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Keshri VR, Jagnoor J, Peden M, Norton R, Abimbola S. Why does a public health issue (not) get priority? Agenda setting for the national burns programme in India. Health Policy Plan 2024; 39:457-468. [PMID: 38511492 PMCID: PMC11095263 DOI: 10.1093/heapol/czae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, India
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, India
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Margie Peden
- The George Institute for Global Health, London, United Kingdom
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, United Kingdom
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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2
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Hemingway CD, Bella Jalloh M, Silumbe R, Wurie H, Mtumbuka E, Nhiga S, Lusasi A, Pulford J. Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone. BMJ Glob Health 2021; 6:bmjgh-2021-006615. [PMID: 34615662 PMCID: PMC8496380 DOI: 10.1136/bmjgh-2021-006615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Disease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results. Methods A qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach. Results 51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation. Conclusion Health systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible.
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Affiliation(s)
| | - Mohamed Bella Jalloh
- University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard Silumbe
- Malaria Program, Clinton Health Access Initiative, Freetown, Sierra Leone
| | - Haja Wurie
- University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | | | - Samuel Nhiga
- National Malaria Control Program, Dodoma, Tanzania, United Republic of
| | - Abdallah Lusasi
- National Malaria Control Program, Dodoma, Tanzania, United Republic of
| | - Justin Pulford
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Regan L, Wilson D, Chalkidou K, Chi YL. The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review. BMJ Glob Health 2021; 6:bmjgh-2021-005842. [PMID: 34344664 PMCID: PMC8336212 DOI: 10.1136/bmjgh-2021-005842] [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: 03/26/2021] [Accepted: 07/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background Countries are recommended to progressively work towards universal health coverage (UHC), and to make explicit choices regarding the expansion of priority services. However, there is little guidance on how to manage the inclusion of vertical programmes, funded by external partners, in health benefits packages (HBP) in low and middle-income countries (LMICs). Objective We conducted a scoping review to map the inclusion of six vertical programmes (HIV, tuberculosis, malaria, maternal and child health, contraceptives, immunisation) in 26 LMICs. Methods We identified 26 LMICs with an HBP that was not aspirational (eg, with evidence of implementation or funding). For each HBP, we collected information on the corresponding UHC scheme, health financing at the time of establishment, revisions since inception and entitlements. For each vertical programme, we developed a list of tracer interventions based on the Disease Control Priorities 3 and the 100 Core Health Indicators List. We then used this list of tracer interventions to map the coverage of the six vertical programmes. Results The review shows that there is no common starting point for countries embarking into UHC. Some HBPs were almost three decades old. Whole package revisions are rare. The inclusion of vertical programme does not follow a given pattern based on health financing indicators or country’s income group. Maternal child health services are the most often included and family planning the least. Six countries in our sample covered all vertical programmes, while one covered only one of six. Conclusions This review has shown that there has been a long history of countries facing this question and we have provided the first mapping of inclusion of vertical programmes in UHC. The results of the mapping can inform decisions in countries embarking in UHC.
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Affiliation(s)
- Lydia Regan
- Global Health, Center for Global Development, London, UK
| | - David Wilson
- Decision Sciences, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Kalipso Chalkidou
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Y-Ling Chi
- Global Health, Center for Global Development, London, UK
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Rahi M, Chaturvedi R, Das P, Sharma A. India can consider integration of three eliminable disease control programmes on malaria, lymphatic filariasis, and visceral leishmaniasis. PLoS Pathog 2021; 17:e1009492. [PMID: 34015028 PMCID: PMC8136677 DOI: 10.1371/journal.ppat.1009492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
| | - Rini Chaturvedi
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Payal Das
- Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India.,ICMR-National Institute of Malaria Research, New Delhi, India
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Uganda's "EID Systems Strengthening" model produces significant gains in testing, linkage, and retention of HIV-exposed and infected infants: An impact evaluation. PLoS One 2021; 16:e0246546. [PMID: 33539425 PMCID: PMC7861549 DOI: 10.1371/journal.pone.0246546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction A review of Uganda’s HIV Early Infant Diagnosis (EID) program in 2010 revealed poor retention outcomes for HIV-exposed infants (HEI) after testing. The review informed development of the ‘EID Systems Strengthening’ model: a set of integrated initiatives at health facilities to improve testing, retention, and clinical care of HIV-exposed and infected infants. The program model was piloted at several facilities and later scaled countrywide. This mixed-methods study evaluates the program’s impact and assesses its implementation. Methods We conducted a retrospective cohort study at 12 health facilities in Uganda, comprising all HEI tested by DNA PCR from June 2011 to May 2014 (n = 707). Cohort data were collected manually at the health facilities and analyzed. To assess impact, retention outcomes were statistically compared to the baseline study’s cohort outcomes. We conducted a cross-sectional qualitative assessment of program implementation through 1) structured clinic observation and 2) key informant interviews with health workers, district officials, NGO technical managers, and EID trainers (n = 51). Results The evaluation cohort comprised 707 HEI (67 HIV+). The baseline study cohort contained 1268 HEI (244 HIV+). Among infants testing HIV+, retention in care at an ART clinic increased from 23% (57/244) to 66% (44/67) (p < .0001). Initiation of HIV+ infants on ART increased from 36% (27/75) to 92% (46/50) (p < .0001). HEI receiving 1st PCR results increased from 57% (718/1268) to 73% (518/707) (p < .0001). Among breastfeeding HEI with negative 1st PCR, 55% (192/352) received a confirmatory PCR test, a substantial increase from baseline period. Testing coverage improved significantly: HIV+ pregnant women who brought their infants for testing after birth increased from 18% (67/367) to 52% (175/334) (p < .0001). HEI were tested younger: mean age at DBS test decreased from 6.96 to 4.21 months (p < .0001). Clinical care for HEI was provided more consistently. Implementation fidelity was strong for most program components. The strongest contributory interventions were establishment of ‘EID Care Points’, integration of clinical care, longitudinal patient tracking, and regular health worker mentorship. Gaps included limited follow up of lost infants, inconsistent buy-in/ownership of health facility management, and challenges sustaining health worker motivation. Discussion Uganda’s ‘EID Systems Strengthening’ model has produced significant gains in testing and retention of HEI and HIV+ infants, yet the country still faces major challenges. The 3 core concepts of Uganda’s model are applicable to any country: establish a central service point for HEI, equip it to provide high-quality care and tracking, and develop systems to link HEI to the service point. Uganda’s experience has shown the importance of intensively targeting systemic bottlenecks to HEI retention at facility level, a necessary complement to deploying rapidly scalable technologies and other higher-level initiatives.
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Vijay S, Gangakhedkar RR, Shekhar C, Walia K. Introducing a national essential diagnostics list in India. Bull World Health Organ 2020; 99:236-238. [PMID: 33716346 PMCID: PMC7941112 DOI: 10.2471/blt.20.268037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansarinagar, New Delhi, 110029, India
| | - Raman R Gangakhedkar
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansarinagar, New Delhi, 110029, India
| | - Chander Shekhar
- Division of Innovation and Translational Research, Indian Council of Medical Research, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansarinagar, New Delhi, 110029, India
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7
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Al-Shakarchi NJ, Evans H, Luchenski SA, Story A, Banerjee A. Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies. Heart 2020; 106:1483-1488. [PMID: 32665359 PMCID: PMC7509384 DOI: 10.1136/heartjnl-2020-316706] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify: (i) risk of cardiovascular disease (CVD) in homeless versus housed individuals and (ii) interventions for CVD in homeless populations. METHODS We conducted a systematic literature review in EMBASE until December 2018 using a search strategy for observational and interventional studies without restriction regarding languages or countries. Meta-analyses were conducted, where appropriate and possible. Outcome measures were all-cause and CVD mortality, and morbidity. RESULTS Our search identified 17 articles (6 case-control, 11 cohort) concerning risk of CVD and none regarding specific interventions. Nine were included to perform a meta-analysis. The majority (13/17, 76.4%) were high quality and all were based in Europe or North America, including 765 459 individuals, of whom 32 721 were homeless. 12/17 studies were pre-2011. Homeless individuals were more likely to have CVD than non-homeless individuals (pooled OR 2.96; 95% CI 2.80 to 3.13; p<0.0001; heterogeneity p<0.0001; I2=99.1%) and had increased CVD mortality (age-standardised mortality ratio range: 2.6-6.4). Compared with non-homeless individuals, hypertension was more likely in homeless people (pooled OR 1.38-1.75, p=0.0070; heterogeneity p=0.935; I2=0.0%). CONCLUSIONS Homeless people have an approximately three times greater risk of CVD and an increased CVD mortality. However, there are no studies of specific pathways/interventions for CVD in this population. Future research should consider design and evaluation of tailored interventions or integrating CVD into existing interventions.
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Affiliation(s)
| | - Hannah Evans
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Serena A Luchenski
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Alistair Story
- Institute of Health Informatics, University College London, London, United Kingdom.,Find and Treat Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom .,Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.,Department of Cardiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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8
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Sieleunou I, De Allegri M, Roland Enok Bonong P, Ouédraogo S, Ridde V. Does performance-based financing curb stock-outs of essential medicines? Results from a randomised controlled trial in Cameroon. Trop Med Int Health 2020; 25:944-961. [PMID: 32446280 DOI: 10.1111/tmi.13447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In 2011, the government of Cameroon launched its performance-based financing (PBF) scheme. Our study examined the effects of the PBF intervention on the availability of essential medicines (EM). METHODS Randomised control trial whereby PBF and three distinct comparison groups were randomised in a total of 205 health facilities across three regions. Baseline data were collected between March and May 2012 and endline data 36 months later. We defined availability of multiple EM groups by assessing stock-outs for at least one day over the 30 days prior to the survey date and estimated changes attributable to PBF using a series of difference-in-difference regression models, adjusted for relevant facility-level covariates. Data were analysed stratified by region and area to assess effect heterogeneity. RESULTS Our estimates suggest that PBF intervention had no effect on the stock-outs of antenatal care drugs (P = 0.160), vaccines (P = 0.396), integrated management of childhood illness drugs (P = 0.681) and labour and delivery drugs (P = 0.589). However, the intervention was associated with a significant reduction of 34% in stock-outs of family planning medicines (P = 0.028). We observed effect heterogeneity across regions and areas, with significant decreases in stock-outs of family planning products in North-West region (P = 0.065) and in rural areas (P = 0.043). CONCLUSIONS The PBF intervention in Cameroon had limited effects on the reduction of EMs stock-outs. These poor results were likely the consequence of partial implementation failure, ranging from disruption and discontinuation of services to limited facility autonomy in managing decision-making and considerable delay in performance payment.
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Affiliation(s)
- Isidore Sieleunou
- University of Montreal Public Health Research Institute, Montreal, QC, Canada.,School of Public Health, University of Montreal, Montreal, QC, Canada.,Research for Development International, Yaoundé, Cameroon
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Samiratou Ouédraogo
- Institut National de Santé Publique du Québec, Montréal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Valéry Ridde
- School of Public Health, University of Montreal, Montreal, QC, Canada.,French Institute for Research on Sustainable Development, Universités Paris Sorbonne Cités, Paris, France
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9
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Ogbuabor DC. Through service providers' eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria. BMC Infect Dis 2020; 20:206. [PMID: 32143584 PMCID: PMC7060534 DOI: 10.1186/s12879-020-4944-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/02/2020] [Indexed: 01/06/2023] Open
Abstract
Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.
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Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria. .,Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria.
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10
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Rahman SMF, Vingilis E, Hameed S. Views of physicians on the establishment of a department of family medicine in South India: A qualitative study. J Family Med Prim Care 2019; 8:3214-3219. [PMID: 31742144 PMCID: PMC6857383 DOI: 10.4103/jfmpc.jfmpc_551_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/26/2022] Open
Abstract
Objective: To explore the experiences and perceptions of physicians involved in establishing a department of Family Medicine in South India. Methods: In this study, descriptive qualitative methodology was used. Nine family physicians and one community medicine physician were interviewed. The data were subjected to thematic analysis. Findings: The establishment of a department of Family Medicine in South India in response to the local health-care demands needed support from the institution, visionary leaders and alumni of the institution. The key challenges perceived were lack of mentorship, lack of identity and misunderstanding of the work of family physicians. Conclusion: This study replicates earlier studies on the role of local health-care needs and visionary leaders in striving towards family medicine-based clinical services that further evolved into training and research opportunities in family medicine. The study identified the challenges and supportive forces behind the initiation of a department of Family Medicine and the role of family physicians in strengthening primary health care.
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Affiliation(s)
- Sajitha M F Rahman
- Department of Family Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Evelyn Vingilis
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Saadia Hameed
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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11
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Nkwanyana NM, Voce AS, Mnqayi SO, Sartorius B, Schneider H. A health system framework for perinatal care in South African district hospitals: a Delphi technique. BMC Health Serv Res 2019; 19:402. [PMID: 31221153 PMCID: PMC6585044 DOI: 10.1186/s12913-019-4200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background The majority of perinatal deaths occurring in low- and middle- income countries are preventable. South Africa is a middle-income country with consistently high perinatal mortality rates and most factors contributing to preventable deaths are linked to the functioning of the health system. Particularly of concern in South Africa is the high perinatal mortality in district hospitals, where most births occur and where intrapartum care is provided to women of low and intermediate risk. Therefore, it is crucial to strengthen the health system for perinatal care in district hospitals. There is currently no consolidated documented framework outlining contextual health system domains and indicators that are key to providing effective perinatal care in district hospitals. The purpose of this study was to derive key health system domains and indicators necessary to measure the performance of the health system for perinatal care in South African district hospitals. Methods The Delphi technique was used in collecting data from a panel with experts drawn from disciplines connected with the functioning of the health system for perinatal care in South Africa. The study enrolled thirteen experts from whom data on key health system domains and indicators for perinatal care were derived. The project reference group gave guidance to the development of the framework and ascertained its relevance to the South African setting. Results The Facility Based Health System Framework for Perinatal Care comprising domains and indicators necessary to measure health system performance in South African district hospitals was derived from data. The broad structure of the proposed framework aligns with the WHO Health Systems Framework. Each critical building block has detailed domains and indicators that illuminate essential facility-level and programme-specific elements that require attention for strengthening the health system for perinatal care. Conclusion The proposed framework can enable district hospital management teams to identify gaps in the health system for perinatal care, which need to be strengthened in order to alleviate the burden of perinatal deaths in district hospitals.
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Affiliation(s)
| | - Anna Silvia Voce
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sthandwa Octavia Mnqayi
- King Cetshwayo Health District Office, KwaZulu-Natal Department of Health, Empangeni, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Schneider
- School of Public Health and SAMRC Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa
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12
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Yasobant S, Bruchhausen W, Saxena D, Falkenberg T. One health collaboration for a resilient health system in India: Learnings from global initiatives. One Health 2019; 8:100096. [PMID: 31304229 PMCID: PMC6606562 DOI: 10.1016/j.onehlt.2019.100096] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 01/24/2023] Open
Abstract
Inter-sectoral collaborations are now recognized as key importance for health system strengthening and health system integration, globally; however, its application in the domain of One Health remains unclear. Over time, as the complexity of the health system has increased within the domain of One Health approach, there is an urgent need for developing collaboration for successful implementation of the One Health. This review focuses on the global One Health collaboration strategies and discusses which type of collaboration might work for the health system of India. We conducted a review in the following three steps: identification of key One Health Collaboration strategies, documentation of the global initiatives and scoping into the initiatives of India in the domain of One Health. We found three major types of collaborations discussed in the One Health literature: level-based collaboration (individual, population or research), solution-based collaboration, and third-party-based collaboration. Twenty-five key global and six Indian One Health initiatives or collaboration strategies are documented in the present review. Although, many initiatives are being undertaken globally for disease prevention and control from the viewpoint of One Health; however, in India, solution-based approaches during emergencies and outbreaks and some sort of level-based collaborations are in place. It is high time to develop a sustainable level-based collaboration integrated with third-party based collaboration within the larger domain of One Health for a resilient health system.
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Affiliation(s)
- Sandul Yasobant
- Center for Development Research (ZEF), University of Bonn, Germany.,Faculty of Medicine, University of Bonn, Germany
| | - Walter Bruchhausen
- Center for Development Research (ZEF), University of Bonn, Germany.,Institute of History and Ethics of Medicine, University of Cologne, Germany
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar, Gujarat, India
| | - Timo Falkenberg
- Center for Development Research (ZEF), University of Bonn, Germany.,GeoHealth Centre, Institute for Hygiene and Public Health, University of Bonn, Germany
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13
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Identifying strengths and weaknesses of the integration of biomedical and herbal medicine units in Ghana using the WHO Health Systems Framework: a qualitative study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:286. [PMID: 30348173 PMCID: PMC6196414 DOI: 10.1186/s12906-018-2334-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/24/2018] [Indexed: 11/14/2022]
Abstract
Background The use of herbal medicines in developing countries has been increasing over the years. In Ghana, since 2011, the government has been piloting the integration of herbal medicine in 17 public hospitals. However, the strengths and the weaknesses of the integration have not been fully explored. The current study sought to examine the strengths and weaknesses of the integration using the WHO health systems framework. Methods This study used qualitative, exploratory study design involving interviews of 25 key informants. The respondents had experience in conducting herbal medicine research. Two key informants were medical herbalists practising in hospitals piloting the integration in Ghana. We used Framework analysis to identify the perspectives of key informants in regards to the integration. Results Key informants mostly support the integration although some noted that the government needs to support scale-up in other public hospitals. Among the strengths cited were the employment of medical herbalists, utilization of traditional knowledge, research opportunities, and efficient service delivery by restricting the prescription and use of fake herbal medicine. The weaknesses were the lack of government policies on implementing the integration, financial challenges because the National Health Insurance Scheme does not cover herbal medicine, poor advocacy and research opportunities, and lack of training of conventional health practitioners in herbal medicine. Conclusions Researchers view the integration of the two healthcare systems–biomedicine, and herbal medicine– positively but it has challenges that need to be addressed. The integration could offer more opportunities for researching into herbal medicine. More training for conventional health professionals in herbal medicine could increase the chances of better coordination between the two units. Additionally, strong advocacy and publicity is needed to educate more people on the integration and the utilization of the services. Electronic supplementary material The online version of this article (10.1186/s12906-018-2334-2) contains supplementary material, which is available to authorized users.
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Salve S, Harris K, Sheikh K, Porter JDH. Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory. Int J Equity Health 2018; 17:73. [PMID: 29880052 PMCID: PMC5991467 DOI: 10.1186/s12939-018-0785-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Public Private Partnerships (PPP) are increasingly utilized as a public health strategy for strengthening health systems and have become a core component for the delivery of TB control services in India, as promoted through national policy. However, partnerships are complex systems that rely on relationships between a myriad of different actors with divergent agendas and backgrounds. Relationship is a crucial element of governance, and relationship building an important aspect of partnerships. To understand PPPs a multi-disciplinary perspective that draws on insights from social theory is needed. This paper demonstrates how social theory can aid the understanding of the complex relationships of actors involved in implementation of Public-Private Mix (PPM)-TB policy in India. Methods Ethnographic research was conducted within a district in a Southern state of India over a 14 month period, combining participant observations, informal interactions and in-depth interviews with a wide range of respondents across public, private and non-government organisation (NGO) sectors. Results Drawing on the theoretical insights from Bourdieu’s “theory of practice” this study explores the relationships between the different actors. The study found that programme managers, frontline TB workers, NGOs, and private practitioners all had a crucial role to play in TB partnerships. They were widely regarded as valued contributors with distinct social skills and capabilities within their organizations and professions. However, their potential contributions towards programme implementation tended to be unrecognized both at the top and bottom of the policy implementation chain. These actors constantly struggled for recognition and used different mechanisms to position themselves alongside other actors within the programme that further complicated the relationships between different actors. Conclusion This paper demonstrates that applying social theory can enable a better understanding of the complex relationship across public, private and NGO sectors. A closer understanding of these processes is a prerequisite for bridging the gap between field-level practices and central policy intentions, facilitating a move towards more effective partnership strategies for strengthening local health systems. The study contributes to our understanding of implementation of PPP for TB control and builds knowledge to help policy makers and programme managers strengthen and effectively implement strategies to enable stronger governance of these partnerships.
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Affiliation(s)
- Solomon Salve
- Health Governance Hub Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India. .,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7H, UK.
| | - Kristine Harris
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7H, UK
| | - Kabir Sheikh
- Health Governance Hub, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India
| | - John D H Porter
- Departments of Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7H, UK
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Gupta V, Mason-Sharma A, Lyon ZM, Orav EJ, Jha AK, Kerry VB. Has development assistance for health facilitated the rise of more peaceful societies in sub-Saharan Africa? Glob Public Health 2018. [PMID: 29532733 DOI: 10.1080/17441692.2018.1449232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Growing evidence suggests that health aid can serve humanitarian and diplomatic ends. This study utilised the Fragile States Index (FSI) for the 47 nations of the World Health Organizations' Africa region for the years 2005-2014 and data on health and non-health development aid spending from the United States (US) for those same years. Absolute amounts of health and non-health aid flows from the US were used as predictors of state fragility. We used time-lagged, fixed-effects multivariable regression modelling with change in FSI as the outcome of interest. The highest quartile of US health aid per capita spending (≥$4.00 per capita) was associated with a large and immediate decline in level of state fragility (b = -7.57; 95% CI, -14.6 to -0.51, P = 0.04). A dose-response effect was observed in the primary analysis, with increasing levels of spending associated with greater declines in fragility. Health per-capita expenditures were correlated with improved fragility scores across all lagged intervals and spending quartiles. The association of US health aid with immediate improvements in metrics of state stability across sub-Saharan Africa is a novel finding. This effect is possibly explained by our observations that relative to non-health aid, US health expenditures were larger and more targeted.
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Affiliation(s)
- Vin Gupta
- a Harvard Global Health Institute , Harvard University , Cambridge , USA.,b Department of Pulmonary & Critical Care Medicine , Brigham & Women's Hospital , Boston , USA
| | | | - Zoe M Lyon
- a Harvard Global Health Institute , Harvard University , Cambridge , USA.,d Department of Health Policy and Management , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Endel John Orav
- d Department of Health Policy and Management , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Ashish K Jha
- d Department of Health Policy and Management , Harvard T.H. Chan School of Public Health , Boston , USA.,e Harvard Global Health Institute , Harvard University , Cambridge , USA
| | - Vanessa B Kerry
- f Department of Global Health and Social Medicine , Harvard Medical School , Boston , USA.,g MGH Global Health , Massachusetts General Hospital , Boston , USA.,h Division of Pulmonary and Critical Care , Massachusetts General Hospital , Boston , USA.,i Seed Global Health , Boston , USA
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16
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Hasan R, Shakoor S, Hanefeld J, Khan M. Integrating tuberculosis and antimicrobial resistance control programmes. Bull World Health Organ 2018. [PMID: 29531418 PMCID: PMC5840628 DOI: 10.2471/blt.17.198614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.
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Affiliation(s)
- Rumina Hasan
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Johanna Hanefeld
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
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Adefemi K, Yates C, Awolaran O, Bakare J. Effects of donor HIV/AIDS funding on primary healthcare delivery in southwest Nigeria: Evidence from hospital administrators. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2016. [DOI: 10.1080/20479700.2016.1229900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kazeem Adefemi
- Department of Health Policy and Management, School of Public Health, Curtin University, Perth, Australia
- Present address: Health & Social Relief Initiatives, Ilorin, Kwara State, Nigeria
| | - Caroline Yates
- Department of Health Policy and Management, School of Public Health, Curtin University, Perth, Australia
| | - Olusegun Awolaran
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Joseph Bakare
- Department of Biostatistics, Faculty of Sciences, University of Ilorin, Kwara State, Nigeria
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Abiiro GA, De Allegri M. Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:17. [PMID: 26141806 PMCID: PMC4491257 DOI: 10.1186/s12914-015-0056-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the various dimensions of UHC emerging from these interpretations and argues for the need to pay attention to the complex interactions across the various components of a health system in the pursuit of UHC as a legal human rights issue. DISCUSSION The literature presents UHC as a multi-dimensional concept, operationalized in terms of universal population coverage, universal financial protection, and universal access to quality health care, anchored on the basis of health care as an international legal obligation grounded in international human rights laws. As a legal concept, UHC implies the existence of a legal framework that mandates national governments to provide health care to all residents while compelling the international community to support poor nations in implementing this right. As a humanitarian social concept, UHC aims at achieving universal population coverage by enrolling all residents into health-related social security systems and securing equitable entitlements to the benefits from the health system for all. As a health economics concept, UHC guarantees financial protection by providing a shield against the catastrophic and impoverishing consequences of out-of-pocket expenditure, through the implementation of pooled prepaid financing systems. As a public health concept, UHC has attracted several controversies regarding which services should be covered: comprehensive services vs. minimum basic package, and priority disease-specific interventions vs. primary health care. As a multi-dimensional concept, grounded in international human rights laws, the move towards UHC in LMICs requires all states to effectively recognize the right to health in their national constitutions. It also requires a human rights-focused integrated approach to health service delivery that recognizes the health system as a complex phenomenon with interlinked functional units whose effective interaction are essential to reach the equilibrium called UHC.
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Affiliation(s)
- Gilbert Abotisem Abiiro
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
- Department of Planning and Management, Faculty of Planning and Land Management, University for Development Studies, University Post Box 3, Wa, Upper West Region, Ghana.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
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Kruk ME, Jakubowski A, Rabkin M, Kimanga DO, Kundu F, Lim T, Lumumba V, Oluoch T, Robinson KA, El-Sadr W. Association between HIV programs and quality of maternal health inputs and processes in Kenya. Am J Public Health 2015; 105 Suppl 2:S207-10. [PMID: 25689188 DOI: 10.2105/ajph.2014.302511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We assessed whether quality of maternal and newborn health services is influenced by presence of HIV programs at Kenyan health facilities using data from a national facility survey. Facilities that provided services to prevent mother-to-child HIV transmission had better prenatal and postnatal care inputs, such as infrastructure and supplies, and those providing antiretroviral therapy had better quality of prenatal and postnatal care processes. HIV-related programs may have benefits for quality of care for related services in the health system.
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Affiliation(s)
- Margaret E Kruk
- At the time of the study, Margaret E. Kruk and Aleksandra Jakubowski were with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Miriam Rabkin and Wafaa El-Sadr are with the Departments of Epidemiology and Medicine, Columbia University, New York. At the time of this research, Davies O. Kimanga was with the National AIDS & STI Control Programme, Nairobi, Kenya. Francis Kundu and Vane Lumumba are with the National Council for Population and Development, Nairobi. Travis Lim is with the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Tom Oluoch and Katherine A. Robinson are with the CDC, Nairobi
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The impact of introducing new vaccines on the health system: Case studies from six low- and middle-income countries. Vaccine 2014; 32:6505-12. [DOI: 10.1016/j.vaccine.2014.09.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/08/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
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Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes. PLoS One 2014; 9:e94016. [PMID: 24718306 PMCID: PMC3981751 DOI: 10.1371/journal.pone.0094016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/12/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. METHODS In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. FINDINGS We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. CONCLUSION We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
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