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Kiendrébéogo JA, Sory O, Kaboré I, Kafando Y, Kumar MB, George AS. Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso. Glob Health Action 2024; 17:2360702. [PMID: 38910459 PMCID: PMC11198144 DOI: 10.1080/16549716.2024.2360702] [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: 09/20/2023] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Burkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. OBJECTIVE This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. METHODS We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. RESULTS There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effective. CONCLUSIONS Few studies have examined national policy processes linked to the GFF or other global health initiatives. This kind of research is needed to better understand the range of challenges in aligning donor and national priorities encountered across diverse health systems contexts. This study may stimulate others to ensure that the GFF and other global health initiatives respond to local needs and policy environments for better implementation.
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Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Research, Expertise and Capacity Building, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium
| | - Orokia Sory
- Department of Research, Expertise and Capacity Building, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Issa Kaboré
- Operations Division, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Yamba Kafando
- Operations Division, Recherche pour la santé et le développement (RESADE), Ouagadougou, Burkina Faso
| | - Meghan Bruce Kumar
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Programme, Nairobi, Kenya
- Northumbria University, Department of Nursing, Midwifery and Health, Newcastle upon Tyne, UK
| | - Asha S. George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Health Systems Extra-Mural Unit, South African Medical Research Council, Cape Town, South Africa
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Murali S, Ding H, Adedeji F, Qin C, Obungoloch J, Asllani I, Anazodo U, Ntusi NAB, Mammen R, Niendorf T, Adeleke S. Bringing MRI to low- and middle-income countries: Directions, challenges and potential solutions. NMR IN BIOMEDICINE 2024; 37:e4992. [PMID: 37401341 DOI: 10.1002/nbm.4992] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
The global disparity of magnetic resonance imaging (MRI) is a major challenge, with many low- and middle-income countries (LMICs) experiencing limited access to MRI. The reasons for limited access are technological, economic and social. With the advancement of MRI technology, we explore why these challenges still prevail, highlighting the importance of MRI as the epidemiology of disease changes in LMICs. In this paper, we establish a framework to develop MRI with these challenges in mind and discuss the different aspects of MRI development, including maximising image quality using cost-effective components, integrating local technology and infrastructure and implementing sustainable practices. We also highlight the current solutions-including teleradiology, artificial intelligence and doctor and patient education strategies-and how these might be further improved to achieve greater access to MRI.
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Affiliation(s)
- Sanjana Murali
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Hao Ding
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Fope Adedeji
- School of Medicine, Faculty of Medicine, University College London, London, UK
| | - Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Iris Asllani
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, USA
| | - Udunna Anazodo
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- The Research Institute of London Health Sciences Centre and St. Joseph's Health Care, London, Ontario, Canada
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (BUFF), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- High Dimensional Neuro-oncology, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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Huang A, Zhao Y, Cao C, Lyu M, Tang K. Integrating interventions supported by development assistance for health into local health system: evidence from a China-World Bank-UK rural health system strengthening project (1998-2007). BMJ Glob Health 2024; 9:e012853. [PMID: 38789275 PMCID: PMC11129031 DOI: 10.1136/bmjgh-2023-012853] [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: 05/15/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system. METHODS From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems. RESULTS Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions. CONCLUSION The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.
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Affiliation(s)
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Petrovic N. Reassessing the VaxTax. JOURNAL OF MEDICAL ETHICS 2024; 50:222-225. [PMID: 37673670 DOI: 10.1136/jme-2023-109045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
To counter the imbalance in vaccine distribution during the COVID-19 pandemic, Albertsen and more recently Germani et al have suggested a new system of taxation coined as 'VaxTax' that would force higher-income countries to fund the access of low-income and middle-income countries (LMICs) to new vaccines in times of pandemic. I will argue that this idea faces numerous challenges of ethical, sociopolitical and economical nature that may hinder any effort to solve the numerous health challenges that LMICs face. I argue that while it is an interesting idea, it is neither sufficient nor will it ever be easily implemented because of socioeconomic or practical reasons.
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Oti SO. Towards authentic institutional allyship by global health funders. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003024. [PMID: 38498386 PMCID: PMC10947633 DOI: 10.1371/journal.pgph.0003024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Samuel Oji Oti
- Global Health Decolonisation Movement in Africa, Nairobi, Kenya
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Ruwanpura VSH, Grietens KP, Price RN, Thriemer K. Evidence uptake is only part of the process: Stakeholders' insights on WHO treatment guideline recommendation processes for radical cure of P. vivax malaria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002990. [PMID: 38483936 PMCID: PMC10939226 DOI: 10.1371/journal.pgph.0002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024]
Abstract
Health policy processes should be evidence-informed, transparent and timely, but these processes are often unclear to stakeholders outside the immediate policymaking environment. We spoke to 36 international malaria stakeholders to gain insights on the processes involved in the World Health Organization's Global Malaria Programme's recommendations for their treatment guidelines of P. vivax malaria. Four key themes which drew on the 3i policy framework and Shiffman's four factors that influence global and national policymaking were identified to understand these processes. Triggers for policy change and change prioritisation, evidence types that inform policy, effects of funding on decision-making processes, and transparency and communication of these processes to external stakeholders. Results indicate that more clarity is needed on what triggers global malaria policy change processes, a clearer justification of evidence types used to inform policymaking, better understanding of the impact of the WHO's funding model on policymaking and further transparency and improved communication of these processes to external stakeholders is also needed. We suggest that global malaria policymaking could be improved by using the following strategies: ensuring that identified triggers actually initiate the policy change process, expediting decision-making timelines by developing a priority framework for assessing new evidence, adopting suitable frameworks to assess contextual evidence, and increasing the transparency of the role of non-state funders in policy decision-making processes and when publishing new recommendations.
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Affiliation(s)
- Varunika S. H. Ruwanpura
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ric N. Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Huang A, Zhao Y, Cao C, Lyu M, Tang K. Development assistance, donor-recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank-UK and Global Fund in China. Glob Health Res Policy 2024; 9:7. [PMID: 38310321 PMCID: PMC10838425 DOI: 10.1186/s41256-024-00344-3] [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: 08/23/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor-recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability. METHODS We conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998-2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010-2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson's health policy analysis model and the World Health Organization's health system building blocks. We used process tracing for analysis. RESULTS According to the collected data, our case study identified three reemergent, interrelated aspects of donor-recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases. CONCLUSIONS Given the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor-recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international-domestic expert partnerships to identify and respond to contextual enablers and barriers.
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Affiliation(s)
- Aidan Huang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Institute for International and Area Studies, Tsinghua University, Beijing, China
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Department of Medicine, University of Oxford, Nuffield Oxford, UK
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China.
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Oliveira Hashiguchi L, Conlin M, Roberts D, McGee K, Marten R, Nachuk S, Mukti AG, Nigam A, Ahluwalia N, Nagpal S. Enabling cross-country learning and exchange to support universal health coverage implementation. Health Policy Plan 2024; 39:i125-i130. [PMID: 38253439 PMCID: PMC10803195 DOI: 10.1093/heapol/czad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 01/24/2024] Open
Abstract
As countries transition from external assistance while pursuing ambitious plans to achieve universal health coverage (UHC), there is increasing need to facilitate knowledge sharing and learning among them. Country-led and country-owned knowledge management is foundational to sustainable, more equitable external assistance for health and is a useful complement to more conventional capacity-building modalities provided under external assistance. In the context of external assistance, few initiatives use country-to-country sharing of practitioner experiences, and link learning to receiving guidance on how to adapt, apply and sustain policy changes. Dominant knowledge exchange processes are didactic, implicitly assuming static technical needs, and that practitioners in low- and middle-income countries require problem-specific, time-bound solutions. In reality, the technical challenges of achieving UHC and the group of policymakers involved continuously evolve. This paper aims to explore factors which are supportive of experience-based knowledge exchange between practitioners from diverse settings, drawing from the experience of the Joint Learning Network (JLN) for UHC-a global network of practitioners and policymakers sharing experiences about common challenges to develop and implement knowledge products supporting reforms for UHC-as an illustration of a peer-to-peer learning approach. This paper considers: (1) an analysis of JLN monitoring and evaluation data between 2020 and 2023 and (2) a qualitative inquiry to explore policymakers' engagement with the JLN using semi-structured interviews (n = 14) with stakeholders from 10 countries. The JLN's experience provides insights to factors that contribute to successful peer-to-peer learning approaches. JLN relies on engaging a network of practitioners with diverse experiences who organically identify and pursue a common learning agenda. Meaningful peer-to-peer learning requires dynamic, structured interactions, and alignment with windows of opportunity for implementation that enable rapid response to emerging and timely issues. Peer-to-peer learning can facilitate in-country knowledge sharing, learning and catalyse action at the institutional and health system levels.
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Affiliation(s)
| | - Maeve Conlin
- Management Sciences for Health, 4301 Fairfax Drive, Suite 400, Arlington, VA 22203, USA
| | | | - Kathleen McGee
- The World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | - Stefan Nachuk
- Morris Brothers LLC, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Ali Ghufron Mukti
- BPJS Kesehatan (Social Insurance Administration Organization), Government of Indonesia, JL Letjen Suprapto Cempaka Putih, Jakarta 10510, Indonesia
| | - Aditi Nigam
- The World Bank, 1818 H Street NW, Washington, DC 20433, USA
| | | | - Somil Nagpal
- The World Bank, 12th Floor, IDX Building, Tower 2, Sudirman CBD, Jakarta, Indonesia
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Huang A, Cao C, Zhao Y, Soselia G, Uchaneishvili M, Chikovani I, Gotsadze G, Lyu M, Tang K. External technical assistance and its contribution to donor transition and long-term sustainability: experience from China and Georgia. Health Policy Plan 2024; 39:i137-i144. [PMID: 38253441 PMCID: PMC10803192 DOI: 10.1093/heapol/czad088] [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: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 01/24/2024] Open
Abstract
External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor-recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.
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Affiliation(s)
- Aidan Huang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
- Institute for International and Area Studies, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, South Parks Road, Oxford OX1 3SY, UK
| | - Giorgi Soselia
- School of Natural Sciences and Medicine, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia
- Medecins Du Monde (France) South Caucasus Regional Program, 3 Elene Akhvlediani Khevi, Tbilisi 0102, Georgia
| | - Maia Uchaneishvili
- School of Natural Sciences and Medicine, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia
| | - Ivdity Chikovani
- School of Natural Sciences and Medicine, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia
| | - George Gotsadze
- School of Natural Sciences and Medicine, Ilia State University, Kakutsa Cholokashvili Ave 3/5, Tbilisi 0162, Georgia
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, United States of America
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China
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Doshmangir L, Doshmangir P, Mobasseri K, Khodayari-Zarnaq R, Ahmadi Teymourlouy A, Sergeevich Gordeev V. Factors Affecting Health Policies for Older People in Iran. J Aging Soc Policy 2023; 35:859-881. [PMID: 37125863 DOI: 10.1080/08959420.2023.2205330] [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: 10/21/2021] [Accepted: 01/22/2023] [Indexed: 05/02/2023]
Abstract
Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.
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Affiliation(s)
- Leila Doshmangir
- Department of Health Policy& Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management &Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parinaz Doshmangir
- School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khorshid Mobasseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Geriatric Health, Tabriz University of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy& Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Services Management, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vladimir Sergeevich Gordeev
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Koto-Shimada K, Carandang RR, Shibanuma A, Kiriya J, Ong KIC, Touch S, Koy V, Jimba M. Understanding competency of nursing students in the course of case-based learning in Cambodia: a convergent mixed method study. BMC Nurs 2023; 22:265. [PMID: 37568231 PMCID: PMC10416455 DOI: 10.1186/s12912-023-01420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND In the last decade, nursing education has begun to reform to competency-based education worldwide, including in low-and middle-income countries. Case-Based Learning (CBL), an approach to delivering competency-based education, contributes to acquiring critical thinking competency, problem-solving, higher knowledge, professional value and attitude. However, it needs to be taught in a culturally appropriate manner. In Cambodia, CBL was initiated in a classroom and clinical practicum by faculty and preceptors who graduated from the upgrading course. This study examined the factors associated with the competency level of nursing students, explored the practice and perceptions of teaching-learning activities among students, faculty members and preceptors and assessed the coherence of qualitative and quantitative findings. METHODS This was a convergent, mixed methods study. Data were collected from eight educational institutions for quantitative and qualitative studies and seven hospitals for qualitative studies. From June to September 2019, a cross-sectional survey of nursing students in the third year of the three-year programme (n = 719), eight focus group discussions (FGDs; n = 55) with 6-8 members and 15 FGDs with faculty (n = 38) and clinical preceptors (n = 37) with 4-7 members were conducted to elicit the teaching-learning experience and perceptions. Multiple linear regression was performed to investigate the factors associated with student competency. Moreover, the study conducted thematic content analysis on the qualitative data. The integrated analysis was presented as side-by-side joint displays. RESULTS First, the quantitative and qualitative findings confirmed each other 's CBL learning experiences. Students had higher levels of nursing competencies if they had CBL experiences, both in the classroom and clinical practicum, both in a group manner. Next, the quantitative and qualitative findings complemented students' academic satisfaction with the teaching by faculty members and preceptors. Finally, the quantitative and qualitative findings were expanded to explain students' academic satisfaction with the programme. CONCLUSIONS The finding of CBL experiences in a group and students' satisfaction with faculty members' and preceptors' teaching improved nursing students' competency development. Meanwhile, students' satisfaction with the design and delivery of the educational programme provides implications for policy level to narrow the theory and practice gaps in low- and middle-income countries.
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Affiliation(s)
- Kyoko Koto-Shimada
- Department of Community and Global Health, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-0033 Japan
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, Storrs, Connecticut, 06030-6325 USA
| | - Akira Shibanuma
- Department of Community and Global Health, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-0033 Japan
| | - Junko Kiriya
- Department of Community and Global Health, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-0033 Japan
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-0033 Japan
| | - Sokneang Touch
- Department of Human Resource Development, Ministry of Health Cambodia, No:80, Samdach Penh Nouth Blvd (289), Sankat Beoungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - Virya Koy
- Department of Hospital Service, Ministry of Health Cambodia, No:80, Samdach Penh Nouth Blvd (289), Sankat Beoungkak 2, Tuol Kork District, Phnom Penh, Cambodia
| | - Masamine Jimba
- Department of Community and Global Health, School of International Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo, 113-0033 Japan
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12
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Koduah A. How and why pharmaceutical reforms contribute to universal health coverage through improving equitable access to medicines: a case of Ghana. Front Public Health 2023; 11:1163342. [PMID: 37483923 PMCID: PMC10360122 DOI: 10.3389/fpubh.2023.1163342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Examining how and why a country prioritizes and implements pharmaceutical reforms tends to show complex processes and myriad efforts made toward improving access to medicines. This study examines factors that enabled the prioritization and implementation of selected pharmaceutical reform items and how these factors contributed to improving equitable access to medicines and universal health coverage in Ghana. Methods An analytical framework was developed to identify variables to explore in answering the study questions and frame the analysis and presentation of findings. Documents analyzed included the National Medicines Policies, Health Sector Program of Work, and other health policies. Quantitative data were sourced from databases maintained by World Health Organization and the Institute for Health Metrics and Evaluation. Results The three main factors, evidence, financial and technical support, and alignment to national and global policies, influenced the prioritization and implementation of access to medicines reforms. The reforms targeted rational selection and use of medicines, medicine pricing, sustainable medicine financing, and regulatory and supply chain systems. Although there were limited quantitative data to quantify access to medicine policies" impact on universal health coverage, it can be reasonably assumed that, in Ghana, access to medicine policies has contributed to financial protection and improved access to quality health services. Conclusion Access to medicine policies targeted at promoting rational medicine selection and use, regulating medicine pricing and improving sustainable financing for medicines as well as the regulatory and supply chain systems arguably contributed to the attainment of UHC and must be sustained. Therefore, data collection and reporting indicators for access to medicines must be prioritized.
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Tang Y, Zhang F, Xu DR. The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon. Glob Health Res Policy 2023; 8:14. [PMID: 37198704 PMCID: PMC10190061 DOI: 10.1186/s41256-023-00299-x] [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: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.
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Affiliation(s)
- Yu Tang
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Feifei Zhang
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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14
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Lombe DC, Mwamba M, Msadabwe S, Bond V, Simwinga M, Ssemata AS, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e067715. [PMID: 37055211 PMCID: PMC10106057 DOI: 10.1136/bmjopen-2022-067715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Late presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA. DESIGN Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. EXCLUSION CRITERIA paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways). DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes. RESULTS 57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines. CONCLUSIONS Robust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.
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Affiliation(s)
| | | | - Susan Msadabwe
- Department of Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Virginia Bond
- Social Science, London School of Hygiene & Tropical Medicine and ZAMBART, Lusaka, Zambia
| | | | - Andrew Sentoogo Ssemata
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Richard Muhumuza
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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15
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Bennett E, Topp SM, Moodie AR. National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries - A Scoping Review and Framework Synthesis. Int J Health Policy Manag 2023; 12:6876. [PMID: 37579395 PMCID: PMC10425693 DOI: 10.34172/ijhpm.2023.6876] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Corporations in unhealthy commodity industries (UCIs) have growing influence on the health of national populations through practices that lead to increased consumption of unhealthy products. The use of government-led public health surveillance is best practice to better understand any emerging public health threat. However, there is minimal systematic evidence, generated and monitored by national governments, regarding the scope of UCI corporate practices and their impacts. This study aims to synthesise current frameworks that exist to identify and monitor UCI influence on health to highlight the range of practices deployed by corporations and inform future surveillance efforts in key UCIs. METHODS Seven biomedical, business and scientific databases were searched to identify literature focused on corporate practices that impact human health and frameworks for monitoring or assessment of the way UCIs impact health. Content analysis occurred in three phases, involving (1) the identification of framework documents in the literature and extraction of all corporate practices from the frameworks; (2) initial inductive grouping and synthesis followed by deductive synthesis using Lima and Galea's 'vehicles of power' as a heuristic; and (3) scoping for potential indicators linked to each corporate practice and development of an integrated framework. RESULTS Fourteen frameworks were identified with 37 individual corporate practices which were coded into five different themes according the Lima and Galea 'Corporate Practices and Health' framework. We proposed a summary framework to inform the public health surveillance of UCIs which outlines key actors, corporate practices and outcomes that should be considered. The proposed framework draws from the health policy triangle framework and synthesises key features of existing frameworks. CONCLUSION Systematic monitoring of the practices of UCIs is likely to enable governments to mitigate the negative health impacts of corporate practices. The proposed synthesised framework highlights the range of practices deployed by corporations for public health surveillance at a national government level. We argue there is significant precedent and great need for monitoring of these practices and the operationalisation of a UCI monitoring system should be the object of future research.
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Affiliation(s)
- Elizabeth Bennett
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, VIC, Australia
| | - Alan Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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16
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Kentikelenis A, Ghaffar A, McKee M, Dal Zennaro L, Stuckler D. Donor support for Health Policy and Systems Research: barriers to financing and opportunities for overcoming them. Global Health 2022; 18:106. [PMID: 36564847 PMCID: PMC9782264 DOI: 10.1186/s12992-022-00896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The vast investments that have been made in recent decades in new medicines, vaccines, and technologies will only lead to improvements in health if there are appropriate and well-functioning health systems to make use of them. However, despite the growing acceptance by major global donors of the importance of health systems, there is an enthusiasm gap when it comes to disbursing funds needed to understand the intricacies of how, why and when these systems deliver effective interventions. To understand the reasons behind this, we open up the black box of donor decision-making vis-à-vis Health Policy and Systems Research (HPSR) financing: what are the organizational processes behind the support for HPSR, and what are the barriers to increasing engagement? METHODS We conducted 27 semi-structured interviews with staff of major global health funders, asking them about four key issues: motivations for HPSR financing; priorities in HPSR financing; barriers for increasing HPSR allocations; and challenges or opportunities for the future. We transcribed the interviews and manually coded responses. RESULTS Our findings point to the growing appreciation that funders have of HPSR, even though it is often still seen as an 'afterthought' to larger programmatic interventions. In identifying barriers to funding HPSR, our informants emphasised the perceived lack of mandate and capacities of their organizations. For most funding organisations, a major barrier was that their leadership often voiced scepticism about HPSR's long time horizons and limited ability to quantify results. CONCLUSION Meeting contemporary health challenges requires strong and effective health systems. By allocating more resources to HPSR, global donors can improve the quality of their interventions, and also contribute to building up a stock of knowledge that domestic policymakers and other funders can draw on to develop better targeted programmes and policies.
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Affiliation(s)
- Alexander Kentikelenis
- Department of Social and Political Sciences, Bocconi University, via Roentgen 1, 20136, Milano, Italy.
| | - Abdul Ghaffar
- grid.3575.40000000121633745Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Livia Dal Zennaro
- grid.3575.40000000121633745Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - David Stuckler
- grid.7945.f0000 0001 2165 6939Department of Social and Political Sciences, Bocconi University, via Roentgen 1, 20136 Milano, Italy
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17
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Noor MN, Khan M, Rahman-Shepherd A, Siddiqui AR, Khan SS, Azam I, Shakoor S, Hasan R. Impact of a multifaceted intervention on physicians' knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial. BMJ Open 2022; 12:e067233. [PMID: 36332959 PMCID: PMC9639112 DOI: 10.1136/bmjopen-2022-067233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands. METHODS AND ANALYSIS This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion. TRIAL REGISTRATION NUMBER ISRCTN12294839.
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Affiliation(s)
- Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Afifah Rahman-Shepherd
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sabeen Sharif Khan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Iqbal Azam
- Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
- Faculty of Infectious and Tropical Disease, The London School of Hygiene and Tropical Medicine, London, UK
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Tangcharoensathien V, Sudhakar M, Birhanu Z, Abraham G, Bawah A, Kyei P, Biney A, Shroff ZC, Witthayapipopsakul W, Panichkriangkrai W. Health Policy and Systems Research Capacities in Ethiopia and Ghana: Findings From a Self-Assessment. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00715. [PMID: 36109057 PMCID: PMC9476481 DOI: 10.9745/ghsp-d-21-00715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022]
Abstract
Government investment in strengthening health policy and systems research capacities is needed to enhance the generation of evidence for effective policy making. Researchers’ engagement in the policy-making process helps shape policy-relevant research and support policy-relevant decisions. Introduction: Health systems are complex. Policies targeted at health system development may be informed by health policy and systems research (HPSR). This study assesses HPSR capacity to generate evidence and inform policy in Ethiopia and Ghana. Methods: We used a mixed-methods approach including a self-administered survey at selected HPSR institutes and in-depth interviews of policy makers. Results: Both countries have limited capacity to generate HPSR evidence, especially in terms of mobilizing adequate funding and retaining a critical number of competent researchers who understand complex policy processes, have the skills to influence policy, and know policy makers’ demands for evidence. Common challenges are limited government research funding, rigidity in executing the research budget, and reliance on donor funding that might not respond to national health priorities. There are no large research programs in either country. The annual number of HPSR projects per research institute in Ethiopia (10 projects) was higher than in Ghana (2.5 projects), Ethiopia has a significantly smaller annual budget for health research. Policy makers in the 2 countries increasingly recognize the importance of evidence-informed policy making, but various challenges remain in building effective interactions with HPSR institutes. Conclusion: We propose 3 synergistic recommendations to strengthen HPSR capacity in Ethiopia and Ghana. First, strengthen researchers’ capacity and enhance their opportunities to know policy actors; engage with the policy community; and identify and work with policy entrepreneurs, who have attributes, skills, and strategies to achieve a successful policy. Second, deliver policy-relevant research findings in a timely way and embed research into key health programs to guide effective implementation. Third, mobilize local and international funding to strengthen HPSR capacities as well as address challenges with recruiting and retaining a critical number of talented researchers. These recommendations may be applied to other low- and middle-income countries to strengthen HPSR capacities.
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Affiliation(s)
| | | | - Zewdie Birhanu
- Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayaga Bawah
- Regional Institute of Population Studies, Accra, Ghana
| | - Pearl Kyei
- Regional Institute of Population Studies, Accra, Ghana
| | - Adriana Biney
- Regional Institute of Population Studies, Accra, Ghana
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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19
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Khan M, Rahman-Shepherd A, Bory S, Chhorn S, Durrance-Bagale A, Hasan R, Heng S, Phou S, Prien C, Probandari A, Saphonn V, Suy S, Wiseman V, Wulandari LPL, Hanefeld J. How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan. BMJ Glob Health 2022; 7:bmjgh-2022-008596. [PMID: 35589155 PMCID: PMC9121421 DOI: 10.1136/bmjgh-2022-008596] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background There has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups—policymakers, healthcare providers and pharmaceutical companies—that can create COI, and elucidate the impacts of COI on stages of the policy process. Methods Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. Findings We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Interpretation Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
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Affiliation(s)
- Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK .,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Anna Durrance-Bagale
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rumina Hasan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | | | | | - Chanra Prien
- University of Health Sciences, Phnom Penh, Cambodia
| | | | | | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Center for International Health Protection, Robert Koch Institut, Berlin, Germany
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20
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Widdig H, Tromp N, Lutwama GW, Jacobs E. The political economy of priority-setting for health in South Sudan: a case study of the health pooled fund. Int J Equity Health 2022; 21:68. [PMID: 35578242 PMCID: PMC9108706 DOI: 10.1186/s12939-022-01665-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In fragile and conflict affected settings (FCAS) such as South Sudan, where health needs are immense, resources are scarce, health infrastructure is rudimentary or damaged, and government stewardship is weak, adequate health intervention priority-setting is especially important. There is a scarcity of research examining priority-setting in FCAS and the related political economy. Yet, capturing these dynamics is important to develop context-specific guidance for priority-setting. The objective of this study is to analyze the priority-setting practices in the Health Pooled Fund (HPF), a multi-donor fund that supports service delivery in South Sudan, using a political economy perspective. METHODS A multi-method study was conducted combining document review, 30 stakeholder interviews, and an examination of service delivery. An adapted version of the Walt and Gilson policy analysis triangle guided the study's design and analysis. RESULTS Priority-setting in HPF occurs in a context of immense fragility where health needs are vast, service delivery remains weak, and external funding is essential. HPF's service package gives priority to the health of mothers and children, gender-sensitive programming, immunization services, and a community health initiative. HPF is structured by a web of actors at national and local levels with pronounced power asymmetries and differing vested interests and ideas about HPF's role. Priority-setting takes place throughout program design, implementing partner (IP) contract negotiation, and implementation of the service package. In practice the BPHNS does not provide adequate guidance for priority-setting because it is too expansive and unrealistic given financial and health system constraints. At the local level, IPs must manage the competing interests of the HPF program and local health authorities as well as challenging contextual factors, including conflict and shortages of qualified health workers, which affect service provision. The resulting priority-setting process remains implicit, scarcely documented, and primarily driven by donors' interests. CONCLUSION This study highlights power asymmetries between donors and national health authorities within a FCAS context, which drive a priority-setting process that is dominated by donor agendas and leave little room for government ownership. These findings emphasize the importance of paying attention to the influence of stakeholders and their interests on the priority-setting process in FCAS.
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Affiliation(s)
- Heloise Widdig
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.
| | - Noor Tromp
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | | | - Eelco Jacobs
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
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21
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Khan U, Lotia-Farrukh I, Akhtar A, Khowaja SN, Khan S, Madhani F, Parekh A, Adnan S, Ahmed S, Chaudhry M, Hussain H, Habib A, Butt S, Siddiqui MR, Ijaz R, Jamal S, Khan AB, Keshavjee S, Khan AJ, Salahuddin N, Khan PY. Re-Evaluating the Merits of Decentralisation as a Core Strategy for Effective Delivery of Drug-Resistant Tuberculosis Care in Pakistan. Health Policy Plan 2022; 37:979-989. [PMID: 35527232 PMCID: PMC9384034 DOI: 10.1093/heapol/czac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/04/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models—made increasingly urgent by the COVID-19 pandemic—are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005–1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
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Affiliation(s)
- Uzma Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Ahwaz Akhtar
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saira N Khowaja
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | | | - Asra Parekh
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Sana Adnan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Mariam Chaudhry
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Hamidah Hussain
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Ali Habib
- Interactive Health Solutions, Karachi, Sindh, Pakistan
| | - Shahid Butt
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Muhammad R Siddiqui
- Provincial TB Program, Sindh, Pakistan
- Institute of Chest Diseases, Kotri, Sindh, Pakistan
| | - Raafia Ijaz
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saba Jamal
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Abdul B Khan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Salmaan Keshavjee
- Harvard University, Cambridge, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Aamir J Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Palwasha Y Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kapiriri L, Razavi SD. Equity, justice, and social values in priority setting: a qualitative study of resource allocation criteria for global donor organizations working in low-income countries. Int J Equity Health 2022; 21:17. [PMID: 35135553 PMCID: PMC8822856 DOI: 10.1186/s12939-021-01565-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing acceptance of the importance of social values such as equity and fairness in health care priority setting (PS). However, equity is difficult to define: the term means different things to different people, and the ways it is understood in theory often may not align with how it is operationalized. There is limited literature on how development assistance partner organizations (DAP) conceptualize and operationalize equity in their health care prioritization decisions that affect low-income countries (LIC). This paper explores whether and how equity is a consideration in DAP priority setting processes. Methods This was a qualitative study involving 38 in-depth interviews with DAPs involved in health-system PS for LICs and a review of their respective webpages. Results While several PS criteria were identified, direct articulation of equity as an explicit criterion was lacking. However, the criterion was implied in some of the responses in terms of prioritizing vulnerable populations. Where mentioned, respondents discussed the difficulties of operationalizing equity as a PS criterion since vulnerability is associated with several varying and competing factors including gender, age, geography, and income. Some respondents also suggested that equity could be operationalized in terms of an organization not supporting the pre-existing inequities. Although several organizations’ webpages identify addressing inequities as a guiding principle, there were variations in how they spoke about its operationalization. While intersectionalities in vulnerabilities complicate its operationalization, if organizations explicitly articulate their equity focus the other organizations who also have equity as a guiding principle may, instead of focusing on the same aspect, concentrate on other dimensions of vulnerability. That way, all organizations will contribute to achieving equity in all the relevant dimensions. Conclusions Since most development organizations support some form of equity, this paper highlights a need for an internationally recognized framework that recognizes the intersectionalities of vulnerability, for mainstreaming and operationalizing equity in DAP priority setting and resource allocation. Such a framework will support consistency in the conceptualization of and operationalization of equity in global health programs. There is a need for studies which to assess the degree to which equity is actually integrated in these programs. Equity has become an increasingly important focus in the health and social science literature, however, equity is a contested concept. While development assistance partners supporting health development subscribe to equity as a guiding principle, they struggle with its operationalization. There is need for a general framework that explicitly conceptualizes the operationalization of equity in health development.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada.
| | - S Donya Razavi
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada
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Kwete X, Tang K, Chen L, Ren R, Chen Q, Wu Z, Cai Y, Li H. Decolonizing global health: what should be the target of this movement and where does it lead us? Glob Health Res Policy 2022; 7:3. [PMID: 35067229 PMCID: PMC8784247 DOI: 10.1186/s41256-022-00237-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
The current decolonizing global health movement is calling us to take a post-colonial perspective at the research and practice of global health, an area that has been re-defined by contemporary scholars and advocates with the purpose of promoting equity and justice. In this article, we summarize the main points of discussion from the Symposium organized by the editorial board of Global Health Research and Policy, convened in July 2021 in Wuhan, China. Experts participating in the symposium discussed what decolonizing global health means, how to decolonize it, and what criteria to apply in measuring its completion. Through the meeting, a consensus was reached that the current status quo of global health is still replete with various forms of colonial vestiges-ideologies and practices-, and to fully decolonize global health, systemic reforms must be taken that target the fundamental assumptions of global health: does investment in global health bring socioeconomic development, or is it the other way around? Three levels of colonial vestiges in global health were raised and one guiding principle was proposed when thinking of solutions for them. More theoretical discussion needs to be explored to guide practices to decolonize global health.
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Affiliation(s)
- Xiaoxiao Kwete
- Global Health Research and Consulting, Yaozhi, Yangzhou, China.
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Lucy Chen
- National School of Development, Peking University, Beijing, China
| | - Ran Ren
- Global Health Research Center, Dalian Medical University, Dalian, China
| | - Qi Chen
- Institute for Advanced Studies in Humanities and Social Sciences, Beihang University, Beijing, China
| | - Zhenru Wu
- Institute for the World Economy, Shanghai Academy of Social Sciences, Shanghai, China
| | - Yi Cai
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hao Li
- Global Health Institute, Wuhan University, Wuhan, China
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24
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Sichimba D, Bandyopadhyay S, Ciuculete AC, Erhabor J, Kotecha J, Egiz A, Bankole NDA, Higginbotham G, Dalle DU, Kanmounye US. Neurosurgical Equipment Donations: A Qualitative Study. Front Surg 2022; 8:690910. [PMID: 35127801 PMCID: PMC8810520 DOI: 10.3389/fsurg.2021.690910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionNeurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. However, there is currently no published literature on whether there is a need for neurosurgical equipment donations or how to design equipment donation programmes that meet the needs of LMIC neurosurgeons. The primary aims of this study were to explore: (1) the need for the donation of neurosurgical equipment from the UK and Ireland to LMICs within the African continent, and (2) the ways through which neurosurgical equipment donations could meet the needs of LMIC neurosurgeons.MethodsThis was a qualitative study using semi-structured, one-on-one, audio-recorded interviews. Purposive sampling was used to recruit and interview consultants or attending neurosurgeons from Ireland, the UK and LMICs in Africa in a continuous process until data saturation. Interviews were conducted by members of the Association of Future African Neurosurgeons during March 2021. Qualitative analysis used a thematic approach using open and axial coding.ResultsFive HIC and 3 LMIC neurosurgeons were interviewed. Five overarching themes were identified: (1) inequality of access to neurosurgical equipment, (2) identifying specific neurosurgical equipment needs, (3) importance of organisations, (4) partnerships between LMIC and HIC centres, and (5) donations are insufficient in isolation.ConclusionThere is a need for greater access to neurosurgical equipment in LMICs. It is unclear if neurosurgical equipment donations are the optimal solution to this issue. Other solutions that are not linked to dependency need to be explored and executed. Collaborative relationships between LMICs and HICs better ensures that neurosurgical equipment donations meet the needs of the recipients. These relationships may be best created within an organisation framework that has the logistical capabilities of coordinating international equipment donation and providing a quality control measure.
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Affiliation(s)
- Dawin Sichimba
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
- *Correspondence: Dawin Sichimba
| | - Soham Bandyopadhyay
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ana Catinca Ciuculete
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Jay Kotecha
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Abdullah Egiz
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - George Higginbotham
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - David Ulrich Dalle
- Department of Research, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Faulkenberry JG, Luberti A, Craig S. Electronic health records, mobile health, and the challenge of improving global health. Curr Probl Pediatr Adolesc Health Care 2022; 52:101111. [PMID: 34969611 DOI: 10.1016/j.cppeds.2021.101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Technology continues to impact healthcare around the world. This provides great opportunities, but also risks. These risks are compounded in low-resource settings where errors in planning and implementation may be more difficult to overcome. Global Health Informatics provides lessons in both opportunities and risks by building off of general Global Health. Global Health Informatics also requires a thorough understanding of the local environment and the needs of low-resource settings. Forming effective partnerships and following the lead of local experts are necessary for sustainability; it also ensures that the priorities of the local community come first. There is an opportunity for partnerships between low-resource settings and high income areas that can provide learning opportunities to avoid the pitfalls that plague many digital health systems and learn how to properly implement technology that truly improves healthcare.
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Affiliation(s)
- J Grey Faulkenberry
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia.
| | - Anthony Luberti
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
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26
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Kwete XJ, Berhane Y, Mwanyika-Sando M, Oduola A, Liu Y, Workneh F, Hagos S, Killewo J, Mosha D, Chukwu A, Salami K, Yusuf B, Tang K, Zheng ZJ, Atun R, Fawzi W. Health priority-setting for official development assistance in low-income and middle-income countries: a Best Fit Framework Synthesis study with primary data from Ethiopia, Nigeria and Tanzania. BMC Public Health 2021; 21:2138. [PMID: 34801001 PMCID: PMC8605935 DOI: 10.1186/s12889-021-12205-6] [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: 04/09/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This process at country level has not been well studied. METHODS This paper developed and applied a new framework to analyze decision-making process for priority setting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refine the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed. RESULTS A framework was developed based on 40 articles selected from 6860 distinct search records. Twenty-one interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specific challenges faced by each country. We found that multiple stakeholders working around one national plan was the preferred approach used for priority setting in the countries studied. CONCLUSIONS Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership of priority setting for ODA and improve aid effectiveness.
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Affiliation(s)
- Xiaoxiao Jiang Kwete
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02150, USA.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Ayo Oduola
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | - Yuning Liu
- JPMorgan Chase Institute, Washington, DC, USA
| | | | - Smret Hagos
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dominic Mosha
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Angela Chukwu
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | - Kabiru Salami
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | - Bidemi Yusuf
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | - Kun Tang
- Tsinghua University Vanke School of Public Health, Beijing, China
| | - Zhi-Jie Zheng
- Peking University School of Public Health, Beijing, China
| | - Rifat Atun
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02150, USA
| | - Wafaie Fawzi
- Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02150, USA
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Ruwanpura V, Neukom J, Grietens KP, Price RN, Thriemer K, Lynch CA. Opening the policy blackbox: unravelling the process for changing national diagnostic and treatment guidelines for vivax malaria in seven countries. Malar J 2021; 20:428. [PMID: 34717642 PMCID: PMC8556862 DOI: 10.1186/s12936-021-03959-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The changing global health landscape has highlighted the need for more proactive, efficient and transparent health policy-making. After more than 60 years of limited development, novel tools for vivax malaria are finally available, but need to be integrated into national policies. This paper maps the malaria policy-making processes in seven endemic countries, to identify areas where it can be improved to align with best practices and optimal efficiency. METHODS Data were collected during a workshop, convened by the Asia Pacific Malaria Elimination Network's Vivax Working Group in 2019, and subsequent interviews with key stakeholders from Cambodia, Ethiopia, Indonesia, Pakistan, Papua New Guinea (PNG), Sri Lanka and Vietnam. Documentation of policy processes provided by respondents was reviewed. Data analysis was guided by an analytic framework focused on three a priori defined domains: "context," "actors" and "processes". RESULTS The context of policy-making varied with available funding for malaria, population size, socio-economic status, and governance systems. There was limited documentation of the process itself or terms of reference for involved actors. In all countries, the NMP plays a critical role in initiating and informing policy change, but the involvement of other actors varied considerably. Available evidence was described as a key influencer of policy change; however, the importance of local evidence and the World Health Organization's endorsement of new treatments and diagnostics varied. The policy process itself and its complexity varied but was mostly semi-siloed from other disease specific policy processes in the wider Ministry of Health. Time taken to change and introduce a new policy guideline previously varied from 3 months to 3 years. CONCLUSIONS In the medium to long term, a better alignment of anti-malarial policy-making processes with the overall health policy-making would strengthen health governance. In the immediate term, shortening the timelines for policy change will be pivotal to meet proposed malaria elimination milestones.
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Affiliation(s)
- Varunika Ruwanpura
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | | | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
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Masefield SC, Msosa A, Chinguwo FK, Grugel J. Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi. BMC Health Serv Res 2021; 21:984. [PMID: 34537033 PMCID: PMC8449519 DOI: 10.1186/s12913-021-07016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through local level stakeholders' perceptions of their involvement in the NHP II and HSSP II. METHODS A qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as CSOs and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed. RESULTS Stakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Five categories were identified: tokenistic involvement; stakeholder hierarchy; mutual distrust; preferred stakeholders; no culture of engagement. CONCLUSIONS Serious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in consultation exercises alongside greater top-down efforts to engage stakeholders via diverse and inclusive methods. These issues are not unique to Malawi or to health policy-making.
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Affiliation(s)
- Sarah C Masefield
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, UK.
| | - Alan Msosa
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, UK
| | - Florence Kasende Chinguwo
- Health Economics and Policy Unit, Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, UK
- Department of Politics, University of York, York, YO10 5DD, UK
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Tadesse AW, Gurmu KK, Kebede ST, Habtemariam MK. Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia. Global Health 2021; 17:53. [PMID: 33902625 PMCID: PMC8074348 DOI: 10.1186/s12992-021-00702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country's health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. METHODS We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the "hardware" (using the World Health Organization's building blocks) and the "software" (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. RESULTS Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. CONCLUSIONS Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country's health indicators and may promote sustained functionality of the health system.
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Affiliation(s)
- Amare Worku Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Reproductive Health, Nutrition and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Kassu Ketema Gurmu
- Department of Global Health and Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Selamawit Tesfaye Kebede
- Department of Global Health and Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Meghani A, Ssemugabo C, Pariyo G, Hyder AA, Rutebemberwa E, Gibson DG. Curbing the Rise of Noncommunicable Diseases in Uganda: Perspectives of Policy Actors. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:149-159. [PMID: 33795366 PMCID: PMC8087435 DOI: 10.9745/ghsp-d-20-00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Uganda faces a complex policy landscape as it simultaneously addresses infectious diseases and noncommunicable diseases (NCDs). The health system has been overwhelmed by the growing burden of NCDs across all socioeconomic strata. In this study, we sought to understand the policy context around NCDs in Uganda, the roles of actors both within and external to the government, and the factors shaping the development and implementation of NCD policies and programs in Uganda. METHODS We conducted in-depth interviews with 30 policy actors from the Ugandan Ministry of Health (MOH), nongovernmental organizations, and academia to understand the roles of different actors in the Ugandan NCD space, the programs and policy measures in discussion, and how to bridge any identified gaps. A thematic data analysis was conducted. RESULTS All national actors viewed funding constraints as a critical barrier to developing and executing an NCD strategic plan and as a barrier to leading and coordinating NCD prevention and control efforts in Uganda. The crowding of nongovernment actors was found to fragment NCD efforts, particularly due to the weak implementation of a framework for action among NCD actors. Relatedly, limited recruitment of technical experts on NCDs within the MOH was viewed to further diminish the government's role in leading policy and program formulation and implementation. Though recent MOH efforts have aimed at addressing these concerns, some skepticism remains about the government's commitment to increase budgetary allocations for NCDs and to address the technical and human resources gaps needed to achieve NCD policy aims in Uganda. CONCLUSIONS This study highlights the immediate need to mobilize more resources, reduce fragmented efforts in the NCD space, and prioritize investment in NCD prevention and management in Uganda.
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Affiliation(s)
- Ankita Meghani
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Charles Ssemugabo
- Makerere University School of Public Health, College of Health Science, Kampala, Uganda
| | - George Pariyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adnan A Hyder
- George Washington University Milken Institute School of Public Health, Washington DC, USA
| | - Elizeus Rutebemberwa
- Makerere University School of Public Health, College of Health Science, Kampala, Uganda
| | - Dustin G Gibson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Salehi AS, Blanchet K, Vassall A, Borghi J. Political economy analysis of the performance-based financing programme in Afghanistan. Glob Health Res Policy 2021; 6:9. [PMID: 33750468 PMCID: PMC7945625 DOI: 10.1186/s41256-021-00191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Performance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. This study aimed to examine the political economy factors influencing the adoption, design and implementation of the PBF programme in Afghanistan. Methods Retrospective qualitative research methods were employed using semi structured interviews as well as a desk review of programme and policy documents. Key informants were selected purposively from the national level (n = 9), from the province level (n = 6) and the facility level (n = 15). Data analysis was inductive as well as deductive and guided by a political economy analysis framework to explore the factors that influenced the adoption and design of the PBF programme. Thematic content analysis was used to analyse the data. Results The global policy context, and implementation experience in other LMIC, shaped PBF and its introduction in Afghanistan. The MoPH saw PBF as a promise of additional resources needed to rebuild the country’s health system after a period of conflict. The MoPH support for PBF was also linked to their past positive experience of performance-based contracting. Power dynamics and interactions between PBF programme actors also shaped the policy process. The PBF programme established a centralised management structure which strengthened MoPH and donor ability to manage the programme, but overlooked key stakeholders, such as provincial health offices and non-state providers. However, MoPH had limited input in policy design, resulting in a design which was not well tailored to the national setting. Conclusions This study shows that PBF programmes need to be designed and adapted according to the local context, involving all relevant actors in the policy cycle. Future studies should focus on conducting empirical research to not only understand the multiple effects of PBF programmes on the performance of health systems but also the main political economy dynamics that influence the PBF programmes in different stages of the policy process.
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Affiliation(s)
- Ahmad Shah Salehi
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.
| | - Karl Blanchet
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.,CERAH, University of Geneva, Geneva, Switzerland
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
| | - Josephine Borghi
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
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EVITA 2.0, an updated framework for understanding evidence-based mental health policy agenda-setting: tested and informed by key informant interviews in a multilevel comparative case study. Health Res Policy Syst 2021; 19:35. [PMID: 33691696 PMCID: PMC7948345 DOI: 10.1186/s12961-020-00651-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Mental health remains a neglected issue on the global health policy agenda, particularly in low- and middle-income countries (LMIC), and the translation of research evidence into policy and practice is slow. The new EVITA framework was developed to improve mental health evidence uptake and policy agenda-setting in LMICs. In addition, behavioural science methods may be able to support knowledge translation to policy. Methods Using a mixed-methods study design, we applied and tested the newly developed EVITA 1.1 framework against three case studies related to South Africa at the district, national and international levels. In-depth interviews with 26 experts were conducted between August and November 2019, transcribed, coded and analysed in NVivo, using iterative categorization. The data were analysed against both the EVITA framework and the MINDSPACE framework for behavioural insights. Results In our case study comparison, we found that (1) research translation to the policy agenda occurs in a complex, fluid system which includes multiple “research clouds”, “policy spheres” and other networks; (2) mental health research policy agenda-setting is based on key individuals and intermediaries and their interrelationships; and (3) key challenges and strategies for successful research to policy agenda impact are known, but are frequently not strategically implemented, such as including all stakeholders to overcome the policy implementation gap. Our data also suggest that behavioural science methods can be strategically applied to support knowledge translation to policy agenda-setting. Conclusion We found that the EVITA framework is useful for understanding and improving mental health research policy interrelationships to support evidence uptake to the policy agenda, and that behavioural science methods are effective support mechanisms. The revised EVITA 2.0 framework therefore includes behavioural insights, for improved mental health policy agenda-setting in LMICs. More research is needed to understand whether EVITA can be applied to other LMICs and to high-income contexts.
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Parkhurst J, Ghilardi L, Webster J, Snow RW, Lynch CA. Competing interests, clashing ideas and institutionalizing influence: insights into the political economy of malaria control from seven African countries. Health Policy Plan 2021; 36:35-44. [PMID: 33319225 PMCID: PMC7938496 DOI: 10.1093/heapol/czaa166] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development.
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Affiliation(s)
- Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Ludovica Ghilardi
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Jayne Webster
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robert W Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Caroline A Lynch
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Matsuoka S, Fujita N, Koto-Shimada K, Zwi AB. Regulation of nursing professionals in Cambodia: strategies to overcome underpinning challenges. Int Nurs Rev 2021; 68:399-411. [PMID: 33459373 DOI: 10.1111/inr.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Abstract
AIMS To elucidate (i) the challenges and constraints in the development and implementation of the regulatory framework for nursing professionals in Cambodia and (ii) the specific strategies adopted to address the challenges experienced in Cambodia. INTRODUCTION The health workforce will be critical to achieving the health-related and wider Sustainable Development Goals in the years up to 2030. BACKGROUND In 2006, the countries of the Association of Southeast Asian Nations signed a Mutual Recognition Arrangement in relation to nursing services in the region with the main aim of facilitating the mobility of nursing professionals between countries. To ensure the competency of the health workforce and the quality and safety of health services, member states are required to establish an appropriate regulatory framework. METHODS This is a qualitative descriptive study. Eighteen key informant interviews were conducted in Cambodia in 2018. Walt and Gilson's policy analysis model was applied to organize and synthesize the data. FINDINGS Major challenges were identified such as conceptual and cultural issues, limited capacity of Cambodian stakeholders and an unstandardized system with limited coordination. DISCUSSION In Cambodia, the nursing regulatory environment has expanded greatly over the last decade. Strategies adopted were 'political leadership', optimal utilization of 'outsider's capacity', strengthening 'insider's capacity', and 'dedicated consultation and collaboration and consensus building' involving all players. IMPLICATIONS FOR NURSING AND HEALTH POLICIES Policymakers in similar resource-limited countries could apply and adapt similar strategic efforts when formulating and implementing health policies, legislation and regulations. 'Outsiders', in this case, represented by development partners can play a vital role in the process, but should not be leading the charge. They should be aligned with national priority to support recipient countries. It is imperative for these countries and development partners to invest in increasing the quantity and quality of nursing leaders who can develop and advance regulatory functions.
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Affiliation(s)
- S Matsuoka
- Department of Human Resource Development, Bureau of International Health Cooperation, National Centre for Global Health and Medicine, Tokyo, Japan
| | - N Fujita
- Department of Global Network and Partnership, Bureau of International Health Cooperation, National Centre for Global Health and Medicine, Tokyo, Japan
| | - K Koto-Shimada
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - A B Zwi
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, Australia
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Khan M. Might representation of the UK's international aid be overly positive? Lancet 2021; 397:193. [PMID: 33347813 DOI: 10.1016/s0140-6736(20)32628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Aga Khan University, Karachi, Sindh, Pakistan.
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Sengchaleun V, Samri MA, Kounnavong S, Reinharz D. Advocacy Coalition by External Actors and Strategies Used to Influence the Emergence of the National Nutrition Policy in Lao PDR. Health (London) 2021. [DOI: 10.4236/health.2021.138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Balane MA, Palafox B, Palileo-Villanueva LM, McKee M, Balabanova D. Enhancing the use of stakeholder analysis for policy implementation research: towards a novel framing and operationalised measures. BMJ Glob Health 2020; 5:e002661. [PMID: 33158851 PMCID: PMC7651378 DOI: 10.1136/bmjgh-2020-002661] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Policy is shaped and influenced by a diverse set of stakeholders at the global, national and local levels. While stakeholder analysis is a recognised practical tool to assess the positions and engagement of actors relevant to policy, few empirical studies provide details of how complex concepts such as power, interest and position are operationalised and assessed in these types of analyses. This study aims to address this gap by reviewing conceptual approaches underlying stakeholder analyses and by developing a framework that can be applied to policy implementation in low-and-middle income countries. METHODS The framework was developed through a three-step process: a scoping review, peer review by health policy experts and the conduct of an analysis using key informant interviews and a consensus building exercise. Four characteristics were selected for inclusion: levels of knowledge, interest, power and position of stakeholders related to the policy. RESULT The framework development process highlighted the need to revisit how we assess the power of actors, a key issue in stakeholder analyses, and differentiate an actor's potential power, based on resources, and whether they exercise it, based on the actions they take for or against a policy. Exploration of the intersections between characteristics of actors and their level of knowledge can determine interest, which in turn can affect stakeholder position on a policy, showing the importance of analysing these characteristics together. Both top-down and bottom-up approaches in implementation must also be incorporated in the analysis of policy actors, as there are differences in the type of knowledge, interest and sources of power among national, local and frontline stakeholders. CONCLUSION The developed framework contributes to health policy research by offering a practical tool for analysing the characteristics of policy actors and tackling the intricacies of assessing complex concepts embedded in the conduct of stakeholder analyses.
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Affiliation(s)
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
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Walsh CM, Mwase T, De Allegri M. How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II. Int J Health Plann Manage 2020; 35:1571-1592. [PMID: 33030271 DOI: 10.1002/hpm.3055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.
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Affiliation(s)
- Caitlin M Walsh
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Takondwa Mwase
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Manuela De Allegri
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
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The role of external actors in shaping migrant health insurance in Thailand. PLoS One 2020; 15:e0234642. [PMID: 32614845 PMCID: PMC7332068 DOI: 10.1371/journal.pone.0234642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
The role of external actors in national health policy in aid-independent countries has received relatively little attention in the literature, despite the fact that influence continues to be exerted once financial support is curtailed as countries graduate from lower income status. Focusing on a specific health policy in an aid-independent country, this qualitative study explores the role of external actors in shaping Thailand’s migrant health insurance. Primary data were collected through in-depth interviews with eighteen key informants from September 2018 to January 2019. The data were analysed using thematic analysis, focusing on three channels of influence, financial resources, technical expertise and inter-sectoral leverage, and their effect on the different stages of the policy process. Given Thailand’s export orientation and the importance of reputational effects, inter-sectoral leverage, mainly through the US TIP Reports and the EU carding decision, emerged as a very powerful channel of influence on priority setting, as it indirectly affected the migrant health insurance through efforts aimed at dealing with problems of human trafficking in the context of labour migration, especially after the 2014 coup d'état. This study helps understand the changed role external actors can play in filling health system gaps in aid-independent countries.
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Wu S, Khan M, Legido-Quigley H. What steps can researchers take to increase research uptake by policymakers? A case study in China. Health Policy Plan 2020; 35:665-675. [PMID: 32386212 DOI: 10.1093/heapol/czaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 11/14/2022] Open
Abstract
Empirical analysis of the connections between research and health policymaking is scarce in middle-income countries. In this study, we focused on a national multidrug-resistant tuberculosis (TB) healthcare provider training programme in China as a case study to examine the role that research plays in influencing health policy. We specifically focused on the factors that influence research uptake within the complex Chinese policymaking process. Qualitative data were collected from 34 participants working at multilateral organizations, funding agencies, academia, government agencies and hospitals through 14 in-depth interviews and 2 focus group discussions with 10 participants each. Themes were derived inductively from data and grouped based on the 'Research and Policy in Developing countries' framework developed by the Overseas Development Institute. We further classified how actors derive their power to influence policy decisions following the six sources of power identified by Sriram et al. We found that research uptake by policymakers in China is influenced by perceived importance of the health issues addressed in the research, relevance of the research to policymakers' information needs and government's priorities, the research quality and the composition of the research team. Our analysis identified that international donors are influential in the TB policy process through their financial power. Furthermore, the dual roles of two government agencies as both evidence providers and actors who have the power to influence policy decisions through their technical expertise make them natural intermediaries in the TB policy process. We concluded that resolving the conflict of interests between researchers and policymakers, as suggested in the 'two-communities theory', is not enough to improve evidence use by policymakers. Strategies such as framing research to accommodate the fast-changing policy environment and making alliances with key policy actors can be effective to improve the communication of research findings into the policy process, particularly in countries undergoing rapid economic and political development.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
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Barlow P. Global disparities in health-systems financing: A cross-national analysis of the impact of tariff reductions and state capacity on public health expenditure in 65 low- and middle-income countries, 1996-2015. Health Place 2020; 63:102329. [PMID: 32543420 DOI: 10.1016/j.healthplace.2020.102329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Abstract
Understanding what contributes to cross-national differences in public health spending among low- and middle-income countries (LMICs) can help identify how policy-makers can reduce global disparities. Yet, research on this topic has so far overlooked the potential influence of one of the most strongly recommended economic reforms during the post-war era: reducing international trade taxes, 'tariffs'. Tariffs are an important source of tax revenue for some LMICs. Tariff declines can impact on government finances, and these changes may constrain public health expenditure where states lack the capacity to tax non-trade activities. We examined the association between tariff changes and public health spending in 65 LMICs, 1996-2015. We identify substantial variation in this association according to one indicator of state capacity, a country's score on the World Governance Indicators government effectiveness (GE) index. For example, tariff declines corresponded to reduced public health expenditures in countries with low GE scores. Our results suggest that tariff changes and domestic taxation capacities have an under-recognised impact on public health expenditure and may contribute to global health spending disparities.
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Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics, Houghton Street, London, WC2A 2AE, United Kingdom.
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Murshid ME, Haque M. Hits and misses of Bangladesh National Health Policy 2011. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:83-93. [PMID: 32742106 PMCID: PMC7373115 DOI: 10.4103/jpbs.jpbs_236_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/04/2022] Open
Abstract
National Health Policy (NHP) is a guiding principle for a country to identify the priority of health-care needs, resource allocations according to prioritization, and to achieve specific health-care goals. In addition, NHP is usually wide-ranging, all-inclusive plan that pursues each and every population to move on the road to better health. NHP targets to achieve universal health coverage and delivering quality health-care services to all at inexpensive cost, through a preemptive, protective, and prophylactic health-care program in all national and international developmental policy and planning. There are quite a few constituents that are valuable in executing health policy. These elements include novelty, technical compendium, communiqué, conglomerates, administration, supervision, and political awareness and promise. Health policies can be implemented at all levels of the government system. It helps in strengthening the overall health-care system of the country by effective public-private coordination and collaboration. In the year 1990, the Government of Bangladesh (GoB) tried to promulgate an NHP. Unfortunately, the attempt failed. The health-care system of the country operated without a policy until 2011. In the year 2011, the country's first health policy was published by the GoB. Though the country has have achieved excellent progress in providing health care, but yet Bangladesh has a few critical challenges that need immediate attention. In this article, we will try to address the pros and cons of the Bangladesh NHP 1990 and the positive aspects and challenges of NHP 2011.
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Affiliation(s)
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia), Kuala Lumpur, Malaysia
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Fisher A, Wallis S, Hassall O, Martin R, Bates I. Collaborations on blood transfusion research in sub-Saharan Africa: who, what and where. Vox Sang 2020; 115:221-232. [PMID: 32026497 PMCID: PMC7187137 DOI: 10.1111/vox.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 01/13/2023]
Abstract
Background and objectives Children and pregnant women use 75% of the blood supply in sub‐Saharan Africa (SSA) but face widespread blood shortages. To increase safe blood supply, Africa‐specific evidence and strengthened capacity for transfusion research are needed. Our study analysed seven years of SSA transfusion publications, compared researched topics against priorities and enumerated SSA transfusion research collaborations. Materials and methods Data on research topic, journal type, authors’ institutions and country were extracted from transfusion‐related SSA articles published between 2008 and 14 and used to construct a quantitative, graphic visualization of collaborations. Research topics were compared to those identified as priorities for SSA blood services in 2008 and 2015. Results Of the 2176, 267 articles (average 38/year) met criteria for analysis. They involved 1245 authors, 673 institutions, 59 countries (35 SSA) and 1375 collaborations. About 41% were on transfusion‐transmitted infections. About 34% were published in specialist transfusion journals. Only 7% involved exclusively collaborations within SSA. Two of the top fifteen institutions by publication quantity were from outside SSA. Conclusion Despite a general paucity of SSA‐relevant transfusion research, Francophone SSA was well‐represented. Published research topics are not well matched to SSA research priorities; research on supply, distribution, financing and systems is particularly neglected. The study provides a baseline against which to track any refocusing of research activity to better meet SSA’s needs. Transfusion research hubs within and beyond SSA have been identified as a springboard network for expanding SSA transfusion research capacity.
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Affiliation(s)
- Amelia Fisher
- St James's University Hospital, University of Leeds, Leeds, UK
| | | | | | - Russell Martin
- Department of Computer Science, University of Liverpool and The Data Incubator, Washington, DC
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, UK
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Khan MS, Durrance-Bagale A, Legido-Quigley H, Mateus A, Hasan R, Spencer J, Hanefeld J. 'LMICs as reservoirs of AMR': a comparative analysis of policy discourse on antimicrobial resistance with reference to Pakistan. Health Policy Plan 2019; 34:178-187. [PMID: 30977804 DOI: 10.1093/heapol/czz022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2019] [Indexed: 11/12/2022] Open
Abstract
Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. We compared representations of AMR across nine policy documents produced by multilateral agencies, donor countries and an LMIC at the forefront of the global response to AMR-Pakistan. We analysed the texts in relation to five narratives that have been commonly used to frame health issues as requiring action: economic impact, stunting of human development, consequences for health equity, health security threats and relationship with food production. We found that AMR was most frequently framed as a threat to human health security and economic progress, with several US, UK and international documents depicting LMICs as 'hotspots' for AMR. Human development and equity dimensions of the problem were less frequently discussed as reasons to address the growing burden of AMR. It is clear that no single coherent narrative on AMR has emerged, with notable differences in framing in Pakistani and external agency led documents, as well as across stakeholders primarily working on human vs animal health. While framing AMR as a threat to economic growth and human security has achieved high-level political attention and catalysed action from governments in high-income countries, our analysis suggests that conflicting narratives relevant to policymakers in Pakistan may affect policy-making and impede the development and implementation of integrated initiatives needed to tackle AMR.
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Affiliation(s)
- Mishal S Khan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Julia Spencer
- London School of Hygiene and Tropical Medicine, London, UK
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Qiu M, Sawadogo-Lewis T, Ngale K, Cane RM, Magaço A, Roberton T. Obstacles to advancing women's health in Mozambique: a qualitative investigation into the perspectives of policy makers. Glob Health Res Policy 2019; 4:28. [PMID: 31572806 PMCID: PMC6757408 DOI: 10.1186/s41256-019-0119-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022] Open
Abstract
Background Despite substantial investment in women’s health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15–24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates on the challenges that are preventing Mozambique from achieving greater gains in women’s health. Methods We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health and affiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic random sampling and snowball sampling. Participants were asked about their experiences formulating and implementing health policies and programs, what is needed to improve women’s health in Mozambique, and the barriers and opportunities to achieving such improvement. Results Participants unanimously argued that women’s health is already sufficiently prioritized in national health policies and strategies in Mozambique; the problem, rather, is the implementation and execution of existing women’s health policies and programs. Participants raised challenges related to the policy making process itself, including an ever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignment of programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership, rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported a disconnect between policy makers at the national level and realities on the ground, with poor dissemination of strategies, limited district resources, and poor consideration of local cultural contexts. Conclusions To achieve meaningful gains in women’s health in Mozambique, more focus must be placed on resolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiple health systems components, therefore, solutions to address them must also reach across these multiple components. A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed. Supplementary information Supplementary information accompanies this paper at (10.1186/s41256-019-0119-x).
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Affiliation(s)
- Mary Qiu
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
| | | | - Katia Ngale
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
| | | | - Amilcar Magaço
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Timothy Roberton
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
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Kiendrébéogo JA, Meessen B. Ownership of health financing policies in low-income countries: a journey with more than one pathway. BMJ Glob Health 2019; 4:e001762. [PMID: 31646009 PMCID: PMC6782032 DOI: 10.1136/bmjgh-2019-001762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Health Sciences Training and Research Unit, Ouagadougou, Kadiogo, Burkina Faso.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Tapera O. Determinants of long-lasting insecticidal net ownership and utilization in malaria transmission regions: evidence from Zimbabwe Demographic and Health Surveys. Malar J 2019; 18:278. [PMID: 31429761 PMCID: PMC6701104 DOI: 10.1186/s12936-019-2912-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/13/2019] [Indexed: 12/04/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLINs) were first introduced in 2010 as a vector control intervention, to complement indoor residual spraying, to reduce malaria transmission in Zimbabwe. The objective of this study was to investigate factors that were associated with LLIN ownership and utilization among households in malaria transmission regions of Zimbabwe. Methods A secondary analysis of cross sectional data from the Zimbabwe demographic and health survey (ZDHS) conducted in 2010 and 2015 surveys round was conducted. The analysis used household-level datasets from across the country to generate evidence for the study. Univariate analysis was used to yield descriptive statistics. Principal component analysis (PCA) was used to calculate wealth quintiles. Binary logistic regression approach was used to identify determinants of LLIN ownership and utilization after controlling for other factors. Data analyses were conducted using STATA version 14 software. Results There were no major changes in demographic characteristics of households sampled between 2010 and 2015 survey cycles. LLIN ownership increased significantly by 42 percentage points from 2010 to 2015. There was a tremendous increase in universal coverage of LLINs between 2010 and 2015. The overall utilization levels of LLINs among children under-5 years decreased by 11 percentage points between 2010 and 2015. LLIN usage amongst households followed the same trend with that of the under-fives. Using logistic regression model for 2015 data, region/province, type of place of residence, availability of electricity, radio, roof type, gender of head of household, having telephone, type of cooking fuel, presence of mobile phone, owning a bank account, IRS spraying in the previous 12 months, wealth index, and satellite television decorder were independently associated with net ownership among households. Type of place of residence, age of household head, type of cooking fuel, IRS in previous 12 months, and pregnancy were associated with LLIN utilization. Conclusion This study revealed increasing LLIN coverage and low usage in malaria-transmission regions of Zimbabwe. Strengthening of LLIN campaigns, social behaviour change communication (SBCC) interventions and programme routine monitoring are recommended.
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Affiliation(s)
- Oscar Tapera
- Department of Mathematics, Faculty of Science, Midlands State University, Gweru, Zimbabwe.
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Wallace LJ, Kapiriri L. Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice. BMC Health Serv Res 2019; 19:465. [PMID: 31286950 PMCID: PMC6615092 DOI: 10.1186/s12913-019-4170-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda. Methods Fifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate priority setting for MNCH. Results There were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity. Conclusions Stronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies. Electronic supplementary material The online version of this article (10.1186/s12913-019-4170-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren J Wallace
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada.
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Meeting the SDG challenge to end fistula and preventable childbirth-related morbidity and mortality. LANCET GLOBAL HEALTH 2019; 7:e835-e836. [DOI: 10.1016/s2214-109x(19)30198-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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50
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Jacobs E. The politics of the basic benefit package health reforms in Tajikistan. Glob Health Res Policy 2019; 4:14. [PMID: 31143840 PMCID: PMC6532152 DOI: 10.1186/s41256-019-0104-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health reform is a fundamentally political process. Yet, evidence on the interplay between domestic politics, international aid and the technical dimensions of health systems, particularly in the former Soviet Union and Central Asia, remains limited. Little regard has been given to the political dimensions of Tajikistan's Basic Benefit Package (BBP) reforms that regulate entitlements to a guaranteed set of healthcare services while introducing co-payments. The objective of this paper is therefore to explore the governance constraints to the introduction and implementation of the BBP and associated health management changes. METHODS This qualitative study draws on literature review and key informant interviews. Data analysis was guided by a political economy framework exploring the interplay between structural and institutional features on the one hand and agency dynamics on the other. Building on that the article presents the main themes that emerged on structure-agency dynamics, forming the key governance constraints to the BBP reform and implementation. RESULTS Policy incoherence, parallel and competing central government mandates, and regulatory fragmentation, have emerged as dominant drivers of most other constraints to effective design and implementation of the BBP and associated health reforms in Tajikistan: overcharging and informal payments, a weak link between budgeting and policymaking, a practice of non-transparent budget bargaining instead of a rationalisation of health expenditure, little donor harmonisation, and weak accountability to citizens. CONCLUSION This study suggests that policy incoherence and regulatory fragmentation can be linked to the neo-patrimonial character of the regime and donor behaviour, with detrimental consequences for the health system.. These findings raise questions on the unintended effects of non-harmonised piloting of health reforms, and the interaction of health financing and management interventions with entrenched power relations. Ultimately these insights serve to underline the relevance of contextualising health programmes and addressing policy incoherence with long horizon planning as a priority.
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Affiliation(s)
- Eelco Jacobs
- University of Basel, Basel, Switzerland
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
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