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Suarez-Herrera JC, Abeldaño Zúñiga RA, Díaz-Castro L. Strategic Alliances in Global Health: Innovative Perspectives in the Era of Sustainable Development. Healthcare (Basel) 2024; 12:1198. [PMID: 38921312 PMCID: PMC11204177 DOI: 10.3390/healthcare12121198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
This article discusses current challenges in the field of global health and the World Health Organization's (WHO) strategies to address them. It highlights the importance of measuring the health impacts of global recession and globalization and the need for human-centered approaches to sustainable development. Emphasis is placed on commitment to health equity and the use of strategic partnerships for health at global, national, and local levels. Improving the health and well-being of populations, as well as public health equity, are core principles of the 2030 Agenda for the Sustainable Development Goals (SDGs). These principles are expressed in SDG 3, which promotes universal access to health services and systems and recognizes global health as a basic human right. It highlights the importance of strategic partnerships to combat emerging health crises, improve public health indices, and address the burden of chronic disease. These partnerships are contemplated in SDG 17 and are manifested in different modalities, such as network governance, cross-sector collaboration, public-private partnership, and social participation. This diversity of alliances has played an important role in scaling up and strengthening universal health systems around the world, including in Latin America and the Caribbean. The text concludes by presenting the essential characteristics of these inter-organizational and inter-institutional alliances in the field of global health.
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Affiliation(s)
- José Carlos Suarez-Herrera
- Office of Research and Knowledge Transfer, Mid-Atlantic University, 35017 Las Palmas de Gran Canaria, Spain;
| | - Roberto Ariel Abeldaño Zúñiga
- Yhteiskuntadatatieteen Keskus, Valtiotieteellinen Tiedekunta, Helsingin Yliopisto, 00150 Helsinki, Finland
- Postgraduate Department, University of Sierra Sur, Oaxaca 70800, Mexico
| | - Lina Díaz-Castro
- Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, México City 14370, Mexico;
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Wodnik BK, Andiappan M, Di Ruggiero E, Lavery JV. The 6I model: an expanded 4I framework to conceptualise interorganisational learning in the global health sector. BMJ Open 2024; 14:e083830. [PMID: 38816060 PMCID: PMC11141175 DOI: 10.1136/bmjopen-2023-083830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION An organisation's ability to learn and adapt is key to its long-term performance and success. Although calls to improve learning within and across health organisations and systems have increased in recent years, global health is lagging behind other sectors in attention to learning, and applications of conceptual models for organisational learning to this field are needed. LEVERAGING THE 4I FRAMEWORK: This article proposes modifications to the 4I framework for organisational learning (which outlines the processes of intuition, interpretation, integration and institutionalisation) to guide the creation, retention and exchange of knowledge within and across global health organisations. PROPOSED EXPANSIONS Two expansions are added to the framework to account for interorganisational learning in the highly interconnected field: (1) learning pathways across organisations via formal or informal partnerships and communities of practice and (2) learning pathways to and from macro-level 'coordinating bodies' (eg, WHO). Two additional processes are proposed by which interorganisational learning occurs: interaction across partnerships and communities of practice, and incorporation linking global health organisations to coordinating bodies. Organisational politics across partnerships, communities of practice and coordinating bodies play an important role in determining why some insights are institutionalised while others are not; as such, the roles of the episodic influence and systemic domination forms of power are considered in the proposed additional organisational learning processes. DISCUSSION When lessons are not shared across partnerships, communities of practice or the research community more broadly, funding may continue to support global health studies and programmes that have already been proven ineffective, squandering research and healthcare resources that could have been invested elsewhere. The '6I' framework provides a basis for assessing and implementing organisational learning approaches in global health programming, and in health systems more broadly.
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Affiliation(s)
- Breanna K Wodnik
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meena Andiappan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Erica Di Ruggiero
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - James V Lavery
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Akmal A, Podgorodnichenko N, Gauld R, Stokes T. New Zealand Pae Ora Healthcare Reforms 2022: Viable by Design? A Qualitative Study Using the Viable System Model. Int J Health Policy Manag 2023; 12:7906. [PMID: 38618773 PMCID: PMC10843487 DOI: 10.34172/ijhpm.2023.7906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The New Zealand (NZ) Pae Ora (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Māori Health Authority (MHA) (Te Aka Whai Ora) - the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform, we aimed to conduct an early evaluation of the design of the reforms to determine if they can deliver a viable and sustainable NZ health system going forward. METHODS The evaluation was informed by Beer's viable system model (VSM). A qualitative exploratory design with semi-structured interviews and documents analysis using thematic analysis was used. We conducted 28 interviews with senior healthcare managers and reviewed over 300 official documents and news analyses. RESULTS The VSM posits that for a system to be viable, all its five sub-systems (operations; co-ordination; operational control; development and governance) need to be strong. Our analysis suggests that the health reforms, despite their strengths, do not satisfy this requirement. The reforms do appreciate the complexity of the healthcare environment: multiple stakeholders, social inequalities, interdependencies. However, our analysis suggests a severe lack of detail regarding the implementation and operationalisation of the reforms. Furthermore, resourcing and coordination within the reformed system is also unclear. CONCLUSION The health system reforms may not lead to a viable future NZ health system. Poor communication of the reform implementation and operationalisation will likely result in system failure and inhibit the ability of frontline health organisations to deliver care.
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Affiliation(s)
- Adeel Akmal
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Business Studies, University of Iceland, Reykjavik, Iceland
| | | | - Robin Gauld
- Department of Management, Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Wernli D, Falcone JL, Davidshofer S, Lee K, Chopard B, Levrat N. Emergent patterns in global health diplomacy: a network analysis of the resolutions adopted by the World Health Assembly from 1948 to 2022. BMJ Glob Health 2023; 8:bmjgh-2022-011211. [PMID: 37024116 PMCID: PMC10083823 DOI: 10.1136/bmjgh-2022-011211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
From a complexity perspective on governance, multilateral diplomacy is based on interactions between people, ideas, norms, policies and institutions. This article uses a computer-assisted methodology to better understand governance systems as a network of norms. All World Health Assembly (WHA) resolutions that were available from 1948 to 2022 were collected from the WHO Institutional Repository for Information Sharing (IRIS) database. Regular expressions were used to identify how resolutions cite other resolutions and the resulting relationships were analysed as a normative network. The findings show that WHA resolutions constitute a complex network of interconnected global health issues. This network is characterised by several community patterns. While chain-like patterns are associated with specific diseases programmes, radial patterns are characteristic of highly important procedural decisions that member states reaffirm in similar situations. Finally, densely connected communities correspond to contested topics and emergencies. While these emergeng patterns suggest the relevance of using network analysis to understand global health norms in international organisations, we reflect on how this computational approach can be extended to provide new understandings of how multilateral governance systems work, and to address some important contemporary questions about the effects of regime complexity on global health diplomacy.
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Affiliation(s)
- Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Falcone
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | | | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bastien Chopard
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Nicolas Levrat
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Faculty of Law, University of Geneva, Geneva, Switzerland
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Knittel B, Coile A, Zou A, Saxena S, Brenzel L, Orobaton N, Bartel D, Williams CA, Kambarami R, Tiwari DP, Husain I, Sikipa G, Achan J, Ajiwohwodoma JO, Banerjee B, Kasungami D. Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance. Gates Open Res 2023; 6:116. [PMID: 36415884 PMCID: PMC9646484 DOI: 10.12688/gatesopenres.13632.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
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Affiliation(s)
- Barbara Knittel
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Amanda Coile
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, CA, 94028, USA
| | - Sweta Saxena
- United States Agency for International Development, Washington, DC, 20523, USA
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Doris Bartel
- Independent Researcher, Washington, District of Columbia, USA
| | | | | | | | - Ishrat Husain
- United States Agency for International Development, Washington, DC, 20523, USA
| | | | | | | | | | - Dyness Kasungami
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
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Borghi J, Ismail S, Hollway J, Kim RE, Sturmberg J, Brown G, Mechler R, Volmink H, Spicer N, Chalabi Z, Cassidy R, Johnson J, Foss A, Koduah A, Searle C, Komendantova N, Semwanga A, Moon S. Viewing the global health system as a complex adaptive system - implications for research and practice. F1000Res 2022; 11:1147. [PMID: 37600221 PMCID: PMC10432894 DOI: 10.12688/f1000research.126201.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 08/22/2023] Open
Abstract
The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highlight the numerous policy insights their application could yield. We also discuss the challenges for researchers of applying these methods and for policy makers of digesting and acting upon them. We encourage application of a CAS approach to GHS research and policy making to help bolster resilience to future risks that transcend national boundaries and system scales.
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Affiliation(s)
- Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Sharif Ismail
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - James Hollway
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Rakhyun E. Kim
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Joachim Sturmberg
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Garrett Brown
- School of Politics and International Studies, University of Leeds, Leeds, UK
| | - Reinhard Mechler
- International Institute for Applied Systems Analysis, Laxenberg, Austria
| | - Heinrich Volmink
- Division of Health Systems and Public Health, Stellenbosch University, Stellenbosch, South Africa
| | - Neil Spicer
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Zaid Chalabi
- Institute for Environmental Design and Engineering, University College London., London, UK
| | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Jeff Johnson
- Faculty of Science, Technology, Engineering & Mathematics, The Open University, Milton Keynes, UK
| | - Anna Foss
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana, Accra, Ghana
| | - Christa Searle
- Edinburgh Business School, Heriot Watt University, Edinburgh, UK
| | | | - Agnes Semwanga
- Health Informatics Research Group, Makerere University, Kampala, Uganda
| | - Suerie Moon
- Graduate Institute of International and Development Studies, Geneva, Switzerland
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7
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Bozorgmehr K, Zick A, Hecker T. Resilience of Health Systems: Understanding Uncertainty Uses, Intersecting Crises and Cross-level Interactions Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada". Int J Health Policy Manag 2022; 11:1956-1959. [PMID: 35658333 PMCID: PMC9808231 DOI: 10.34172/ijhpm.2022.7279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/23/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created opportunities to study resilience in multiple, interrelated societal systems while considering the institutional, community and individual level. We aim to discuss critical, yet underrepresented, issues in resilience discourses which are fundamental to advance theories, concepts and measurement of health system resilience. These relate to a better understanding of (i) how government's handle and use uncertainties to facilitate or impede change, including the role of negotiation and conflicts, (ii) the intersections of health with multiple, co-occurring crises (systemic intersections), and (iii) cross-level interactions, ie, the interrelation between individual-level resilience, the collective resilience of groups and communities, and the resilience of a system as a whole (and vice versa). Analyses of these aspects can help to "contextualize" our understanding of resilience in complex adaptive systems. However, conceptual clarity is needed whether resilience is considered an underlying feature, outcome, or intermediate determinant of a (health) system's performance.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict & Violence (IKG), Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Zick
- Institute for Interdisciplinary Research on Conflict & Violence (IKG), Bielefeld University, Bielefeld, Germany
- Faculty of Educational Science, Bielefeld University, Bielefeld, Germany
- Research Institute Social Cohesion (FGZ/RISC), Bielefeld, Germany
| | - Tobias Hecker
- Institute for Interdisciplinary Research on Conflict & Violence (IKG), Bielefeld University, Bielefeld, Germany
- Working Unit Clinical Developmental Psychopathology, Faculty for Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
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8
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Knittel B, Coile A, Zou A, Saxena S, Brenzel L, Orobaton N, Bartel D, Williams CA, Kambarami R, Tiwari DP, Husain I, Sikipa G, Achan J, Ajiwohwodoma JO, Banerjee B, Kasungami D. Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance. Gates Open Res 2022; 6:116. [PMID: 36415884 PMCID: PMC9646484 DOI: 10.12688/gatesopenres.13632.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
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Affiliation(s)
- Barbara Knittel
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Amanda Coile
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, CA, 94028, USA
| | - Sweta Saxena
- United States Agency for International Development, Washington, DC, 20523, USA
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Doris Bartel
- Independent Researcher, Washington, District of Columbia, USA
| | | | | | | | - Ishrat Husain
- United States Agency for International Development, Washington, DC, 20523, USA
| | | | | | | | | | - Dyness Kasungami
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
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9
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Ahmed KA, Grundy J, Hashmat L, Ahmed I, Farrukh S, Bersonda D, Shah MA, Yunus S, Banskota HK. An analysis of the gender and social determinants of health in urban poor areas of the most populated cities of Pakistan. Int J Equity Health 2022; 21:52. [PMID: 35436931 PMCID: PMC9017040 DOI: 10.1186/s12939-022-01657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent surveys, studies and reviews in urban areas of Pakistan have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Objectives The Urban Slum Profiles and coverage surveys were conducted between 2017 and 2019. The objective of the profiles was to obtain an updated listing of slums and other underserved areas, and to better understand current vaccination and health service coverage in these areas. Utilising findings from these studies, this paper aims to better understand the gender and social determinants of health that are giving rise to health inequalities in the slums. Methods The Urban Slum Profiles adopted a mixed methods approach combining both qualitative and quantitative methods. The study was comprised of two main survey approaches of Urban Slum Profiles and Immunisation Coverage Survey in 4431 urban poor areas of the 10 most highly populated cities of Pakistan. Results Findings are classified into six analytic categories of (1) access to health services, (2) female workforce participation, (3) gender-friendly health services, (4) access to schools and literacy, (5) social connections, and (6) autonomy of decision making. Out of a national sample of 14,531 children in urban poor areas of 10 cities, the studies found that just over half of the children are fully immunised (54%) and 14% of children had received zero doses of vaccine. There are large shortages of health facilities and female health workforce in the slums, with significant gaps in the quality of health infrastructure, which all serve to limit both demand for, and supply of, health services for women and children. Results demonstrate low availability of schools, low levels of female literacy and autonomy over decision making, limited knowledge of the benefits of vaccination, and few social connections outside the home. All these factors interact and reinforce existing gender norms and low levels of health literacy and service access. Conclusion The Urban Slum profiles and coverage studies provide an opportunity to introduce gender transformative strategies that include expansion of a female health workforce, development of costed urban health action plans, and an enabling policy environment to support community organisation and more equitable health service delivery access.
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Affiliation(s)
| | - John Grundy
- College of Public Health, Medicine, and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Lubna Hashmat
- Civil Society Human and Institutional Development Programme - CHIP, CHIP House # 1, Street # 9, G.8/2, Islamabad, Pakistan
| | - Imran Ahmed
- Civil Society Human and Institutional Development Programme - CHIP, CHIP House # 1, Street # 9, G.8/2, Islamabad, Pakistan
| | | | | | - Muhammad Akram Shah
- EPI Program, National Institute of Health (NIH), Prime Minister's Health Complex, Park Road, Chakshahzad, Islamabad, Pakistan
| | - Soofia Yunus
- EPI Program, National Institute of Health (NIH), Prime Minister's Health Complex, Park Road, Chakshahzad, Islamabad, Pakistan
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10
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Nyanchoga MM, Sackey D, Farley R, Claydon R, Mukandi B. Ripple effects: integrating international medical graduates from refugee backgrounds into the health system in Australia. BMJ Glob Health 2022; 7:bmjgh-2021-007911. [PMID: 35418413 PMCID: PMC9014005 DOI: 10.1136/bmjgh-2021-007911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/20/2022] [Indexed: 11/06/2022] Open
Abstract
The field of ‘refugee health’ is generally understood in terms of the efforts of health professionals from a host country to provide care for humanitarian entrants. This paper attempts to undermine that idea, focusing instead on the service that health workers from refugee background communities are able to render, both to their own communities and to broader society, when barriers to their participation are made more equitable. The point of departure for this Practice paper is the 2019 pilot ‘Observership Program’ that was initiated by Mater Refugee Health in Brisbane, Australia. This was in response to, and in collaboration with, international medical graduates from refugee backgrounds. The two doctors who advocated for the programme had already independently embarked on a series of advocacy initiatives aimed at facilitating health workforce participation for members of their communities. In what follows we: outline the barriers to their medical registration and employment in Queensland, Australia; describe the process of setting up a 9-month clinical observership for two participants; and we reflect on the implications of the programme from a health policy and systems perspective. Ultimately, our contention is that because health systems are complex and adaptive, increased health workforce participation by members of marginalised communities has the potential to change the culture of the health system, making it more adept and responsive. Such, we propose, are the ‘ripple effects’ of addressing the obstacles to health workforce participation by members of refugee background communities.
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Affiliation(s)
- Mercy Moraa Nyanchoga
- Mater Refugee Health Service, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Donata Sackey
- Mater Refugee Health Service, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Rebecca Farley
- Mater Refugee Health Service, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel Claydon
- Mater Refugee Health Service, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Office of Medical Education, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bryan Mukandi
- School of Languages and Cultures, The University of Queensland, Saint Lucia, Brisbane, Queensland, Australia
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11
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Lokot M, Bou-Orm I, Zreik T, Kik N, Fuhr DC, El Masri R, Meagher K, Smith J, Asmar MK, McKee M, Roberts B. Health System Governance in Settings with Conflict-Affected Populations: A Systhematic Review. Health Policy Plan 2022; 37:655-674. [PMID: 35325120 DOI: 10.1093/heapol/czac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.
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Affiliation(s)
- Michelle Lokot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Ibrahim Bou-Orm
- Saint Joseph University of Beirut, B.P. 11-5076 Riad El Solh, Beyrouth 1107 2180, Lebanon
| | - Thurayya Zreik
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | - Nour Kik
- Ministry of Public Health, Lebanese University Central Directorate, 4th Floor, Museum Square, Beirut 9800, Lebanon
| | - Daniela C Fuhr
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Rozane El Masri
- War Child Holland, Verdun, Hussein Oweini street, Beirut, Lebanon
| | | | - James Smith
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
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Majumdar P, Gupta SD, Mangal DK, Sharma N, Kalbarczyk A. Understanding the role of power and its relationship to the implementation of the polio eradication initiative in india. FRONTIERS IN HEALTH SERVICES 2022; 2:896508. [PMID: 36925767 PMCID: PMC10012611 DOI: 10.3389/frhs.2022.896508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022]
Abstract
Background Power is exercised everywhere in global health, although its presence may be more apparent in some instances than others. Studying power is thus a core concern of researchers and practitioners working in health policy and systems research (HPSR), an interdisciplinary, problem-driven field focused on understanding and strengthening multilevel systems and policies. This paper aims to conduct a power analysis as mobilized by the actors involved in implementation of the polio program. It will also reflect how different power categories are exerted by actors and embedded in strategies to combat program implementation challenges while planning and executing the Global Polio Eradication Initiative. Methods We collected quantitative and qualitative data from stakeholders who were part of the Polio universe as a part of Synthesis and Translation of Research and Innovations from the Polio Eradication Project. Key informants were main actors of the polio eradication program, both at the national and sub-national levels. Research tools were designed to explore the challenges, strategies and unintended consequences in implementing the polio eradication program in India. We utilized Moon's expanded typology of power in global governance to analyze the implementation of the polio eradication programme in India. Results We collected 517 survey responses and conducted 25 key informant interviews. Understanding power is increasingly recognized as an essential parameter to understand global governance and health. Stakeholders involved during polio program implementation have exerted different kinds of power from structural to discursive, moral power wielded by religious leaders to institutional power, expert power used by professional doctors to commoners like female vaccinators, and network power exercised by community influencers. Hidden power was also demonstrated by powerless actors like children bringing mothers to polio booths. Conclusion Power is not a finite resource, and it can be used, shared, or created by stakeholders and networks in multiple ways. Those people who seem to be powerless possess invisible power that can influence decision making. Moreover, these power categories are not mutually exclusive and may be deeply interconnected with each other; one type of power can be transformed into another. Power and relations play an important role in influencing the decision-making of the community and individuals. Mid-range theories of core implementation science like PARIHAS and CFIR can also add an important variable of power in their construct necessary for implementation success of any health program.
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Affiliation(s)
- Piyusha Majumdar
- SD Gupta School of Public Health, IIHMR University, Jaipur, Rajasthan, India
| | - S D Gupta
- Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - D K Mangal
- IIHMR University, Jaipur, Rajasthan, India
| | - Neeraj Sharma
- SD Gupta School of Public Health, IIHMR University, Jaipur, Rajasthan, India
| | - Anna Kalbarczyk
- International Health, Bloomberg School of Public Health, Baltimore, MD, United States
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Epistemic injustice in academic global health. LANCET GLOBAL HEALTH 2021; 9:e1465-e1470. [PMID: 34384536 DOI: 10.1016/s2214-109x(21)00301-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022]
Abstract
This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health.
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Shah N, Mathew S, Pereira A, Nakaima A, Sridharan S. The role of evaluation in iterative learning and implementation of quality of care interventions. Glob Health Action 2021; 14:1882182. [PMID: 34148508 PMCID: PMC8216261 DOI: 10.1080/16549716.2021.1882182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022] Open
Abstract
Background: The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems.Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and 'more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed.Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives.Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives.Conclusion: One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals.
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Affiliation(s)
- Nikhil Shah
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sharon Mathew
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amanda Pereira
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - April Nakaima
- The Evaluation Centre for Complex Health Interventions, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Akmal A, Gauld R. What components are important for effective healthcare alliance governance? Findings from a modified Delphi study in New Zealand. Health Policy 2020; 125:239-245. [PMID: 33390279 DOI: 10.1016/j.healthpol.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes an integrated and whole of systems approach to care. Little is known about the model in healthcare, nor what those involved in an alliance should be focused upon. Using a modified Delphi method, this research presents a set of components that research participants agreed should underpin development of an effective alliance governance arrangement. These characteristics include a systems perspective-a truly shared governance protocol based on a shared vision and a common purpose; performance measurement-collecting and using real-time data that depicts the realities of an end-to-end system to establish better and more achievable goals based on alliance performance; a relational perspective to promote trust, respect and collaboration amongst alliance members, who historically have been competing for contracts and resources; structural changes that enable and promote a shared governance system; and, finally, equity and inclusion to ensure a diverse alliance which promotes diversity of ideas, and involvement of all stakeholders in the decision making process. This research is relevant to policymakers seeking to develop effective alliance-type arrangements as well as to those involved in the practice of alliance governance.
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Affiliation(s)
- Adeel Akmal
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
| | - Robin Gauld
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
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16
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Race Against the Pandemic: The United States and Global Health. J Emerg Med 2020; 60:402-406. [PMID: 33334648 DOI: 10.1016/j.jemermed.2020.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/20/2022]
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17
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Horvat A, Filipovic J. Healthcare system quality indicators: the complexity perspective. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2017.1421062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ana Horvat
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - Jovan Filipovic
- Department for Quality Management and Standardization, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
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Abstract
The exercise of power permeates global governance processes, making power a critical concept for understanding, explaining, and influencing the intersection of global governance and health. This article briefly presents and discusses three well-established conceptualizations of power-Dahl's, Bourdieu's, and Barnett and Duvall's-from different disciplines, finding that each is important for understanding global governance but none is sufficient. The conceptualization of power itself needs to be expanded to include the multiple ways in which one actor can influence the thinking or actions of others. I further argue that global governance processes exhibit features of complex adaptive systems, the analysis of which requires taking into account multiple types of power. Building on established frameworks, the article then offers an expanded typology of eight kinds of power: physical, economic, structural, institutional, moral, discursive, expert, and network. The typology is derived from and illustrated by examples from global health, but may be applicable to global governance more broadly. Finally, one seemingly contradictory - and cautiously optimistic - conclusion emerges from this typology: multiple types of power can mutually reinforce tremendous power disparities in global health; but at the same time, such disparities are not necessarily absolute or immutable. Further research on the complex interaction of multiple types of power is needed for a better understanding of global governance and health.
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Affiliation(s)
- Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland.
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19
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Morin JF, Blouin C. How environmental treaties contribute to global health governance. Global Health 2019; 15:47. [PMID: 31324253 PMCID: PMC6642604 DOI: 10.1186/s12992-019-0493-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent work in international relations theory argues that international regimes do not develop in isolation, as previously assumed, but evolve as open systems that interact with other regimes. The implications of this insight's for sustainable development remains underexplored. Even thought environmental protection and health promotion are clearly interconnected at the impact level, it remains unclear how global environmental governance interacts with global health governance at the institutional level. In order to fill this gap, this article aims to assess how environmental treaties contribute to global health governance. METHODS AND RESULTS To assess how environmental treaties contribute to global health governance, we conducted a content analysis of 2280 international environmental treaties. For each of these treaties, we measure the type and number of health-related provisions in these treaties. The result is the Health and Environment Interplay Database (HEIDI), which we make public with the publication of this article. This new database reveals that more than 300 environmental treaties have health-related provisions. CONCLUSIONS We conclude that the global environmental regime contributes significantly to the institutionalization of the global health regime, considering that the health regime includes itself very few treaties focusing primarily on health. When reflecting on how global governance can improve population health, decision makers should not only consider the instruments available to them within the realm of global health institutions. They should broaden their perspectives to integrate the contribution of other global regimes, such as the global environmental regime.
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20
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Wilcox BA, Aguirre AA, De Paula N, Siriaroonrat B, Echaubard P. Operationalizing One Health Employing Social-Ecological Systems Theory: Lessons From the Greater Mekong Sub-region. Front Public Health 2019; 7:85. [PMID: 31192179 PMCID: PMC6547168 DOI: 10.3389/fpubh.2019.00085] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/26/2019] [Indexed: 12/15/2022] Open
Abstract
The idea of the interdependency of the health of humans, animals, and ecosystems emerged from the interplay of theory and concepts from medicine, public health and ecology among leading thinkers in these fields during the last century. The rationale for One Health and its focus on the “human, animal, and environmental interface” stems from this legacy and points to transdisciplinary, ecological and complex systems approaches as central to One Health practice. Demonstration of One Health's efficacy, its wider adoption and continual improvement require explicit operational criteria and evaluation metrics on this basis. Social-Ecological Systems Theory with its unique conception of resilience (SESR) currently offers the most well-developed framework for understanding these approaches and development of performance standards. This paper describes operational criteria for One Health developed accordingly, including a protocol currently being tested for vector borne disease interventions. Wider adoption of One Health is most likely to occur as One Health practitioners gain an increasing familiarity with ecological and complex systems concepts in practice employing a transdisciplinary process. Two areas in which this inevitably will be required for significant further progress, and where the beginnings of a foundation for building upon exist, include: (1) Emerging and re-emerging zoonotic diseases, and (2) successful implementation of the United Nations (UN) Sustainable Development Goals (SDGs). The former includes the challenge of stemming the threat of new microbial pathogens, anti-microbial resistant variants of existing pathogens, as well as resurgence of malaria and other recalcitrant diseases. The applicability of SESR in this regard is illustrated with two case examples from the Greater Mekong Subregion, Avian Influenza (H5N1) and Liver Fluke (Opisthorchis viverrini). Each is shown to represent a science and policy challenge suggestive of an avoidable social-ecological system pathology that similarly has challenged sustainable development. Thus, SESR framing arguably is highly applicable to the SDGs, which, to a large extent, require consideration of human-animal-environmental health linkages. Further elaboration of these One Health operational criteria and metrics could contribute to the achievement of many of the SDGs.
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Affiliation(s)
- Bruce A Wilcox
- ASEAN Institute for Health Development, Mahidol University, Nakon Pathom, Thailand
| | - A Alonso Aguirre
- Department of Environmental Science and Policy, George Mason University, Fairfax, VA, United States
| | | | - Boripat Siriaroonrat
- Department of Research and Conservation, Zoological Park Organization of Thailand, Bangkok, Thailand
| | - Pierre Echaubard
- ASEAN Institute for Health Development, Mahidol University, Nakon Pathom, Thailand
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Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393:791-846. [PMID: 30700377 DOI: 10.1016/s0140-6736(18)32822-8] [Citation(s) in RCA: 1206] [Impact Index Per Article: 241.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/10/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia.
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Steven Allender
- Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Phillip I Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Jessica R Bogard
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | | | | | - Olivier De Schutter
- Institute for Interdisciplinary Research in Legal Sciences, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Raji Devarajan
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Shifalika Goenka
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Ross A Hammond
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA; Public Health & Social Policy Department, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Corinna Hawkes
- Centre for Food Policy, City University, University of London, London, UK
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Peter S Hovmand
- Social System Design Lab, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Mark Howden
- Climate Change Institute, Australian National University, Canberra, ACT, Australia
| | - Lindsay M Jaacks
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariadne B Kapetanaki
- Department of Marketing and Enterprise, Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Matt Kasman
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA
| | - Harriet V Kuhnlein
- Centre for Indigenous Peoples' Nutrition and Environment, McGill University, Montreal, QC, Canada
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Michael W Long
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Victor K R Matsudo
- Physical Fitness Research Laboratory of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
| | - Susanna D H Mills
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alexandra Morshed
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA
| | | | - An Pan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Meera Shekar
- Health, Nutrition, and Population Global Practice, The World Bank, Washington, DC, USA
| | | | - Warren Smit
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - Ali Tootee
- Diabetes Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Stefanie Vandevijvere
- School of Population Health, University of Auckland, Auckland, New Zealand; Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Wilma E Waterlander
- Department of Public Health Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - William H Dietz
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Reddy SK, Mazhar S, Lencucha R. The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals. Global Health 2018; 14:119. [PMID: 30486890 PMCID: PMC6264055 DOI: 10.1186/s12992-018-0436-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.
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Affiliation(s)
- Srikanth K. Reddy
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
| | - Sumaira Mazhar
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
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Clesse C, Lighezzolo-Alnot J, Dumand I, Salime S, Savini C, Decker M. Globalisation des politiques de santé et psychiatrie française : enjeux et impacts. EVOLUTION PSYCHIATRIQUE 2018. [DOI: 10.1016/j.evopsy.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Background The lack of primary healthcare integration has been identified as one of the main limits to programs’ efficacy in low- and middle-income countries. This is especially relevant to the Millennium Development Goals, whose health objectives were not attained in many countries at their term in 2015. While global health scholars and decision-makers are unanimous in calling for integration, the objective here is to go further and contribute to its promotion by presenting two of the most important challenges to be met for its achievement: 1) developing a “crosswise approach” to implementation that is operational and effective; and 2) creating synergy between national programs and interventions driven by non-State actors. Main body The argument for urgently addressing this double challenge is illustrated by drawing on observations made and lessons learned during a four-year research project (2011–2014) evaluating the effects of interventions against malaria in Burkina Faso. The way interventions were framed was mostly vertical, leaving little room for local adaptation. In addition, many non-governmental organizations intervened and contributed to a fragmented and heteronomous health governance system. Important ethical issues stem from how interventions against malaria were shaped and implemented in Burkina Faso. To further explore this issue, a scoping literature review was conducted in August 2016 on the theme of integrated primary healthcare. It revealed that no clear definition of the concept has been advanced or endorsed thus far. We call for caution in conceptualizing it as a simple juxtaposition of different tasks or missions at the primary care level. It is time to go beyond the debate around selective versus comprehensive approaches or fragmentation versus cohesion. Integration should be thought of as a process to reconcile these tensions. Conclusions In the context that characterizes many low- and middle-income countries today, better aid coordination and public health systems strengthening, as promoted by multisectoral approaches, might be among the best options to sustainably and ethically integrate primary healthcare interventions.
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Affiliation(s)
- Thomas Druetz
- Department of Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA, USA.
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Lencucha R, Dubé L, Blouin C, Hennis A, Pardon M, Drager N. Fostering the Catalyst Role of Government in Advancing Healthy Food Environments. Int J Health Policy Manag 2018; 7:485-490. [PMID: 29935125 PMCID: PMC6015513 DOI: 10.15171/ijhpm.2018.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/29/2018] [Indexed: 01/20/2023] Open
Abstract
Effective approaches to non-communicable disease (NCD) prevention require intersectoral action targeting health and engaging government, industry, and society. There is an ongoing vigorous exploration of the most effective and appropriate role of government in intersectoral partnerships. This debate is particularly pronounced with regards to the role of government in controlling unhealthy foods and promoting healthy food environments. Given that food environments are a key determinant of health, and the commercial sector is a key player in shaping such environments (eg, restaurants, grocery stores), the relationship between government and the commercial sector is of primary relevance. The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. We propose that a clear distinction between the regulatory and catalyst roles of government is necessary when considering the nature of the relationship between government and the commercial food sector. We introduce a typology of three catalyst roles for government to foster healthy food environments with the commercial sector and suggest that a richer understanding of the contrasting roles of government is needed when considering approaches NCD prevention via healthy food environments.
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Affiliation(s)
- Raphael Lencucha
- School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Laurette Dubé
- McGill Centre for the Convergence for Health and Economics, McGill University, Montréal, QC, Canada
| | | | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Horvat A, Filipovic J. Service quality and maturity of health care organizations through the lens of Complexity Leadership Theory. J Eval Clin Pract 2018; 24:301-307. [PMID: 28714561 DOI: 10.1111/jep.12789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This research focuses on Complexity Leadership Theory and the relationship between leadership-examined through the lens of Complexity Leadership Theory-and organizational maturity as an indicator of the performance of health organizations. METHODS The research adopts a perspective that conceptualizes organizations as complex adaptive systems and draws upon a survey of opinion of 189 managers working in Serbian health organizations. RESULTS AND CONCLUSIONS As the results indicate a dependency between functions of leadership and levels of the maturity of health organizations, we propose a model that connects the two. The study broadens our understanding of the implications of complexity thinking and its reflection on leadership functions and overall organizational performance. The correlations between leadership functions and maturity could have practical applications in policy processing, thus improving the quality of outcomes and the overall level of service quality.
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Affiliation(s)
- Ana Horvat
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
| | - Jovan Filipovic
- University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia
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Tosun J. Polycentrism in Global Health Governance Scholarship Comment on "Four Challenges That Global Health Networks Face". Int J Health Policy Manag 2018; 7:78-80. [PMID: 29325406 PMCID: PMC5745871 DOI: 10.15171/ijhpm.2017.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/17/2017] [Indexed: 12/02/2022] Open
Abstract
Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors.
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Affiliation(s)
- Jale Tosun
- Institute of Political Science, Heidelberg University, Heidelberg, Germany
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Bennett B, Cohen IG, Davies SE, Gostin LO, Hill PS, Mankad A, Phelan AL. Future-proofing global health: Governance of priorities. Glob Public Health 2017; 13:519-527. [PMID: 28271746 DOI: 10.1080/17441692.2017.1296172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.
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Affiliation(s)
- Belinda Bennett
- a Australian Centre for Health Law Research , Queensland University of Technology , Brisbane , Australia
| | - I Glenn Cohen
- b Petrie Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School , Harvard University , Cambridge , MA , USA
| | - Sara E Davies
- c Centre for Governance and Public Policy , Griffith University , Brisbane , Australia
| | - Lawrence O Gostin
- d O'Neill Institute for National and Global Health Law, Georgetown University , Washington , DC , USA
| | - Peter S Hill
- e School of Public Health , University of Queensland , Brisbane , Australia
| | | | - Alexandra L Phelan
- d O'Neill Institute for National and Global Health Law, Georgetown University , Washington , DC , USA
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Jones CM, Clavier C, Potvin L. Adapting public policy theory for public health research: A framework to understand the development of national policies on global health. Soc Sci Med 2017; 177:69-77. [DOI: 10.1016/j.socscimed.2017.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/04/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
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Van de Pas R, Hill PS, Hammonds R, Ooms G, Forman L, Waris A, Brolan CE, McKee M, Sridhar D. Global health governance in the sustainable development goals: Is it grounded in the right to health? GLOBAL CHALLENGES (HOBOKEN, NJ) 2017; 1:47-60. [PMID: 28616255 PMCID: PMC5445596 DOI: 10.1002/gch2.1022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 06/02/2023]
Abstract
This paper explores the extent to which global health governance - in the context of the early implementation of the Sustainable Development Goals is grounded in the right to health. The essential components of the right to health in relation to global health are unpacked. Four essential functions of the global health system are assessed from a normative, rights-based, analysis on how each of these governance functions should operate. These essential functions are: the production of global public goods, the management of externalities across countries, the mobilization of global solidarity, and stewardship. The paper maps the current reality of global health governance now that the post-2015 Sustainable Development Goals are beginning to be implemented. In theory, the existing human rights legislation would enable the principles and basis for the global governance of health beyond the premise of the state. In practice, there is a governance gap between the human rights framework and practices in global health and development policies. This gap can be explained by the political determinants of health that shape the governance of these global policies. Current representations of the right to health in the Sustainable Development Goals are insufficient and superficial, because they do not explicitly link commitments or right to health discourse to binding treaty obligations for duty-bearing nation states or entitlements by people. If global health policy is to meaningfully contribute to the realization of the right to health and to rights based global health governance then future iterations of global health policy must bridge this gap. This includes scholarship and policy debate on the structure, politics, and agency to overcome existing global health injustices.
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Affiliation(s)
- Remco Van de Pas
- Department of Public HealthInstitute of Tropical Medicine, AntwerpAntwerpen2000Belgium
- Clingendael InstituteThe HagueDen Haag2509 ABThe Netherlands
| | - Peter S. Hill
- School of Public HealthUniversity of QueenslandBrisbane4072QueenslandAustralia
| | - Rachel Hammonds
- Faculty of Law, Law and Development Research GroupUniversity of AntwerpAntwerpen2000Belgium
| | - Gorik Ooms
- Heidelberg University HospitalInstitute of Public HealthHeidelbergBaden‐Württemberg69120Germany
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lisa Forman
- University of TorontoDalla Lana School of Public HealthTorontoOntarioM5T3M7Canada
| | | | - Claire E. Brolan
- School of Public HealthUniversity of QueenslandBrisbane4072QueenslandAustralia
- University of TorontoDalla Lana School of Public HealthTorontoOntarioM5T3M7Canada
| | - Martin McKee
- London School of Hygiene and Tropical MedicineLondonUK
| | - Devi Sridhar
- University of EdinburghCentre for Global Health ResearchEdinburghEH8 9YLUK
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Modisenyane SM, Hendricks SJH, Fineberg H. Understanding how domestic health policy is integrated into foreign policy in South Africa: a case for accelerating access to antiretroviral medicines. Glob Health Action 2017; 10:1339533. [PMID: 28685669 PMCID: PMC5533135 DOI: 10.1080/16549716.2017.1339533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/21/2017] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy (GHD). However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study seeks to address this knowledge gap. It takes the form of an empirical case study which analyses how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines. OBJECTIVE To explore state and non-state actors' perceptions regarding how domestic health policy is integrated into foreign policy. The ultimate goal of this study was to achieve better insights into the health and foreign policy processes at the national level. METHODS Employing qualitative approaches, we examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. This content was coded, and the codes were collated into tentative categories and sub-categories using Atlas.ti v.7 software. RESULTS The findings of this work illustrate the interplay among social, political, economic and institutional conditions in determining the success of this integration process. Our study shows that a series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa's domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilization of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right. CONCLUSIONS Transnational networks may influence government's decision making by providing information and moving issues up the agenda.
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Affiliation(s)
- Simon Moeketsi Modisenyane
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | | | - Harvey Fineberg
- President of Gordon and Betty Moore Foundation, Palo Alto, CA, USA
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Ooms G, Hammonds R. Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies. Global Health 2016; 12:84. [PMID: 27914471 PMCID: PMC5135750 DOI: 10.1186/s12992-016-0216-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 11/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. Analysis This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. Discussion Leading global health institutions are structurally skewed to preserve high incomes countries’ disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. Conclusion A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power.
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Affiliation(s)
- Gorik Ooms
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Rachel Hammonds
- Law and Development Research Group, Faculty of Law, University of Antwerp, Venusstraat 23, 2000, Antwerpen, Belgium
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Shaping the midwifery profession in Nepal – Uncovering actors' connections using a Complex Adaptive Systems framework. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 10:48-55. [DOI: 10.1016/j.srhc.2016.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
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Bogren MU, Wigert H, Edgren L, Berg M. Towards a midwifery profession in Bangladesh--a systems approach for a complex world. BMC Pregnancy Childbirth 2015; 15:325. [PMID: 26634695 PMCID: PMC4669606 DOI: 10.1186/s12884-015-0740-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background The midwifery profession is crucial for a functioning health system aiming at improved maternal and child health outcomes. Complex Adaptive Systems (CAS) can be used as a tool to understand actors’ interactions in the system around midwifery profession for improved maternal and child health. The purpose of this study is to explore how actors connect to promote the Bangladesh’s midwifery profession. Methods An explorative study based on the framework of CAS was performed. Data were collected through semi-structured interviews with 16 key persons representing nine different organisations promoting the establishment of the midwifery profession. Qualitative analysis was used. Results Findings show that the actors were intertwined and driving towards a common goal; to save lives through education and deployment of 3000 midwives. The unique knowledge contributions of everyone involved were giving the system strength and power to perform. Collaboration was seen as more could be achieved compared to what an individual organisation could do. Significant results of this were that two midwifery curricula and faculty development had been produced. Although collaboration was mostly seen as something positive to move the system forward, the approach to reach the set goal varied with different interests, priorities and concerns, both on individual organisational level as well as at system level. Frequent struggles of individual philosophies versus organisational mandates were seen as competing interests for advancing the national priorities. It would appear that newcomers with innovative ideas were denied access on the same terms as other actors. Conclusions This study illustrates that CAS thinking can be used as a metaphor to understand how to adapt more emergent ways of working instead of the traditional planned approaches to change and develop in order to deal better with a more complex world. Through examining how actors connect for establishing a midwifery profession, offers insights of shared interests towards stepping up efforts for a competent midwifery profession in Bangladesh and elsewhere. Good relationships, where everyone’s expertise and innovations, are used to the full, are crucial for establishing a strong midwifery profession and thus improved maternal and child health.
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Affiliation(s)
- Malin Upper Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden.
| | - Helena Wigert
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Lars Edgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, S-405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
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Amaya AB, Rollet V, Kingah S. What's in a word? The framing of health at the regional level: ASEAN, EU, SADC and UNASUR. GLOBAL SOCIAL POLICY 2015; 15:229-260. [PMID: 26635496 PMCID: PMC4639831 DOI: 10.1177/1468018115599816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Association of Southeast Asian Nations, the European Union, the Southern African Development Community and the Union of South American Nations have increasingly been involved in health diplomacy in the past decade, yet little is known about how they frame health as a foreign policy issue and how this has an impact on their prioritisation of policies. For this, we conducted a review of existing grey and peer-reviewed literature that address regional integration and health, as well as a documentary review according to security, development, trade, human rights, moral/ethical reasonings and global public goods frames identified in the literature. The policy frames identified responded to the challenges these regions currently face. The Association of Southeast Asian Nation's struggle with re-emerging diseases has led to favouring a securitisation approach to health, the European Union approaches health as a cross-cutting policy issue, the Southern African Development Community presents health as a driver for development, and while the Union of South American Nations emphasises health as a human right and addresses the social determinants of health as an ethical imperative. Overall, these policy frames were useful in analysing the framing of health in foreign policy at the regional level. However, within our analysis, we identified a new frame that approaches health as an intersectoral issue. The impact of regional organisations' forward will depend on their ability to harness their convening power and speak in a coherent voice on health matters.
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Affiliation(s)
- Ana B Amaya
- United Nations University Institute on
Comparative Regional Integration Studies, Belgium
| | - Vincent Rollet
- Wenzao Ursuline University/French Center for
Research on Contemporary China (CEFC), Taiwan
| | - Stephen Kingah
- United Nations University Institute on
Comparative Regional Integration Studies, Belgium
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Brolan CE, Hill PS. Universal Health Coverage's evolving location in the post-2015 development agenda: Key informant perspectives within multilateral and related agencies during the first phase of post-2015 negotiations. Health Policy Plan 2015; 31:514-26. [PMID: 26494847 PMCID: PMC4986244 DOI: 10.1093/heapol/czv101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 01/09/2023] Open
Abstract
In 2001, technocrats from four multilateral organizations selected the Millennium Development Goals mainly from the previous decade of United Nations (UN) summits and conferences. Few accounts are available of that significant yet cloistered synthesis process: none contemporaneous. In contrast, this study examines health's evolving location in the first-phase of the next iteration of global development goal negotiation for the post-2015 era, through the synchronous perspectives of representatives of key multilateral and related organizations. As part of the Go4Health Project, in-depth interviews were conducted in mid-2013 with 57 professionals working on health and the post-2015 agenda within multilaterals and related agencies. Using discourse analysis, this article reports the results and analysis of a Universal Health Coverage (UHC) theme: contextualizing UHC's positioning within the post-2015 agenda-setting process immediately after the Global Thematic Consultation on Health and High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (High-Level Panel) released their post-2015 health and development goal aspirations in April and May 2013, respectively. After the findings from the interview data analysis are presented, the Results will be discussed drawing on Shiffman and Smith (Generation of political priority for global health initiatives: a framework and case study of maternal mortality.The Lancet2007; 370: : 1370-79) agenda-setting analytical framework (examining ideas, issues, actors and political context), modified by Benzianet al.(2011). Although more participants support the High-Level Panel's May 2013 report's proposal-'Ensure Healthy Lives'-as the next umbrella health goal, they nevertheless still emphasize the need for UHC to achieve this and thus be incorporated as part of its trajectory. Despite UHC's conceptual ambiguity and cursory mention in the High-Level Panel report, its proponents suggest its re-emergence will occur in forthcoming State led post-2015 negotiations. However, the final post-2015 SDG framework for UN General Assembly endorsement in September 2015 confirms UHC's continued distillation in negotiations, as UHC ultimately became one of a litany of targets within the proposed global health goal.
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Affiliation(s)
- Claire E Brolan
- School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
| | - Peter S Hill
- School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
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Lockard DW. A framework for evaluating global policy on sustainability. JOURNAL OF GLOBAL RESPONSIBILITY 2015. [DOI: 10.1108/jgr-06-2015-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this study is to evaluate whether the global policy on sustainability, United Nations Global Compact (UNGC), is in alignment with the complexity of the sustainability landscape utilizing complex adaptive system (CAS) theory and theory of change.
Design/methodology/approach
– An original Complex Adaptive Policy System (CAPS) framework is used as a qualitative instrument with a constant comparison of 11 CAS themes in analyzing 117 UNGC speeches listed on the Global Compact Web site.
Findings
– Although this study is intended as a preliminary study, the findings raise important questions regarding the long-term impact of the Global Compact as a global policy on sustainability.
Research limitations/implications
– The limitations of the study include the preliminary study design and limited source of information. Future research should include a comprehensive evaluation of the UNGC to yield specific recommendations for aligning policy with the landscape.
Originality/value
– The study offers an original systems framework to evaluate public and private organizational polices on sustainability.
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Edgren L, Barnard K. Achieving integrated care through CAS thinking and a collaborative mindset. JOURNAL OF INTEGRATED CARE 2015. [DOI: 10.1108/jica-02-2015-0012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose
– The purpose of this paper is to contribute to knowledge by exploring and distilling how providers in health and social care who have adopted complex adaptive systems thinking (CAS thinking) and have a collaborative mindset are in a better position to achieve integrated care than those who adopt reductionist approaches.
Design/methodology/approach
– This paper is a research review and a conceptual analysis of key aspects drawn from the literature on CAS thinking and collaborative mindset applied to integrated care. By choosing this approach the authors intend to promote understanding and efforts made to put it into action. The intended audience comprises managers responsible for addressing the problem of fragmentation and the research community challenged by the task of supporting those managers.
Findings
– Specialization of knowledge and skill has increased the risk of fragmentation. It is possible to reduce that risk and hence to foster integrated care when providers with different specializations stimulated by a collaborative mindset develop an understanding of how they connect with others in a CAS. The essence of CAS thinking applied to integrated care is the readiness to connect. This readiness is facilitated by adopting a collaborative mindset.
Originality/value
– Literature on CAS thinking and collaborative mindset have evolved independently of one another. The study points at the importance of connecting the two concepts to produce effective action.
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Dao A, Nichter M. The Social Life of Health Insurance in Low- to Middle-income Countries: An Anthropological Research Agenda. Med Anthropol Q 2015; 30:122-43. [DOI: 10.1111/maq.12191] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Amy Dao
- Department of Sociomedical Sciences; Columbia University
| | - Mark Nichter
- School of Anthropology; University of Arizona; Tucson
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Menon P, Covic NM, Harrigan PB, Horton SE, Kazi NM, Lamstein S, Neufeld L, Oakley E, Pelletier D. Strengthening implementation and utilization of nutrition interventions through research: a framework and research agenda. Ann N Y Acad Sci 2014; 1332:39-59. [PMID: 24934307 DOI: 10.1111/nyas.12447] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Undernutrition among women and children contributes to almost half the global burden of child mortality in developing countries. The impact of nutrition on economic development has highlighted the need for evidence-based solutions and yielded substantial global momentum. However, it is now recognized that the impact of evidence-based interventions is limited by the lack of evidence on the best operational strategies for scaling up nutrition interventions. With the goal of encouraging greater engagement in implementation research in nutrition and generating evidence on implementation and utilization of nutrition interventions, this paper brings together a framework and a broad analysis of literature to frame and highlight the crucial importance of research on the delivery and utilization of nutrition interventions. The paper draws on the deliberations of a high-level working group, an e-consultation, a conference, and the published literature. It proposes a framework and areas of research that have been quite neglected, and yet are critical to better understanding through careful research to enable better translation of global and national political momentum for nutrition into public health impact.
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Affiliation(s)
- Purnima Menon
- International Food Policy Research Institute, New Delhi, India
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Brolan CE, Lee S, Kim D, Hill PS. Back to the future: what would the post-2015 global development goals look like if we replicated methods used to construct the Millennium Development Goals? Global Health 2014; 10:19. [PMID: 24708796 PMCID: PMC4008441 DOI: 10.1186/1744-8603-10-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Millennium Development Goals (MDGs) were 'top-down' goals formulated by policy elites drawing from targets within United Nations (UN) summits and conferences in the 1990s. Contemporary processes shaping the new post-2015 development agenda are more collaborative and participatory, markedly different to the pre-MDG era. This study examines what would the outcome be if a methodology similar to that used for the MDGs were applied to the formulation of the post-2015 development goals (Post-2015DGs), identifying those targets arising from UN summits and conferences since the declaration of the MDGs, and aggregating them into goals. METHODS The UN Department of Economic and Social Affairs (DESA) list of major UN summits and conferences from 2001 to 2012 was utilised to examine targets. The DESA list was chosen due to the agency's core mission to promote development for all. Targets meeting MDG criteria of clarity, conciseness and measurability were selected and clustered into broad goals based on processes outlined by Hulme and Vandemoortele. The Post-2015DGs that were identified were formatted into language congruent with the MDGs to assist in the comparative analysis, and then further compared to the 12 illustrative goals offered by the UN High-Level Panel of Eminent Persons on the Post-2015 Development (High-Level Panel) Agenda's May 2013 report. RESULTS Ten Post-2015DGs were identified. Six goals expressly overlapped with the current MDGs and four new goals were identified. Health featured prominently in the MDG agenda, and continues to feature strongly in four of the 10 Post-2015DGs. However the Post-2015DGs reposition health within umbrella agendas relating to women, children and the ageing. Six of the 10 Post-2015DGs incorporate the right to health agenda, emphasising both the standing and interconnection of the health agenda in DESA's summits and conferences under review. Two Post-2015DGs have been extended into six separate goals by the High-Level Panel, and it is these goals that are clearly linked to sustainable development diaspora. CONCLUSIONS This study exposes the evolving political agendas underplaying the current post-2015 process, as targets from DESA's 22 major UN summits and conferences from 2001 to 2012 are not wholly mirrored in the HLP's 12 goals.
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Affiliation(s)
- Claire E Brolan
- School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
| | - Scott Lee
- School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
| | - David Kim
- School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
| | - Peter S Hill
- School of Population Health, The University of Queensland, Herston Road, Herston, Brisbane, Queensland 4006, Australia
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Watt NF, Gomez EJ, McKee M. Global health in foreign policy--and foreign policy in health? Evidence from the BRICS. Health Policy Plan 2013; 29:763-73. [DOI: 10.1093/heapol/czt063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hill PS, Goeman L, Sofiarini R, Djara MM. 'Desa SIAGA', the 'Alert Village': the evolution of an iconic brand in Indonesian public health strategies. Health Policy Plan 2013; 29:409-20. [PMID: 23650333 DOI: 10.1093/heapol/czt027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 1999, the Ministry of Women's Empowerment in Indonesia worked with advertisers in Jakarta and international technical advisors to develop the concept of 'Suami SIAGA', the 'Alert Husband', confronting Indonesian males with their responsibilities to be aware of their wives' needs and ensure early access if needed to trained obstetrics care. The model was rapidly expanded to apply to the 'Desa SIAGA', the 'Alert Village', with communities assuming the responsibility for awareness of the risks of pregnancy and childbirth, and supporting registered pregnant mothers with funding and transportation for emergency obstetric assistance, and identified blood donors. Based on the participant observation, interviews and documentary analysis, this article uses a systems perspective to trace the evolution of that iconic 'brand' as new national and international actors further developed the concept and its application in provincial and national programmes. In 2010, it underwent a further transformation to become 'Desa Siaga Aktif', a national programme with responsibilities expanded to include the provision of basic health services at village level, and the surveillance of communicable disease, monitoring of lifestyle activities and disaster preparedness, in addition to the management of obstetric emergencies. By tracking the use of this single 'brand', the study provides insights into the complex adaptive system of policy and programme development with its rich interactions between multiple international, national, provincial and sectoral stakeholders, the unpredictable responses to feedback from these actors and their activities and the resultant emergence of new policy elements, new programmes and new levels of operation within the system.
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Affiliation(s)
- Peter S Hill
- Australian Centre for International and Tropical Health, The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia
| | - Lieve Goeman
- Australian Centre for International and Tropical Health, The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia
| | - Rahmi Sofiarini
- Australian Centre for International and Tropical Health, The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH, Mataram 83121, IndonesiaAustralian Centre for International and Tropical Health, The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia
| | - Maddi M Djara
- Australian Centre for International and Tropical Health, The University of Queensland, Herston Road, Herston, 4006 Queensland, Australia, Sector and Thematic Expertise, Belgian Development Agency, Hoogstraat 147, 1000 Brussels, Belgium, USAID-IMACS Project Chemonics International, Jl. Bung Hatta No. 19, Mataram 83121, Indonesia and Consolidation Programme Health/Policy Analysis and Formulation in the Health Sector (PAF), Deutsche Gesellschaft für International Zusammenarbeit (GIZ) GmbH, Mataram 83121, Indonesia
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Ager A. Annual Research Review: Resilience and child well-being--public policy implications. J Child Psychol Psychiatry 2013; 54:488-500. [PMID: 23240912 DOI: 10.1111/jcpp.12030] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND There has been an 8-fold increase in use of the term resilience within scientific and scholar literature over the last twenty years. The arena of public policy has also seen increasing use made of the concept, both with respect to child well-being and development and wider issues. METHOD A focal sample of literature comprising 108 papers addressing public policy implications of work on child resilience was identified by a structured bibliographic search. RESULTS This literature suggests that current work: is characterized by a breadth of sectoral engagement across the fields of education, social work, and health; demonstrates diversity with regard to the systemic levels--individual (biological and psychological), communal (including systems of faith and cultural identity), institutional and societal--with which it engages; but is based more upon conceptual rather than empirical analysis. Major themes of policy recommendation target strengthened family dynamics, increased capacity for counseling and mental health services, supportive school environments, development of community programs, promotion of socioeconomic improvement and adoption of a more comprehensive conception of resilience. Evaluations of resiliency-informed policy initiatives are limited in number, with greatest rigor in design associated with more discrete programmatic interventions. CONCLUSION A number of strategies to strengthen research-policy linkages are identified. These include greater commitment to operationalize indicators of resilience at all levels of analysis; more coherent engagement with the policy making process through explicit knowledge translation initiatives; and developing complex adaptive systems models amenable to exploring policy scenarios.
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Affiliation(s)
- Alastair Ager
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Rani M, Nusrat S, Hawken LH. A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options. BMC Public Health 2012; 12:877. [PMID: 23067232 PMCID: PMC3487912 DOI: 10.1186/1471-2458-12-877] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 08/29/2012] [Indexed: 11/17/2022] Open
Abstract
Background Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Methods Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Results Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms. Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. Conclusions The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH. The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs.
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Affiliation(s)
- Manju Rani
- Western Pacific Regional Office, World Health Organization, Manila, Philippines.
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Kruk ME. Globalisation and global health governance: Implications for public health. Glob Public Health 2012; 7 Suppl 1:S54-62. [DOI: 10.1080/17441692.2012.689313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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Hill PS, Dodd R, Brown S, Haffeld J. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment. Global Health 2012; 8:5. [PMID: 22420459 PMCID: PMC3338403 DOI: 10.1186/1744-8603-8-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/15/2012] [Indexed: 12/03/2022] Open
Abstract
The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain.
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Affiliation(s)
- Peter S Hill
- Australian Centre for International and Tropical Health, The University Of Queensland, Herston Road Herston, 4006 Queensland, Australia.
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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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