1
|
Parashar R, Nanda S, Smith SL, Shroff Z, Shawar YR, Hamunakwadi DL, Shiffman J. Comparing priority received by global health issues: a measurement framework applied to tuberculosis, malaria, diarrhoeal diseases and dengue fever. BMJ Glob Health 2024; 9:e014884. [PMID: 38977402 DOI: 10.1136/bmjgh-2023-014884] [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: 12/20/2023] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION The relative priority received by issues in global health agendas is subjected to impressionistic claims in the absence of objective methods of assessment of priority. To build an approach for conducting structured assessments of comparative priority health issues receive, we expand the public arenas model (2021) and offer a framework for future assessments of health issue priority in global and national health agendas. METHODS We aimed to develop a more comprehensive set of measures for conducting multiyear priority comparisons of health issues in six agenda-setting arenas by identifying possible measures and data sources, selecting indicators based on feasibility and comparability of measures and gathering the data on selected indicators. We applied these measures to four communicable diseases-tuberculosis (TB), malaria, diarrhoeal diseases and dengue fever-given their differing impressionistic claims of priority. Where possible, we analysed the annual and/or 5-year trends from 2000 through 2022. RESULTS We observed that TB and malaria received the highest priority for most periods in the past two decades in most arenas. However, a stagnation in development funding for these two conditions over the last 8-10 years may have fuelled the neglect claims. Despite having a higher disease burden, diarrhoea has been slipping in global priority with reduced spending, fewer clinical trials and stagnating publications. Dengue remains a low-priority condition but has witnessed a sharp rise in attention from the pharmaceutical industry. DISCUSSIONS We expanded the arenas model by including a transnational arena (international representation) and additional measurements for various arenas. This analysis presents an approach to enable comparative trend analysis of the markers of agenda status over a multiyear period. More such analyses can bring much-desired objectivity in understanding how attention to global or national health issues changes over time in different arenas, potentiating a more equitable allocation of resources.
Collapse
Affiliation(s)
- Rakesh Parashar
- Health Systems and Policy, Independent Consultant, New Delhi, Delhi, India
- Global Business School of Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Sharmishtha Nanda
- Independent Consultant, Delhi, India
- International Center for Research on Women Asia Regional Office, New Delhi, India
| | - Stephanie L Smith
- School of Public and International Affairs, Virginia Tech, Arlington, Texas, USA
| | - Zubin Shroff
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Yusra R Shawar
- International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jeremy Shiffman
- International Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Harpham T, Tetui M, Smith R, Okwaro F, Biney A, Helzner J, Duminy J, Parnell S, Ganle J. Urban Family Planning in Sub-Saharan Africa: an Illustration of the Cross-sectoral Challenges of Urban Health. J Urban Health 2022; 99:1044-1053. [PMID: 35699888 PMCID: PMC9195389 DOI: 10.1007/s11524-022-00649-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/31/2022]
Abstract
The multi-sectoral nature of urban health is a particular challenge, which urban family planning in sub-Saharan Africa illustrates well. Rapid urbanisation, mainly due to natural population increase in cities rather than rural-urban migration, coincides with a large unmet urban need for contraception, especially in informal settlements. These two phenomena mean urban family planning merits more attention. To what extent are the family planning and urban development sectors working together on this? Policy document analysis and stakeholder interviews from both the family planning and urban development sectors, across eight sub-Saharan African countries, show how cross-sectoral barriers can stymie efforts but also identify some points of connection which can be built upon. Differing historical, political, and policy landscapes means that entry points to promote urban family planning have to be tailored to the context. Such entry points can include infant and child health, female education and employment, and urban poverty reduction. Successful cross-sectoral advocacy for urban family planning requires not just solid evidence, but also internal consensus and external advocacy: FP actors must consensually frame the issue per local preoccupations, and then communicate the resulting key messages in concerted and targeted fashion. More broadly, success also requires that the environment be made conducive to cross-sectoral action, for example through clear requirements in the planning processes' guidelines, structures with focal persons across sectors, and accountability for stakeholders who must make cross-sectoral action a reality.
Collapse
Affiliation(s)
| | - Moses Tetui
- University of Waterloo, Waterloo, Canada.,Makerere University, Kampala, Uganda
| | | | | | | | - Judith Helzner
- International Union for the Scientific Study of Population, Paris, France. .,J. F. Helzner Consulting, Stamford, CT, USA.
| | - James Duminy
- University of Bristol, Bristol, UK.,University of Cape Town, Cape Town, South Africa
| | - Susan Parnell
- University of Bristol, Bristol, UK.,University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
3
|
Scarr JP, Buse K, Norton R, Meddings DR, Jagnoor J. Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis. THE LANCET GLOBAL HEALTH 2022; 10:e1058-e1066. [PMID: 35461520 PMCID: PMC9197772 DOI: 10.1016/s2214-109x(22)00074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Drowning has been a neglected health issue, largely absent from the global health and development discourse, until the UN General Assembly adopted its first resolution on global drowning prevention in 2021. This policy analysis examines the role of issue characteristics, actor power, ideas, and political contexts in the emergence of drowning prevention, and it also identifies opportunities for future actions. We identified three factors crucial to enhancing prioritisation: (1) methodological advancements in population-representative data and evidence for effective interventions; (2) reframing drowning prevention in health and sustainable development terms with an elevated focus on high burdens in low-income and middle-income contexts; and (3) political advocacy by a small coalition. Ensuring that the UN resolution on global drowning prevention is a catalyst for action requires positioning of drowning prevention within global health and sustainable development agendas; strengthening of capacity for multisectoral action; expansion of research measuring burden and identifying solutions in diverse contexts; and incorporation of inclusive global governance, commitments, and mechanisms that hold stakeholders to account.
Collapse
|
4
|
Buser JM, Bakari A, Moyer CA. Viability of an urban maternity waiting home in Kumasi, Ghana: a qualitative needs assessment. Midwifery 2022; 110:103349. [DOI: 10.1016/j.midw.2022.103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/20/2020] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
|
5
|
Shrestha R, Yadav UN, Shrestha A, Paudel G, Makaju D, Poudel P, Iwashita H, Harada Y, Shrestha A, Karmacharya B, Koju R, Sugishita T, Rawal L. Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal. Front Public Health 2022; 10:763784. [PMID: 35223722 PMCID: PMC8864089 DOI: 10.3389/fpubh.2022.763784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal. Methods This study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes. Results Four key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems. Conclusion This study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.
Collapse
Affiliation(s)
- Rabina Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Abha Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
| | - Deepa Makaju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Prakash Poudel
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Hanako Iwashita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Archana Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Rajendra Koju
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, QLD, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- *Correspondence: Lal Rawal ;
| |
Collapse
|
6
|
Ludwick T, Morgan A, Kane S, Kelaher M, McPake B. The distinctive roles of urban community health workers in low- and middle-income countries: a scoping review of the literature. Health Policy Plan 2021; 35:1039-1052. [PMID: 32494801 DOI: 10.1093/heapol/czaa049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
Addressing urban health challenges in low- and middle-income countries (LMICs) has been hampered by lack of evidence on effective mechanisms for delivering health services to the poor. The urban disadvantaged experience poor health outcomes (often worse than rural counterparts) and face service barriers. While community health workers (CHWs) have been extensively employed in rural communities to address inequities, little attention has been given to understanding the roles of CHWs in urban contexts. This study is the first to systematically examine urban CHW roles in LMICs. It aims to understand their roles vis-à-vis other health providers and raise considerations for informing future scope of practice and service delivery models. We developed a framework that presents seven key roles performed by urban CHWs and position these roles against a continuum of technical to political functions. Our scoping review included publications from four databases (MEDLINE, EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource hubs. We included all peer-reviewed, CHW studies situated in urban/peri-urban, LMIC contexts. We identify roles (un)commonly performed by urban CHWs, present the range of evidence available on CHW effectiveness in performing each role and identify considerations for informing future roles. Of 856 articles, 160 met the inclusion criteria. Programmes spanned 34 LMICs. Studies most commonly reported evidence on CHWs roles related to health education, outreach and elements of direct service provision. We found little overlap in roles between CHWs and other providers, with some exceptions. Reported roles were biased towards home visiting and individual-capacity building, and not well-oriented to reach men/youth/working women, support community empowerment or link with social services. Urban-specific adaptations to roles, such as peer outreach to high-risk, stigmatized communities, were limited. Innovation in urban CHW roles and a better understanding of the unique opportunities presented by urban settings is needed to fully capitalize on their potential.
Collapse
Affiliation(s)
- Teralynn Ludwick
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, Carlton, Melbourne, VIC, 3004, Australia
| | - Alison Morgan
- Maternal Sexual and Reproductive Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sumit Kane
- Maternal Sexual and Reproductive Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
7
|
Abboah-Offei M, Gyasi Darkwa A, Ayim A, Ansah-Ofei AM, Dovlo D, Awoonor-Williams JK, Agongo EEA, Agyepong IA, Elsey H. Adapting the Community-based Health Planning and Services (CHPS) to engage poor urban communities in Ghana: protocol for a participatory action research study. BMJ Open 2021; 11:e049564. [PMID: 34315798 PMCID: PMC8317127 DOI: 10.1136/bmjopen-2021-049564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/13/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION With rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities. METHODS AND ANALYSIS A Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 ('reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement. ETHICS AND DISSEMINATION This study has been approved by the University of York's Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK.
Collapse
Affiliation(s)
| | - Akosua Gyasi Darkwa
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | - Andrews Ayim
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | | | - Delanyo Dovlo
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | | | | | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
8
|
Teixeira de Siqueira-Filha N, Li J, Kibuchi E, Quayyum Z, Phillips-Howard P, Awal A, Mithu MIH, Manzoor F, Karuga R, Saidu S, Smith J, Sai V, Garimella S, Chumo I, Mberu B, Tolhurst R, Mazumdar S, Rao V, Farnaz N, Alam W, Elsey H. Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents. BMJ Open 2021; 11:e045441. [PMID: 34244254 PMCID: PMC8273471 DOI: 10.1136/bmjopen-2020-045441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION People living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents. METHODS AND ANALYSIS This scoping review adopts the framework suggested by Arksey and O'Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported. ETHICS AND DISSEMINATION Ethical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.
Collapse
Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Zahidul Quayyum
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Abdul Awal
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Farzana Manzoor
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | | | | | - Varun Sai
- The George Institute for Global Health India, New Delhi, India
| | | | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Rachel Tolhurst
- Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sumit Mazumdar
- Centre for Health Economics, University of York, York, UK
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Center, Mumbai, India
| | - Nadia Farnaz
- School of Public Health, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Wafa Alam
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
9
|
Duminy J. Beyond growth and density: Recentring the demographic drivers of urban health and risk in the global south. URBAN STUDIES (EDINBURGH, SCOTLAND) 2021:00420980211014410. [PMCID: PMC10043354 DOI: 10.1177/00420980211014410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Debates within urban studies concerning the relationship between urbanisation and infectious disease focus on issues of urban population growth, density, migration and connectivity. However, an effective long-term risk and wellbeing agenda, without which the threat of future pandemics cannot be mitigated, must also take account of demographic forces and changes as critical drivers of transmission and mortality risk within and beyond cities. A better understanding of the dynamics of fertility, mortality and changing age structures – key determinants of urban decline/growth in addition to migration – provides the foundation upon which healthier cities and a healthy global urban system can be developed. The study of how basic demographic attributes and trends are distributed in space and how they interact with risks, including those of infectious disease, must be incorporated as a priority into a post-COVID-19 urban public health agenda. This perspective concurs with recent debates in urban studies emphasising the demographic drivers of urban change. Moreover, it raises critical questions about the microbial and environmental emphasis of much research on the interface of urban health and governance.
Collapse
Affiliation(s)
- James Duminy
- James Duminy, School of Geographical Sciences, University of Bristol, University Road, Bristol, BS8 1SS, UK.
| |
Collapse
|
10
|
Abstract
BACKGROUND Many global health organisations have adopted formal strategies to integrate gender in their programming. In practice, few prioritise the issue. Institutions with considerable global power therefore largely overlook fundamental drivers of adverse health outcomes: gender inequality and harmful gender norms. We analyse the factors shaping attention to gender in organisations involved in global health governance. METHODS Drawing on scholarship from the fields of organisational behavior and management, sociology, international relations and the policy process, we undertook a thematic analysis of peer-reviewed scholarship and organisational documents. We also conducted 20 semi-structured interviews over Skype with individuals working at the cross-section of gender and health. RESULTS In seeking to reform the policies and practices of global health organisations, gender proponents confront patriarchal organisational cultures, hostile political environments and an issue that is difficult to address as it requires upsetting existing power structures. Proponents also face three linked challenges internal to their own networks. First, there is little cohesion among champions themselves, as they are fragmented into multiple networks. Second, proponents differ on the nature of the problem and solutions, including whether reducing gender inequality or addressing harmful gender norms is the primary goal, the role of men in gender initiatives, which health issues to prioritise, and even the value of proponent cohesion. Third, there are disagreements among proponents on how to convey the problem. Some advance an instrumental case, while others believe that it should be portrayed as a human rights issue and using any other argument undermines that fundamental justification. CONCLUSIONS Prospects for building more gender-responsive global health organisations will depend in part on the ability of proponents to address these disagreements and develop strategies for negotiating difficult organisational cultures and political environments.
Collapse
Affiliation(s)
- Yusra Ribhi Shawar
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
| | - Jeremy Shiffman
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C., USA
| |
Collapse
|
11
|
Zavos HMS, Dalton B, Jayaweera K, Harber-Aschan L, Pannala G, Adikari A, Hatch SL, Siribaddana S, Sumathipala A, Hotopf M, Rijsdijk FV. The relationship between independent and dependent life events and depression symptoms in Sri Lanka: a twin and singleton study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:237-249. [PMID: 31482195 PMCID: PMC7024056 DOI: 10.1007/s00127-019-01765-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 08/20/2019] [Indexed: 12/05/2022]
Abstract
PURPOSE Life events have been associated with a variety of mental health conditions including depression. There is a scarcity of research in South Asia exploring the aetiology of independent and dependent life events and their relationship with depression symptoms. This study aimed, in a Sri Lankan population, to identify the socio-demographic correlates and genetic and environmental influences on independent and dependent life events and their relationship with depression. METHODS Questionnaire data came from the Colombo Twin and Singleton Follow-up Study, CoTaSS-2 (N = 3969), a population study of Sri Lankan twins and singletons. Lifetime-ever independent and dependent life events were measured using a questionnaire and depressive symptoms using the Revised Beck's Depression Inventory. Structural Equation Model-fitting analyses explored the genetic and environmental influences on life events and depression. RESULTS Living in a rural environment and financial hardship were associated with greater reporting of independent and dependent life events. Sex differences were evident in the aetiology of life events and depression symptoms. Independent and dependent life events, but not depression symptoms, were heritable in males. Independent life events and depression symptoms, but not dependent life events, were heritable in females. Non-shared environmental influences explained phenotypic associations between independent life events and depression symptoms in both males and females. Genetic and non-shared environmental influences explained the phenotypic associations between dependent life events and depression symptoms in males. Only non-shared environment explained the covariation between dependent life events and depression symptoms in females. CONCLUSIONS Socio-demographic correlates of independent and dependent life events were similar to those reported in Western populations. Life events were associated with increased depression symptoms. Contrary to research in Western populations, we found that non-shared environmental, rather than genetic, influences explained much of the covariation between life events and depression symptoms. This suggests that whilst independent LEs may be heritable, the relationship is unlikely to be confounded by genetic influences and has significant implications for possible interventions for depression.
Collapse
Affiliation(s)
- Helena M S Zavos
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Lisa Harber-Aschan
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Gayani Pannala
- Institute for Research and Development, Colombo, Sri Lanka
| | | | - Stephani L Hatch
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Sisira Siribaddana
- Department of Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Athula Sumathipala
- Institute for Research and Development, Colombo, Sri Lanka
- School of Primary, Community and Social Care, Faculty of Medicine & Health Sciences, Keele University, Staffordshire, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Frühling V Rijsdijk
- Social Genetic and Developmental Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
12
|
Mirzoev T, Poudel AN, Gissing S, Doan TTD, Ferdous T, Regmi S, Duong MD, Baral S, Chand O, Huque R, Hoang VM, Elsey H. Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities. Health Policy Plan 2019; 34:773-783. [PMID: 31603206 PMCID: PMC6913712 DOI: 10.1093/heapol/czz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2019] [Indexed: 11/23/2022] Open
Abstract
City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.
Collapse
Affiliation(s)
- Tolib Mirzoev
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Ak Narayan Poudel
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Stefanie Gissing
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Thi Thuy Duong Doan
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Tarana Ferdous
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Shophika Regmi
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Minh Duc Duong
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Sushil Baral
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Obindra Chand
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Rumana Huque
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Van Minh Hoang
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Helen Elsey
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| |
Collapse
|
13
|
Zabihi A, Amiri SRJ, Hosseini SR, Padehban V. The association of high-risk behaviors and their relationship with identity styles in adolescents. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:152. [PMID: 31544117 PMCID: PMC6745875 DOI: 10.4103/jehp.jehp_375_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Adolescence is considered an important stage in the onset of high-risk behaviors. Identity styles have significant pathological effects in various aspects of high-risk behaviors. The present study was conducted aiming at investigating the association between high-risk behaviors and identity styles in adolescents. MATERIALS AND METHODS The present cross-sectional research studied 384 girls and boys studying in the second grade of High School in Babol in 2018. Data collection was done through a demographic questionnaire, Mohammadkhani's Risky Behaviour Questionnaire, and Berzonsky's Identity Style Inventory. Data analysis was performed using Chi-square test, Pearson's correlation coefficient, and linear regression analysis. P ≤ 0.05 was considered statistically significant. RESULTS The mean age of adolescents was 17.21 ± 48.4 years (aged 16-19 years). Aggression (23.4%), relationship with the opposite gender (14.5%), smoking cigarettes and hookah (10.9%), consuming alcohol (9.3%), suicidal thoughts and attempts (5.7%), running away from home (3.9%), and consuming psychotropic substances (1.8%) were among the most common high-risk behaviors observed in the adolescents. The scores of high-risk behaviors were negatively correlated with the identity scores of informational style (4.56 ± 3.107), normative style (4.45 ± 2.581), and identity commitment style (4.15 ± 2.245) and positively correlated with the scores of diffuse-avoidant style (4.15 ± 3.089). Regression analysis showed that only the informational style had a negative and significant correlation with high-risk behaviors. CONCLUSIONS The present study showed significant prevalence of high-risk behaviors and its relationship with identity styles in adolescents, which requires regular and planned health education intervention at schools.
Collapse
Affiliation(s)
- Ali Zabihi
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Seyed Reza Hosseini
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Valiollah Padehban
- Department of Nursing, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
14
|
Elsey H, Agyepong I, Huque R, Quayyem Z, Baral S, Ebenso B, Kharel C, Shawon RA, Onwujekwe O, Uzochukwu B, Nonvignon J, Aryeetey GC, Kane S, Ensor T, Mirzoev T. Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries. BMJ Glob Health 2019; 4:e001501. [PMID: 31297245 PMCID: PMC6577312 DOI: 10.1136/bmjgh-2019-001501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/26/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022] Open
Abstract
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the 'urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.
Collapse
Affiliation(s)
- Helen Elsey
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Irene Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra Region, Ghana
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Zahidul Quayyem
- Centre of Excellence for Urban Equity and Health, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - Riffat Ara Shawon
- Public Health Research, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, Universiy of Nigeria, Enugu, Nigeria
| | - Justice Nonvignon
- School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | | | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Ensor
- Nuffield Centre for Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
15
|
Heller O, Somerville C, Suggs LS, Lachat S, Piper J, Aya Pastrana N, Correia JC, Miranda JJ, Beran D. The process of prioritization of non-communicable diseases in the global health policy arena. Health Policy Plan 2019; 34:370-383. [PMID: 31199439 PMCID: PMC6736081 DOI: 10.1093/heapol/czz043] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/31/2022] Open
Abstract
Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith's (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370-9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization's (WHO) NCD Global Action Plan 2013-20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.
Collapse
Affiliation(s)
- Olivia Heller
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Claire Somerville
- Gender Centre, Graduate Institute of International and Development Studies, Ch. Eugène-Rigot 2, Geneva, Switzerland
| | - L Suzanne Suggs
- BeCHANGE Research Group, Institute of Public Communication, Università della Svizzera italiana, Via G. Buffi 13, Lugano CH, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Julianne Piper
- Graduate Institute of International and Development Studies, Ch. Eugène-Rigot 2, Geneva, Switzerland
| | - Nathaly Aya Pastrana
- BeCHANGE Research Group, Institute of Public Communication, Università della Svizzera italiana, Via G. Buffi 13, Lugano CH, Switzerland
| | - Jorge C Correia
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima 18, Peru
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| |
Collapse
|