid, Spain
- REDISSEC and REDIAPP, 28029 Madrid, Spain
| | - Amanuel Yoseph
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 5, Ethiopia
| | | | - Rosa Alas-Brun
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
| | - Alberto Arnedo-Pena
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain
- Public Health and Epidemiology (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ines Aguinaga-Ontoso
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Avda. de Baranain sn, 31008 Pamplona, Spain
| | - Francisco Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
- Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Center for Biomedical Research Network, Physiopathology of Obesity and CIBER-OBN, Instituto de Salud Carlos III, 28029 Madrid, Spain
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3
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Ly MS, Bassoum O, Faye A. Universal health insurance in Africa: a narrative review of the literature on institutional models. BMJ Glob Health 2022; 7:bmjgh-2021-008219. [PMID: 35483710 PMCID: PMC9052052 DOI: 10.1136/bmjgh-2021-008219] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals. Method This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection). Results Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa. Conclusion Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.
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Affiliation(s)
- Mamadou Selly Ly
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Oumar Bassoum
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
| | - Adama Faye
- Institut Santé et Développement (ISED), Cheikh Anta Diop University, Dakar, Senegal
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4
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Darrudi A, Ketabchi Khoonsari MH, Tajvar M. Challenges to Achieving Universal Health Coverage Tthroughout the World: A Systematic Review. J Prev Med Public Health 2022; 55:125-133. [PMID: 35391524 PMCID: PMC8995934 DOI: 10.3961/jpmph.21.542] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC. Methods A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables. Results Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported. Conclusions This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.
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Affiliation(s)
- Alireza Darrudi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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5
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Fasseeh A, ElEzbawy B, Adly W, ElShahawy R, George M, Abaza S, ElShalakani A, Kaló Z. Healthcare financing in Egypt: a systematic literature review. JOURNAL OF THE EGYPTIAN PUBLIC HEALTH ASSOCIATION 2022; 97:1. [PMID: 34994859 PMCID: PMC8741917 DOI: 10.1186/s42506-021-00089-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.
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Affiliation(s)
- Ahmad Fasseeh
- Syreon Middle East, Alexandria, Egypt.,Eötvös Loránd University University, Budapest, Hungary
| | | | - Wessam Adly
- The School of Global Affairs and Public Policy, American University in Cairo, Cairo, Egypt
| | | | - Mohsen George
- Universal Health Insurance Authority, Cairo, Egypt.,Health Insurance Organization, Cairo, Egypt
| | | | - Amr ElShalakani
- Health, Nutrition, and Population Global Practice - World Bank, Cairo, Egypt
| | - Zoltán Kaló
- Semmelewis University, Budapest, Hungary.,Syreon Research Institute, Budapest, Hungary
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6
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Sanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review. Global Health 2021; 17:129. [PMID: 34784948 PMCID: PMC8594189 DOI: 10.1186/s12992-021-00778-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/14/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Developing essential health services through non-governmental organisations (NGOs) is an important strategy for progressing towards Universal Health Coverage (UHC), especially in low- and middle-income countries. It is crucial to understand NGOs' role in reaching UHC and the best way to engage them. OBJECTIVE This study reviewed the role of NGOs and their engagement strategies in progress toward UHC. METHOD We systematically reviewed studies from five databases (PubMed, Web of Science (ISI), ProQuest, EMBASE and Scopus) that investigated NGOs interventions in public health-related activities. The quality of the selected studies was assessed using the mixed methods appraisal tool. PRISMA reporting guidelines were followed. FINDINGS Seventy-eight studies met the eligibility criteria. NGOs main activities related to service and population coverage and used different strategies to progress towards UHC. To ensure services coverage, NGOs provided adequate and competent human resources, necessary health equipment and facilities, and provided public health and health care services strategies. To achieve population coverage, they provided services to vulnerable groups through community participation. Most studies were conducted in middle-income countries. Overall, the quality of the reported evidence was good. The main funding sources of NGOs were self-financing and grants from the government, international organisations, and donors. CONCLUSION NGOs can play a significant role in the country's progress towards UHC along with the government and other key health players. The government should use strategies and interventions in supporting NGOs, accelerating their movement toward UHC.
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Affiliation(s)
- Arman Sanadgol
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management&Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management&Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Tabriz Univerisity of Medical Sciences, Tabriz, Iran.
| | - Reza Majdzadeh
- CenterCommunity Based Participatory Research Center and Knowledge Utilization Research Center, Tehran Univerisity of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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7
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Balkhi B, Alshayban D, Alotaibi NM. Impact of Healthcare Expenditures on Healthcare Outcomes in the Middle East and North Africa (MENA) Region: A Cross-Country Comparison, 1995-2015. Front Public Health 2021; 8:624962. [PMID: 33614570 PMCID: PMC7890180 DOI: 10.3389/fpubh.2020.624962] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022] Open
Abstract
The association between healthcare expenditures and outcomes, mainly mortality and life expectancy, is complex. The real explanation for this association is not clear, especially in the Middle East and North Africa (MENA) region. This study assesses the impact of health expenditures on improving healthcare systems and health status and finds a relationship between health expenditures and health outcomes across different region. Annual time series data on healthcare spending and outcomes from 1995 to 2015 were used for MENA region in comparison to developed and developing countries. Health expenditure was adjusted by the consumer price index equation to the 2015 US dollar eliminate the impact of inflation on our results. For many countries, spending on healthcare continues to rise, Among MENA countries, we found that the United Arab Emirates and Kuwait spent more per capita on health, $1,711 and $1,420, respectively, than any other countries in the region. Although this study demonstrated a relationship between total healthcare expenditure and outcomes, some countries spend more on healthcare but have shorter life expectancy. In most countries, efficient and effective utilization of healthcare resources is the key strategy for improving health outcomes in any country. The lack of a positive correlation between healthcare spending and life expectancy may indicate that health resources are not allocated effectively. In those cases, increasing health spending does not guarantee that there is any kind of improvement in healthcare.
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Affiliation(s)
- Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Dhfer Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nawaf M Alotaibi
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha, Saudi Arabia
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8
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Derakhshani N, Doshmangir L, Ahmadi A, Fakhri A, Sadeghi-Bazargani H, Gordeev VS. Monitoring Process Barriers and Enablers Towards Universal Health Coverage Within the Sustainable Development Goals: A Systematic Review and Content Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:459-472. [PMID: 32922051 PMCID: PMC7457838 DOI: 10.2147/ceor.s254946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study builds on previous successes of using tracer indicators in tracking progress towards Universal Health Coverage (UHC) and complements them by offering a more detailed tool that would allow us to identify potential process barriers and enablers towards such progress. PURPOSE This tool was designed accounting for possibly available data in low- and middle-income counties. METHODOLOGY A systematic review of relevant studies was carried out using PubMed, ISI Web of Science, Embase, Scopus, and ProQuest databases with no time restriction. The search was complemented by a scoping review of grey literature, using the World Bank and the World Health Organization (WHO) official reports depositories. Next, an inductive content analysis identified determinants influencing the progress towards UHC and its relevant indicators. The conceptual proximity between indicators and categorized themes was explored through three focus group discussion with 18 experts in UHC. Finally, a comprehensive list of indicators was converted into an assessment tool and refined following three consecutive expert panel discussions and two rounds of email surveys. RESULTS A total of 416 themes (including indicators and determinants factors) were extracted from 166 eligible articles and documents. Based on conceptual proximity, the number of factors was reduced to 119. These were grouped into eight domains: social infrastructure and social sustainability, financial and economic infrastructures, population health status, service delivery, coverage, stewardship/governance, and global movements. The final assessment tool included 20 identified subcategories and 88 relevant indicators. CONCLUSION Identified factors in progress towards UHC are interrelated. The developed tool can be adapted and used in whole or in part in any country. Periodical use of the tool is recommended to understand potential factors that impede or advance progress towards UHC.
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Affiliation(s)
- Naser Derakhshani
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Fakhri
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Vladimir Sergeevich Gordeev
- The Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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9
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Sajadi HS, Goodarzi Z, Takian A, Mohamadi E, Olyaeemanesh A, Hosseinzadeh Lotfi F, Sharafi H, Noori Hekmat S, Jowett M, Majdzadeh R. Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:20. [PMID: 32612458 PMCID: PMC7324989 DOI: 10.1186/s12962-020-00215-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries. METHODS We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General government health expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of total health expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for 6 years (2010-2015). RESULTS The TE scores of Iran's health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. CONCLUSION There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran's health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Goodarzi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Global Health & Public Policy, Department of Management Sciences & Health Economics, School of Public Health, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research, Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamid Sharafi
- Department of Mathematics, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Somayeh Noori Hekmat
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Matthew Jowett
- Department of Health Systems Governance & Financing, World Health Organization, Geneva, Switzerland
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community-Based Participatory-Research Center,and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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10
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Mataria A, Hajjeh R, Al-Mandhari A. Surviving or thriving in the Eastern Mediterranean region: the quest for universal health coverage during conflict. Lancet 2020; 395:13-15. [PMID: 31837813 DOI: 10.1016/s0140-6736(19)33061-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Awad Mataria
- World Health Organization Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt
| | - Rana Hajjeh
- World Health Organization Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt.
| | - Ahmed Al-Mandhari
- World Health Organization Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt
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11
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Schenkman S, Bousquat AEM. Alteridade ou austeridade: uma revisão acerca do valor da equidade em saúde em tempos de crise econômica internacional. CIENCIA & SAUDE COLETIVA 2019; 24:4459-4473. [DOI: 10.1590/1413-812320182412.23202019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Nas últimas décadas, o sistema capitalista, transformado por meio de crises mais agressivas e globais, tem submetido a sociedade à austeridade fiscal e tensionado a garantia dos direitos à saúde, como imposição para ampliar a eficiência e efetividade dos sistemas de saúde. A equidade em saúde, por outro lado, opera como fator protetor em relação aos efeitos nocivos da austeridade sobre a saúde da população. O objetivo deste artigo é analisar o efeito da crise financeira global quanto à valorização da equidade em saúde frente à efetividade nas comparações internacionais de eficiência dos sistemas de saúde na literatura científica. Realizada revisão integrativa, com busca nas bases de dados PubMed e BVS, de 2008-18, com análise cross-case. O equilíbrio entre equidade e efetividade deve ser buscado desde o financiamento até os resultados em saúde, de modo eficiente, como forma de fortalecimento dos sistemas de saúde. A escolha entre alteridade ou austeridade deve ser feita de forma explícita e transparente, com resiliência dos valores societais e princípios de universalidade, integralidade e equidade.
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12
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Phillimore P, Sibai AM, Rizk A, Maziak W, Unal B, Abu Rmeileh N, Ben Romdhane H, Fouad FM, Khader Y, Bennett K, Zaman S, Mataria A, Ghandour R, Kılıç B, Ben Mansour N, Fadhil I, O'Flaherty M, Capewell S, Critchley JA. Context-led capacity building in time of crisis: fostering non-communicable diseases (NCD) research skills in the Mediterranean Middle East and North Africa. Glob Health Action 2019; 12:1569838. [PMID: 30721116 PMCID: PMC6366406 DOI: 10.1080/16549716.2019.1569838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This paper examines one EC-funded multinational project (RESCAP-MED), with a focus on research capacity building (RCB) concerning non-communicable diseases (NCDs) in the Mediterranean Middle East and North Africa. By the project’s end (2015), the entire region was engulfed in crisis. Objective: Designed before this crisis developed in 2011, the primary purpose of RESCAP-MED was to foster methodological skills needed to conduct multi-disciplinary research on NCDs and their social determinants. RESCAP-MED also sought to consolidate regional networks for future collaboration, and to boost existing regional policy engagement in the region on the NCD challenge. This analysis examines the scope and sustainability of RCB conducted in a context of intensifying political turmoil. Methods: RESCAP-MED linked two sets of activities. The first was a framework for training early- and mid-career researchers through discipline-based and writing workshops, plus short fellowships for sustained mentoring. The second integrated public-facing activities designed to raise the profile of the NCD burden in the region, and its implications for policymakers at national level. Key to this were two conferences to showcase regional research on NCDs, and the development of an e-learning resource (NETPH). Results: Seven discipline-based workshops (with 113 participants) and 6 workshops to develop writing skills (84 participants) were held, with 18 fellowship visits. The 2 symposia in Istanbul and Beirut attracted 280 participants. Yet the developing political crisis tagged each activity with a series of logistical challenges, none of which was initially envisaged. The immediacy of the crisis inevitably deflected from policy attention to the challenges of NCDs. Conclusions: This programme to strengthen research capacity for one priority area of global public health took place as a narrow window of political opportunity was closing. The key lessons concern issues of sustainability and the paramount importance of responsively shaping a context-driven RCB.
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Affiliation(s)
- Peter Phillimore
- a School of Geography, Politics & Sociology , Newcastle University , Newcastle , UK
| | - Abla M Sibai
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Anthony Rizk
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Wasim Maziak
- c Department of Epidemiology , Florida International University, USA; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Belgin Unal
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | - Niveen Abu Rmeileh
- e Institute of Community and Public Health , Birzeit University , Palestine
| | | | - Fouad M Fouad
- g Department of Epidemiology & Population Health American University of Beirut , Lebanon; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Yousef Khader
- h Public Health Department , Jordan University of Science and Technology , Irbid , Jordan
| | | | | | - Awad Mataria
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Rula Ghandour
- e Institute of Community and Public Health , Birzeit University , Palestine
| | - Bülent Kılıç
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | | | - Ibtihal Fadhil
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Martin O'Flaherty
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Simon Capewell
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Julia A Critchley
- n Population Health Research Institute , St George's, University of London , London , UK
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Elmontsri M, Almashrafi A, Dubois E, Banarsee R, Majeed A. Improving patient safety in Libya: insights from a British health system perspective. Int J Health Care Qual Assur 2018; 31:237-248. [PMID: 29687755 DOI: 10.1108/ijhcqa-09-2016-0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Patient safety programmes aim to make healthcare safe for both patients and health professionals. The purpose of this paper is to explore the UK's patient safety improvement programmes over the past 15 years and explore what lessons can be learnt to improve Libyan healthcare patient safety. Design/methodology/approach Publications focusing on UK patient safety were searched in academic databases and content analysed. Findings Several initiatives have been undertaken over the past 15 years to improve British healthcare patient safety. Many stakeholders are involved, including regulatory and professional bodies, educational providers and non-governmental organisations. Lessons can be learnt from the British journey. Practical implications Developing a national patient safety strategy for Libya, which reflects context and needs is paramount. Above all, Libyan patient safety programmes should reference internationally approved guidelines, evidence, policy and learning from Britain's unique experience. Originality/value This review examines patient safety improvement strategies adopted in Britain to help developing country managers to progress local strategies based on lessons learnt from Britain's unique experience.
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Affiliation(s)
| | - Ahmed Almashrafi
- Primary Care and Public Health, Imperial College London, London, UK
| | - Elizabeth Dubois
- Primary Care and Public Health, Imperial College London, London, UK
| | - Ricky Banarsee
- Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Primary Care and Public Health, Imperial College London, London, UK
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Fouda A, Paolucci F. Path Dependence and Universal Health Coverage: The Case of Egypt. Front Public Health 2017; 5:325. [PMID: 29276704 PMCID: PMC5727010 DOI: 10.3389/fpubh.2017.00325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022] Open
Abstract
Universal health coverage (UHC) is the big objective in health policy which several countries are seeking to achieve. Egypt is no different and its endeavors to attain UHC have been going on since the 1960s. This article discusses the status of UHC in Egypt using theories of political science and economics by analyzing the historical transformations in the Egyptian health system and its institutional settings. This article then specifically examines the path dependence theory against the sociopolitical background of Egypt and assesses any pattern between the theory and the current UHC status in Egypt. The important finding of this analysis is that the health policies and reforms in Egypt have been significantly influenced and limited by its historical institutional structure and development. Both the health policies and the institutional settings adopted a dependent path that limited Egypt’s endeavors to achieve the universal coverage. This dependent path also yielded many of the present-day challenges as in the weaknesses of the healthcare financing system and the inability to extend health coverage to the poor and the informal sector. These challenges subsequently had a negative impact on the accessibility of the healthcare services.
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Affiliation(s)
- Ayman Fouda
- Department of Economics, School of Economics, Management and Statistics, University of Bologna, Bologna, Italy.,School of Law, Rotterdam Institute of Law and Economics, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Francesco Paolucci
- Department of Economics, School of Economics, Management and Statistics, University of Bologna, Bologna, Italy.,Sir Walter Murdoch School of Public Policy and International Affairs, Murdoch University, Perth, WA, Australia
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Asbu EZ, Masri MD, Kaissi A. Health status and health systems financing in the MENA region: roadmap to universal health coverage. Glob Health Res Policy 2017; 2:25. [PMID: 29202093 PMCID: PMC5683471 DOI: 10.1186/s41256-017-0044-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage. METHODS Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages. RESULTS Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care. CONCLUSION The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP and GDP growth rate, and high OOPS pose serious challenges for universal health coverage. Using multi-sector interventions, countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.
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Affiliation(s)
- Eyob Zere Asbu
- Health System Financing Division, Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maysoun Dimachkie Masri
- Health System Financing Division, Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Amer Kaissi
- Department of Healthcare Administration, Trinity University, San Antonio, TX USA
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Banks C, Rawaf S, Hassounah S. Factors influencing the tobacco control policy process in Egypt and Iran: a scoping review. Glob Health Res Policy 2017; 2:19. [PMID: 29202087 PMCID: PMC5683450 DOI: 10.1186/s41256-017-0039-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/05/2017] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Tobacco control policy is essential for addressing the growing tobacco consumption seen in the Eastern Mediterranean Region, the single greatest preventable contributor to the non-communicable disease epidemic. Egypt and Iran have had varied success in using policy to combat this issue. The study aims to identify and compare the factors which have influenced different stages of the policy process - evidence generation, development and implementation. METHODS A scoping review was conducted with a systematic search of 7 databases which was conducted along with searches of Google Scholar, and the World Health Organisation and Eastern Mediterranean Regional Office websites to identify influencing factors at each stage of the policy process. RESULTS Twenty-seven relevant articles were identified from the literature search. Factors identified as influencing tobacco control policy in these countries were lobbying by the tobacco industry, the rise of water-pipe smoking, lack of political commitment and the lack of resources to for policy implementation. Iran was found to be leading Egypt on all three areas of the policy process. Implementation was found to be the most pivotal part of the policy process and the area in which Egypt was weakest compared to Iran. CONCLUSION This study addresses a gap in knowledge concerning tobacco control in the Middle East and has identified multiple factors which are potentially slowing the process of enforcing policy to address tobacco consumption. Iran is the regional leader for tobacco control and it is important for Egypt to assess the transferability of its tactics and immediately start implementing measures to control tobacco use.
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Affiliation(s)
- C. Banks
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
| | - S. Rawaf
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
| | - S. Hassounah
- WHO Collaborating Centre for Public Health Education & Training, Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Campus, 3rd Floor, The Reynolds Building, St Dunstan’s Road, London, W6 8RF UK
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Mumghamba EG, Joury E, Fatusi O, Ober-Oluoch J, Onigbanjo RJ, Honkala S. Capacity Building and Financing Oral Health in the African and Middle East Region. Adv Dent Res 2017; 27:32-42. [PMID: 26101338 DOI: 10.1177/0022034515578909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.
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Affiliation(s)
- E G Mumghamba
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - E Joury
- Faculty of Dentistry, Damascus University, Damascus, Syria
| | - O Fatusi
- Obafemi Awolowo University Ile-Ife, Ile-Ife, Nigeria
| | - J Ober-Oluoch
- IADR-East and Southern African Region-Country Councillor, Nairobi, Kenya
| | | | - S Honkala
- Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
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Al-Akily SA, AlShaer MY, Bamashmus MA, AlBarrag AO, Alkhatib TK, Al-Akhlee HA. Cataract surgical rate in Yemen: 2012. Saudi J Ophthalmol 2017; 31:25-29. [PMID: 28337059 PMCID: PMC5352943 DOI: 10.1016/j.sjopt.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/23/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine cataract surgical rate (CSR) in 2012 (01 January to 31 December 2012) in 22 Governorates of Yemen in order to identify the needs to reduce cataract related blindness. METHODS A standardized questionnaire was sent to the 184 eye units in governmental, university, military, private and charity clinics and hospitals in Yemen. RESULTS The response rate to the questionnaire was 80.7%, and the collected data are summarized. During the 12-month period, a total of 62,577 cataract surgeries were performed by 268 ophthalmology specialists and residents. The cataract surgical rate was 2473 cataract operations per million inhabitants per year. Intraocular lens implantation was performed on 98% of the cases. CONCLUSION CSR has increased in Yemen in the recent years but is still below the target suggested by WHO. There is need to increase the cataract surgical rate in Yemen mainly in rural areas. Inadequate number of eye surgeons, limited accessibility of cataract surgical services in rural areas and the affordability of surgery to large sections of society are major constraints that have to be addressed. The information from this study will help and enable Ministry of Health and other eye care providers to more equitably disperse trained ophthalmic personnel and eye units in Yemeni governorates.
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Affiliation(s)
- Saleh A. Al-Akily
- Eye Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Mutahar Y. AlShaer
- Eye Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Mahfouth A. Bamashmus
- Eye Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- Magrabi Eye Hospital, Sana’a, Yemen
| | | | - Tawfik K. Alkhatib
- Eye Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
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A 3-Year Workplace-Based Intervention Program to Control Noncommunicable Disease Risk Factors in Sousse, Tunisia. J Occup Environ Med 2016; 57:e72-7. [PMID: 26147554 DOI: 10.1097/jom.0000000000000500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of a 3-year workplace-based intervention program on the control of the main noncommunicable disease risk factors (poor nutrition, physical inactivity, and tobacco use) among the employees of Sousse, Tunisia. METHODS We conducted a quasi-experimental study (pre- and postassessments with intervention and control groups) in six companies of the governorate of Sousse in Tunisia.The intervention program consisted of health education programs (eg, workshops, films and open sensitization days). We also scheduled free physical activity sessions and free smoking cessation consultations. RESULTS Our intervention program showed meaningful improvement among the employees toward dietary and physical activity behaviors but not for tobacco use. CONCLUSIONS Workplace is a crucial setting for health promotion, and future programs should consider a multisectoral approach to control the main noncommunicable disease risk factors.
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El-Zein A, DeJong J, Fargues P, Salti N, Hanieh A, Lackner H. Who's been left behind? Why sustainable development goals fail the Arab world. Lancet 2016; 388:207-10. [PMID: 26782981 DOI: 10.1016/s0140-6736(15)01312-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Abbas El-Zein
- School of Civil Engineering, University of Sydney, Sydney, NSW, Australia.
| | - Jocelyn DeJong
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Philippe Fargues
- Migration Policy Centre, European University Institute, Florence, Italy
| | - Nisreen Salti
- Department of Economics, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Adam Hanieh
- Department of Development Studies, School of Oriental and African Studies, University of London, London, UK
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Obermeyer CM, Bott S, Sassine AJ. Arab Adolescents: Health, Gender, and Social Context. J Adolesc Health 2015; 57:252-62. [PMID: 25770651 DOI: 10.1016/j.jadohealth.2015.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 01/02/2015] [Accepted: 01/02/2015] [Indexed: 11/18/2022]
Abstract
This article reviews the evidence about adolescent health in the Arab world, against the background of social, economic, and political change in the region, and with a particular focus on gender. For the literature review, searches were conducted for relevant articles, and data were drawn from national population- and school-based surveys and from the Global Burden of Disease project. In some parts of the Arab world, adolescents experience a greater burden of ill health due to overweight/obesity, transport injuries, cardiovascular and metabolic conditions, and mental health disorders than those in other regions of the world. Poor diets, insufficient physical activity, tobacco use, road traffic injuries, and exposure to violence are major risk factors. Young men have higher risks of unsafe driving and tobacco use and young women have greater ill-health due to depression. Several features of the social context that affect adolescent health are discussed, including changing life trajectories and gender roles, the mismatch between education and job opportunities, and armed conflict and interpersonal violence. Policy makers need to address risk factors behind noncommunicable disease among adolescents in the Arab region, including tobacco use, unhealthy diets, sedentary lifestyles, unsafe driving, and exposure to violence. More broadly, adolescents need economic opportunity, safe communities, and a chance to have a voice in their future.
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Affiliation(s)
- Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Sarah Bott
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Anniebelle J Sassine
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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AlJaroudi W, Isma'eel H, El Merhi F, Assad T, Hourani M. Appropriateness and diagnostic yield of cardiac magnetic resonance imaging from a tertiary referral center in the Middle East. Cardiovasc Diagn Ther 2015; 5:88-97. [PMID: 25984448 DOI: 10.3978/j.issn.2223-3652.2014.11.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022]
Abstract
PURPOSE Cardiac magnetic resonance imaging (CMRI) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program. METHODS All patients who underwent CMR studies between January 1(st) 2013 and June 18(th) 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines. RESULTS There were a total of 142 patients [mean age 42.1 (SD: 18) years, 24.6% females] that underwent CMR study. Two-thirds of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value. Of the remaining 130 appropriate studies (appropriateness level A8-A9), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant scar volume quantification (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation. CONCLUSIONS Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.
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Affiliation(s)
- Wael AlJaroudi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hussain Isma'eel
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi El Merhi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tony Assad
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mukbil Hourani
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Saleh S, Alameddine M, Mourad Y, Natafgi N. Quality of care in primary health care settings in the Eastern Mediterranean region: a systematic review of the literature. Int J Qual Health Care 2015; 27:79-88. [PMID: 25574040 DOI: 10.1093/intqhc/mzu103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This systematic review aims at offering a comprehensive synthesis of studies addressing quality of care in the primary healthcare (PHC) sector of the Eastern Mediterranean Region (EMR). DATA SOURCES A systematic search was conducted using Medline, Embase and Global Health Library (IMEMR) electronic databases to identify studies related to quality in PHC between years 2000 and 2012. STUDY SELECTION/DATA EXTRACTION One hundred and fifty-nine (159) studies fulfilled the eligibility criteria. Each paper was independently reviewed by two reviewers, and the following information was extracted/calculated: dimension of care investigated (structure, processes and outcomes), focus, disease groups, study design, sample size, unit of analysis, response rate, country, setting (public or private) and level of rigor (LOR) score. RESULTS OF DATA SYNTHESIS Most of the studies were descriptive/cross-sectional in nature with a relatively modest LOR score. Assessment of quality of care revealed that the process dimension of quality, specifically clinical practice and patient-provider relationship, is an area of major concern. However, interventions targeting enhanced quality in PHC in the EMR countries had favorable and effective outcomes in terms of clinical practice. CONCLUSION These findings highlight gaps in evidence on quality in PHC in the EMR; such evidence is key for decision-making. Researchers and policy-makers should address these gaps to generate contextualized information and knowledge that ensures relevance and targeted high-impact interventions.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Yara Mourad
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nabil Natafgi
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa, USA
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El-Jardali F, Adam T, Ataya N, Jamal D, Jaafar M. Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries. Int J Health Policy Manag 2014; 3:399-407. [PMID: 25489598 DOI: 10.15171/ijhpm.2014.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/13/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Systems Thinking (ST) has recently been promoted as an important approach to health systems strengthening. However, ST is not common practice, particularly in Low- and Middle-Income Countries (LMICs). This paper seeks to explore the barriers that may hinder its application in the Eastern Mediterranean Region (EMR) and possible strategies to mitigate them. METHODS A survey consisting of open-ended questions was conducted with a purposive sample of health policy-makers such as senior officials from the Ministry of Health (MoH), researchers, and other stakeholders such as civil society groups and professional associations from ten countries in the region. A total of 62 respondents participated in the study. Thematic analysis was conducted. RESULTS There was strong recognition of the relevance and usefulness of ST to health systems policy-making and research, although misconceptions about what ST means were also identified. Experience with applying ST was very limited. Approaches to designing health policies in the EMR were perceived as reactive and fragmented (66%). Commonly perceived constraints to application of ST were: a perceived notion of its costliness combined with lack of the necessary funding to operationalize it (53%), competing political interests and lack of government accountability (50%), lack of awareness about relevance and value (47%), limited capacity to apply it (45%), and difficulty in coordinating and managing stakeholders (39%). CONCLUSION While several strategies have been proposed to mitigate most of these constraints, they emphasized the importance of political endorsement and adoption of ST at the leadership level, together with building the necessary capacity to apply it and apply the learning in research and practice.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon. ; Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. ; Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. ; Research, Advocacy and Public Policy-Making, Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Beirut, Lebanon. ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Taghreed Adam
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Nour Ataya
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Diana Jamal
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon. ; Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maha Jaafar
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
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Ben Romdhane H, Tlili F, Skhiri A, Zaman S, Phillimore P. Health system challenges of NCDs in Tunisia. Int J Public Health 2014; 60 Suppl 1:S39-46. [PMID: 25399240 DOI: 10.1007/s00038-014-0616-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 10/20/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). METHODS Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. RESULTS Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. CONCLUSION This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.
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Affiliation(s)
- Habiba Ben Romdhane
- CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia
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A renaissance in herbal medicine identification: from morphology to DNA. Biotechnol Adv 2014; 32:1237-1244. [PMID: 25087935 DOI: 10.1016/j.biotechadv.2014.07.004] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 02/08/2023]
Abstract
Numerous adverse reactions have arisen following the use of inaccurately identified medicinal plant ingredients, resulting in conditions such as aristolochic acid nephropathy and herb-induced poisoning. This problem has prompted increased global concern over the safety of herbal medicines. DNA barcoding, a technique aiming at detecting species-specific differences in a short region of DNA, provides a powerful new tool for addressing this problem. A preliminary system for DNA barcoding herbal materials has been established based on a two-locus combination of ITS2+psbA-trnH barcodes. There are 78,847 sequences belonging to 23,262 species in the system, which include more than 95% of crude herbal drugs in pharmacopeia, such as those of China, Japan, Korea, India, USA, and Europe. The system has been widely used in traditional herbal medicine enterprises. This review summarizes recent key advances in the DNA barcoding of medicinal plant ingredients (herbal materia medica) as a contribution towards safe and efficacious herbal medicines.
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El-Zein A, Jabbour S, Tekce B, Zurayk H, Nuwayhid I, Khawaja M, Tell T, Al Mooji Y, De-Jong J, Yassin N, Hogan D. Health and ecological sustainability in the Arab world: a matter of survival. Lancet 2014; 383:458-76. [PMID: 24452051 PMCID: PMC4238938 DOI: 10.1016/s0140-6736(13)62338-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Discussions leading to the Rio+20 UN conference have emphasised the importance of sustainable development and the protection of the environment for future generations. The Arab world faces large-scale threats to its sustainable development and, most of all, to the viability and existence of the ecological systems for its human settlements. The dynamics of population change, ecological degradation, and resource scarcity, and development policies and practices, all occurring in complex and highly unstable geopolitical and economic environments, are fostering the poor prospects. In this report, we discuss the most pertinent population-environment-development dynamics in the Arab world, and the two-way interactions between these dynamics and health, on the basis of current data. We draw attention to trends that are relevant to health professionals and researchers, but emphasise that the dynamics generating these trends have implications that go well beyond health. We argue that the current discourse on health, population, and development in the Arab world has largely failed to convey a sense of urgency, when the survival of whole communities is at stake. The dismal ecological and development records of Arab countries over the past two decades call for new directions. We suggest that regional ecological integration around exchange of water, energy, food, and labour, though politically difficult to achieve, offers the best hope to improve the adaptive capacity of individual Arab nations. The transformative political changes taking place in the Arab world offer promise, indeed an imperative, for such renewal. We call on policy makers, researchers, practitioners, and international agencies to emphasise the urgency and take action.
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Affiliation(s)
| | | | | | - Huda Zurayk
- American University of Beirut, Beirut, Lebanon
| | | | - Marwan Khawaja
- UN Economic and Social Commission for Western Asia, Beirut, Lebanon
| | - Tariq Tell
- American University of Beirut, Beirut, Lebanon
| | - Yusuf Al Mooji
- UN Economic and Social Commission for Western Asia, Beirut, Lebanon
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28
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Affiliation(s)
- Samer Jabbour
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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30
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Mokdad AH, Jaber S, Aziz MIA, AlBuhairan F, AlGhaithi A, AlHamad NM, Al-Hooti SN, Al-Jasari A, AlMazroa MA, AlQasmi AM, Alsowaidi S, Asad M, Atkinson C, Badawi A, Bakfalouni T, Barkia A, Biryukov S, El Bcheraoui C, Daoud F, Forouzanfar MH, Gonzalez-Medina D, Hamadeh RR, Hsairi M, Hussein SS, Karam N, Khalifa SEAH, Khoja TAM, Lami F, Leach-Kemon K, Memish ZA, Mokdad AA, Naghavi M, Nasher J, Qasem MBH, Shuaib M, Al Thani AAM, Al Thani MH, Zamakhshary M, Lopez AD, Murray CJL. The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors. Lancet 2014; 383:309-20. [PMID: 24452042 DOI: 10.1016/s0140-6736(13)62189-3] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). METHODS We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. FINDINGS Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. INTERPRETATION Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Sara Jaber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Fadia AlBuhairan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Suad N Al-Hooti
- Kuwait Institute for Scientific Research, Kuwait City, Kuwait
| | | | | | | | | | | | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | - Stan Biryukov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Diego Gonzalez-Medina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Tawfik A M Khoja
- Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Faris Lami
- Baghdad College of Medicine, Baghdad, Iraq
| | - Katherine Leach-Kemon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ali A Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jamal Nasher
- Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | | | | | | | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Abstract
Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.
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Affiliation(s)
- Rajaie Batniji
- Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Lina Khatib
- Carnegie Middle East Center, Beirut, Lebanon
| | - Melani Cammett
- Department of Political Science, Brown University, Providence, RI, USA
| | - Jeffrey Sweet
- Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Amaney Jamal
- Department of Political Science, Princeton University, Princeton, NJ, USA
| | - Paul Wise
- Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Rita Giacaman
- Institute for Community and Public Health, Birzeit University, Birzeit, West Bank, occupied Palestinian territory
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