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Mensah Abrampah NA, Okwaraji YB, You D, Hug L, Maswime S, Pule C, Blencowe H, Jackson D. Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda. Int J Health Policy Manag 2023; 12:7391. [PMID: 38618824 PMCID: PMC10590256 DOI: 10.34172/ijhpm.2023.7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. METHODS A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. RESULTS Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. CONCLUSION The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.
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Affiliation(s)
- Nana A. Mensah Abrampah
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yemisrach B. Okwaraji
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Caroline Pule
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Kleine-Bingham MB, Rangel G, Sarakbi D, Kelleher T, Mensah Abrampah NA, Neilson M, Bodson O, White P, Bothra V, M de Carvalho H, da C A Pinto F, Babar Syed S. Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis. BMJ Open 2023; 13:e071879. [PMID: 37085306 PMCID: PMC10123858 DOI: 10.1136/bmjopen-2023-071879] [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] [Received: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE This case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic. DESIGN A qualitative case study triangulated information from 22 documents, 44 key informant interviews and 6 focus group discussions. The framework method was used to thematically examine the factors impacting quality EHS in TLS. SETTING National, municipal, facility levels in Baucau, Dili and Ermera municipalities in TLS. RESULTS Based on the TLS National Health Statistics Reports, a reduction in outpatient, emergency department and primary care service delivery visits was observed in 2020 when compared with 2019. However, in contrast, maternal child health services simultaneously improved in the areas of skilled birth attendants, prenatal coverage and vitamin A distribution, for example. From the thematic analysis, five themes emerged as contributing to or impeding the maintenance of quality EHS including (1) high-level strategy for maintaining quality EHS, (2) measurement for quality and factors affecting service utilisation, (3) challenges in implementation of quality activities across the three levels of the health system, (4) the impact of quality improvement leadership in health facilities during COVID-19 and (5) learning systems for maintaining quality EHS now and for the future. CONCLUSION The maintenance of quality EHS is critical to mitigate adverse health effects from the COVID-19 pandemic. When quality health services are delivered prior to and maintained during public health emergencies, they build trust within the health system and promote healthcare-seeking behaviour. Planning for quality as part of emergency preparedness can facilitate a high standard of care by ensuring health services continue to provide a safe environment, reduce harm, improve clinical care and engage patients, facilities and communities.
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Affiliation(s)
| | - Gregorio Rangel
- Health Systems, World Health Organization, Dili, Timor-Leste
| | - Diana Sarakbi
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
| | - Treasa Kelleher
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Nana Afriyie Mensah Abrampah
- Faculty of Epidemiology and Population Health Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Neilson
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Oriane Bodson
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Philippa White
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Vinay Bothra
- Health Systems, World Health Organization, Dili, Timor-Leste
| | | | | | - Shamsuzzoha Babar Syed
- Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
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Lounsbury O, Roberts L, Kurek N, Shaw A, Flott K, Ghafur S, Labrique A, Leatherman S, Darzi A, Luísa Neves A. The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.37241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background High quality is a necessary feature of healthcare delivery. Healthcare quality challenges are particularly present in conditions of extreme adversity, such as conflict settings or sustained humanitarian crises. Digital health technologies have recently emerged as an innovation to deliver care around the world in a variety of settings. However, there is little insight into how digital health technologies can be used to improve the quality of care where extreme adversity introduces unique challenges. This study aimed to identify how digital health technologies may be most impactful in improving the quality of care and evaluate opportunities for accelerated and meaningful digital innovation in adverse settings. Methods A phenomenological approach (Interpretative Phenomenological Approach [IPA]), using semi-structured interviews, was adopted. Six individuals were interviewed in person based on their expertise in global health, international care delivery, and the application of digital health technologies to improve the quality of care in extreme adversity settings. The interviews were informed by a semi-structured topic guide with open-ended questions. The transcripts were compiled verbatim and were systematically examined by two authors, using the framework analysis method to extract themes and subthemes. Results The participants identified several areas in which digital health technologies could be most impactful, which include engagement in care, continuity of care, workforce operations, and data collection. Opportunities for accelerated digital innovation include improving terminology, identity, ownership, and interoperability, identifying priority areas for digital innovation, developing tailored solutions, coordination and standardisation, and sustainability and resilience. Conclusions These results suggest that there are conditions that favour or challenge the application of digital health technologies, even in specific areas in which they could be useful. A better understanding of the drivers and barriers to digitally driven quality improvement in settings of extreme adversity could inform international policies and optimisation strategies for the future.
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Affiliation(s)
- Olivia Lounsbury
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Lily Roberts
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Natalia Kurek
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Alexandra Shaw
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Kelsey Flott
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Saira Ghafur
- Johns Hopkins Children's Center, Baltimore, MD, United States; Patient Safety Translational Research Centre, Imperial College London, UK
| | - Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Ana Luísa Neves
- Patient Safety Translational Research Centre, Imperial College London, UK; Centre for Health Technology and Services Research/Department of Community Medicine, Information and Decision in Health, University of Porto, Portugal
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O’Brien N, Shaw A, Flott K, Leatherman S, Durkin M. Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions. J Glob Health 2022; 12:04018. [PMID: 35265329 PMCID: PMC8876158 DOI: 10.7189/jogh.12.04018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the ‘better bet’, eg, the most effective and appropriate intervention in FCV settings. Methods An evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020. Results The majority of studies identified related to strengthening infection prevention and control which was also found to be the ‘better bet’ intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes. Conclusions Infection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, and impact on patient and health worker well-being. However, there is an urgent need to further develop the evidence base, specialist knowledge, and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions, and risk management.
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Affiliation(s)
- Niki O’Brien
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexandra Shaw
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Sheila Leatherman
- UNC Gillings School of Global Public Health, University of North Carolina, North Carolina, USA
| | - Mike Durkin
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
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Shaw A, O'Brien N, Flott K, Leatherman S, Durkin M, Darzi A, Neves AL. How to improve patient safety in fragile, conflict-affected and vulnerable settings: a Delphi study protocol. BMJ Open 2021; 11:e052960. [PMID: 34615683 PMCID: PMC8496379 DOI: 10.1136/bmjopen-2021-052960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There is a high burden of adverse events and poor outcomes in fragile, conflict-affected and vulnerable (FCV) settings. To improve outcomes, there is a need to better identify which interventions can improve patient safety in these settings, as well as to develop strategies to optimise their implementation. OBJECTIVE This study intends to generate a consensus on the most relevant patient safety interventions from experts with experience on FCV settings, including frontline clinicians and managers/administrators, non-governmental organisations, policymakers and researchers. METHODS AND ANALYSIS The study uses an online Delphi research approach (eDelphi). Participants will include experts from a range of backgrounds, including those working in a variety of FCV settings. Participants will be established contacts known to the research team or recruited via snowball sampling, and will be asked to identify and rank the importance of a variety of patient safety interventions. Consensus will be defined as >70% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing with a statement. Data analysis will be completed in Microsoft Excel and NVivo. The primary outcome of the study will be a list of the most relevant and applicable patient safety interventions for FCV settings. ETHICS AND DISSEMINATION The study has received approval from Imperial College London Ethics Committee (reference number 20IC665). Anonymous results will be made available to the public, academic organisations and policymakers.
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Affiliation(s)
- Alexandra Shaw
- Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Niki O'Brien
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kelsey Flott
- Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Sheila Leatherman
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Durkin
- Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Imperial College London, London, UK
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) / Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
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Neilson M, Leatherman S, Syed S. The quality-of-care agenda in fragile, conflict-affected and vulnerable settings. Bull World Health Organ 2021; 99:170-170A. [PMID: 33716335 PMCID: PMC7941104 DOI: 10.2471/blt.21.285627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Matthew Neilson
- Department of Integrated Health Services, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sheila Leatherman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Shamsuzzoha Syed
- Department of Integrated Health Services, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Affiliation(s)
- Sheila Leatherman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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