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Waitzberg R, Pfundstein I, Maresso A, Rechel B, van Ginneken E, Quentin W. Health system description and assessment: a scoping review of templates for systematic analyses. Health Res Policy Syst 2024; 22:82. [PMID: 38992666 PMCID: PMC11238392 DOI: 10.1186/s12961-024-01166-y] [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: 03/11/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Understanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their content and the way data is presented. MAIN BODY Based on the WHO building blocks framework, we defined templates as having (1) an overall framework, (2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5) an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping review of grey literature published between 2000 and 2023 to identify templates. The content of the identified templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health workforce'. Health system performance is frequently assessed with regard to 'access and coverage', 'quality and safety', and 'financial protection'. Most templates do not cover 'responsiveness' and 'efficiency'. Seven templates combine quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region, or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators than administrative data. CONCLUSIONS This is the first scoping review of templates for standardized descriptions of health systems and assessments of their performance. The implications are that (1) templates can help analyze health systems across countries while accounting for context; (2) template-guided analyses of health systems could underpin national health policies, strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4) more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview and help identify the most important aspects and topics to look at when comparing and analyzing health systems, and how data are commonly presented. The templates were created by organizations with different agendas and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons require production of quantitative indicators and complementing them with qualitative information to build a holistic picture. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Isabel Pfundstein
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
| | - Anna Maresso
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Department of Health Care Management, Technische Universität Berlin, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Wilm Quentin
- Planetary & Public Health, University of Bayreuth, Bayreuth, Germany
- German West-African Centre for Global Health and Pandemic Prevention, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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Obi C, Ojiakor I, Etiaba E, Onwujekwe O. Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage. Int J Public Health 2024; 69:1606810. [PMID: 38887723 PMCID: PMC11180759 DOI: 10.3389/ijph.2024.1606810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Objectives Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Results Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Conclusion Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.
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Affiliation(s)
- Chinelo Obi
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Iheomimichineke Ojiakor
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
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Gutiérrez-Alba G, Muños Hernández JA, Juárez-Ramírez C, Reartes-Peñafiel DL, Reyes-Morales H. Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study. HEALTH EDUCATION & BEHAVIOR 2024; 51:376-387. [PMID: 38334128 DOI: 10.1177/10901981241230492] [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] [Indexed: 02/10/2024]
Abstract
BACKGROUND The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. AIMS To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. METHODS This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. RESULTS The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. CONCLUSIONS We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.
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Affiliation(s)
| | | | | | | | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, MOR, México
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Haenssgen MJ, Elliott EM, Phommachanh S, Phomkong S, Kounnavong S, Kubota S. Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People's Democratic Republic. BMJ Glob Health 2024; 9:e014640. [PMID: 38754897 PMCID: PMC11097858 DOI: 10.1136/bmjgh-2023-014640] [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: 11/23/2023] [Accepted: 03/14/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Global health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions, drivers and downstream behavioural consequences. This paper aims to contribute to the conceptual development and measurement of 'patient trust in primary healthcare' from the lower middle-income country perspective of rural Lao PDR. METHODS A two-phase mixed-method research design was implemented between January 2021 and April 2023. Phase 1 involved exploratory qualitative research to understand the local expressions and dimensions of patient trust in primary healthcare, with 25 semistructured interviews and 17 focus group discussions (120 participants) in eight villages in Bokeo Province. Phase 2 involved explanatory research to assess patterns of trust systematically at scale in 14 villages across four provinces, wherein 26 cognitive interviews, 17 expert interviews and non-participant community observations informed a community census survey with 1838 participants. We analysed qualitative data through content-oriented thematic analysis and developed an 8-item trust scale on that basis. Quantitative data analysis used descriptive statistical and regression analysis. RESULTS We found that trust in primary healthcare is readily understood and intrinsically valuable in rural Lao PDR. Key dimensions included communication, respectful care, relationship, fairness, integrity, reputation, assurance of treatment and competence. The survey highlighted that reputation, competence, integrity and respectful care had the lowest trust scores. Health centre operations predicted the local expressions of trust. The behavioural consequences of trust were limited to a positive statistical association with antenatal care uptake among pregnant women but outweighed by alternative measures that also captured the availability of healthcare facilities. CONCLUSIONS Overall, the development of our quantitative trust scale offers a process model for future researchers. We conclude that interpersonal, institutional and service-related trust require more explicit recognition in health system development and integration into health policy.
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Affiliation(s)
- Marco J Haenssgen
- Department of Social Science and Development, Chiang Mai University, Chiang Mai, Thailand
| | - Elizabeth M Elliott
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Sylivanh Phomkong
- World Health Organization Representative Office, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Shogo Kubota
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
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Kananura RM, Birabwa C, Ssanyu JN, Kizito F, Kagaha A, Namutanba S, Kyangwa M, Kakaire O, Waiswa P. Increasing coverage and uptake of voluntary family planning in Uganda's emerging municipalities and secondary cities: An implementation research study protocol. PLoS One 2024; 19:e0293351. [PMID: 38728317 PMCID: PMC11086862 DOI: 10.1371/journal.pone.0293351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/26/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION While urban areas are often perceived to have better access to healthcare services, including modern family planning (FP) services, urban dwellers including those with better socioeconomic status are faced with multidimensional challenges that shape their access to appropriate FP services. In Uganda's urban spaces, there is currently a lack of understanding among service providers, civil society organizations, and individuals/communities regarding the implementation of interventions that promote informed choice and voluntary use of family planning services. This knowledge gap has profound implications for reproductive rights. This study seeks to enhance existing efforts towards increasing coverage and uptake of Voluntary Family Planning (VFP) in Jinja City and Iganga Municipality, central eastern Uganda. Our primary question is, "What interventions can effectively be packaged and delivered to increase the uptake of VFP among different segments of urban residents?" METHODS We propose to use the Human-Centered Design (HCD) approach to understand the needs and challenges of users and community capabilities in ensuring access to VFP services. Co-creating with stakeholders' engagement and a data-driven-centric approach will steer design and adaptation that respond to the different population segments within the urban space. As such, the study will be implemented in three phases: formative assessment, design and implementation, and implementation monitoring and evaluation. The implementation process will incorporate robust monitoring, learning, and adaptation mechanisms. The primary focus of these mechanisms will be to utilize gathered information effectively to inform the design of the implementation and facilitate continuous learning throughout the process. The study will apply a process monitoring and evaluation approach to address questions related to what package of FP interventions work, for whom, under what circumstances and why. DISCUSSION Guided by strong learning and implementation flexibility, we hypothesize that our implementation will provide segmentation-specific high-impact interventions in an urban context. REGISTRATION This implementation research protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/vqxu9; DOI: 10.17605/OSF.IO/VQXU9).
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Affiliation(s)
- Rornald Muhumuza Kananura
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Birabwa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Jacquellyn Nambi Ssanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Alexander Kagaha
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University School of Public Health, Kampala, Uganda
- Advance Innovations for Transforming Health in Africa, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
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Naser K, Haq Z, Naughton BD. The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:434. [PMID: 38673345 PMCID: PMC11050668 DOI: 10.3390/ijerph21040434] [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: 01/15/2024] [Revised: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Aim: The aim of this study was to assess the impact of climate change on health services as categorized by the WHO's Building Blocks for creating Climate-Resilient Health Systems. Objective: The objective was to conduct a systematized review of the published literature concerning the impact of climate change, using a thematic analysis approach to address our aim and identify areas for further research. Design: A search was conducted on 8 February 2022 using the Embase and PubMed research databases. Peer-reviewed scientific studies that were published in English from 2012 to 2022, which described at least one report concerning the impact of climate change on health services in LMICs, were included. Studies were organized based on their key characteristics, which included the date of publication, objective, method, limitations, participants, and geographical focus. The Mixed-Methods Appraisal Tool (MMAT) was used to assess the risk of bias in the included studies. Results: Twenty-three studies were included in this review. Five areas of health services which align with the WHO building blocks framework were impacted by climate change. These health service areas included: (1) Service Delivery, (2) Human Resources, (3) Health Finance, (4) Healthcare Products and Technology, and (5) Leadership and Governance. However, research concerning the impact of climate change on health information systems, which is part of the WHO building blocks framework, did not feature in our study. The climatic effects were divided into three themes: meteorological effects, extreme weather events, and general. The research in this study found that climate change had a detrimental impact on a variety of health services, with service delivery being the most frequently reported. The risk of bias varied greatly between studies. Conclusions: Climate change has negatively impacted health services in a variety of different ways, and without further actions, this problem is likely to worsen. The WHO building blocks have provided a useful lens through which to review health services. We built an aligned framework to describe our findings and to support future climate change impact assessments in this area. We propose that further research concerning the impact of climate change on health information systems would be valuable, as well as further education and responsible policy changes to help build resilience in health services affected by climate change.
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Affiliation(s)
- Kamar Naser
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, College Green, D02PN40 Dublin, Ireland
| | - Zaeem Haq
- Save the Children St Vincent House, 30 Orange Street, London WC2H 7HH, UK
| | - Bernard D. Naughton
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, College Green, D02PN40 Dublin, Ireland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, Kings College London, London SE1 9NH, UK
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Carson SL, Cameron F, Lee D, Zúñiga D, Poole K, Jones A, Herman C, Ramirez M, Harlow S, Johnson J, Agonafer EP, Hong CS, Brown AF. A collaboration team to build social service partnerships within a safety-net health system. BMC Public Health 2024; 24:654. [PMID: 38429651 PMCID: PMC10905940 DOI: 10.1186/s12889-024-18155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To facilitate safety-net healthcare system partnerships with community social service providers, the Los Angeles County Department of Health Services (LAC DHS) created a new collaboration team to spur cross-agency social and medical referral networks and engage communities affected by health disparities as part of a Sect. 1115 Medicaid waiver in Los Angeles County entitled Whole Person Care-Los Angeles (WPC-LA). METHODS This observational research reviews three years of collaboration team implementation (2018-2020) through Medicaid-reportable engagement reports, a collaboration team qualitative survey on challenges, facilitators, and recommendations for community engagement. Member reflections for survey findings were conducted with the collaboration team and LAC DHS WPC-LA leadership. RESULTS Collaboration team Medicaid engagement reports (n = 144) reported > 2,700 events, reaching > 70,000 individuals through cross-agency and community-partnered meetings. The collaboration team survey (n = 9) and member reflection sessions portrayed engagement processes through outreach, service assessments, and facilitation of service partnerships. The collaboration team facilitated community engagement processes through countywide workgroups on justice-system diversion and African American infant and maternal health. Recommendations for future safety net health system engagement processes included assessing health system readiness for community engagement and identifying strategies to build mutually beneficial social service partnerships. CONCLUSIONS A dedicated collaboration team allowed for bi-directional knowledge exchange between county services, populations with lived experience, and social services, identifying service gaps and recommendations. Engagement with communities affected by health disparities resulted in health system policy recommendations and changes.
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Affiliation(s)
- Savanna L Carson
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA.
| | - Francesca Cameron
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
| | - Diamond Lee
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Diana Zúñiga
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
- Tres Lunas Consulting, 1509 Stanley Ave. #302, Long Beach, 90804, USA
| | - Kelli Poole
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Adjoa Jones
- Los Angeles County Department of Health Services, 313 N Figueroa St, Los Angeles, CA, 90012, USA
| | - Cristina Herman
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Mayra Ramirez
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Simone Harlow
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Jeannette Johnson
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Etsemaye P Agonafer
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Clemens S Hong
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
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Truppa C, Yaacoub S, Valente M, Celentano G, Ragazzoni L, Saulnier D. Health systems resilience in fragile and conflict-affected settings: a systematic scoping review. Confl Health 2024; 18:2. [PMID: 38172918 PMCID: PMC10763433 DOI: 10.1186/s13031-023-00560-7] [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: 05/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Health systems resilience (HSR) research is a rapidly expanding field, in which key concepts are discussed and theoretical frameworks are emerging with vibrant debate. Fragile and conflict-affected settings (FCAS) are contexts exposed to compounding stressors, for which resilience is an important characteristic. However, only limited evidence has been generated in such settings. We conducted a scoping review to: (a) identify the conceptual frameworks of HSR used in the analysis of shocks and stressors in FCAS; (b) describe the representation of different actors involved in health care governance and service provision in these settings; and (c) identify health systems operations as they relate to absorption, adaptation, and transformation in FCAS. METHODS We used standard, extensive search methods. The search captured studies published between 2006 and January 2022. We included all peer reviewed and grey literature that adopted a HSR lens in the analysis of health responses to crises. Thematic analysis using both inductive and deductive approaches was conducted, adopting frameworks related to resilience characteristics identified by Kruk et al., and the resilience capacities described by Blanchet et al. RESULTS: Thirty-seven studies met our inclusion criteria. The governance-centred, capacity-oriented framework for HSR emerged as the most frequently used lens of analysis to describe the health responses to conflict and chronic violence specifically. Most studies focused on public health systems' resilience analysis, while the private health sector is only examined in complementarity with the former. Communities are minimally represented, despite their widely acknowledged role in supporting HSR. The documentation of operations enacting HSR in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven different domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. CONCLUSIONS Our review findings suggest that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens.
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Affiliation(s)
- Claudia Truppa
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy.
- International Committee of the Red Cross, Geneva, Switzerland.
| | - Sally Yaacoub
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Giulia Celentano
- ETH Zürich, Institut Für Bau- Und Infrastrukturmanagement, Chair of Sustainable Construction, Zurich, Schweiz
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Dell Saulnier
- Division of Social Medicine and Global Health/Department of Clinical Sciences, Lund University, Malmö, Sweden
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Namukose S, Kiwanuka SN, Makumbi FE, Maina GW. Extent of integration of nutrition assessment counselling and support interventions in the health system and respective drivers: A case of Tororo district, Uganda. PLoS One 2023; 18:e0289389. [PMID: 38128006 PMCID: PMC10735038 DOI: 10.1371/journal.pone.0289389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Uganda embraced Nutrition Assessment Counselling and Support (NACS) since 2009 as a health system strengthening approach to improve health and nutrition outcomes. However, scant evidence exists on NACS integration and drivers. This study therefore assessed the extent of NACS integration in the health system and identified key drivers and barriers. METHODS A mixed method design was employed. In a facilitated panel discussions at each of the 17 health facilities, 4-5 health staff participated, responding to a semi-structured questionnaire. Integration was assessed on a 5-point scoring scale of 1 for not done nor integrated, 2-4 for partial and 5 for fully integration. Data was captured, analysed in microsoft excel and presented using as bar and spider charts. Integration drivers were identified deductively from key informant and in-depth interviews using Atlas.ti 9 and thematic analysis. RESULTS The NACS integration across the health facility level was partial at a score of 2.9 indicating a weak integration into the health system. Integration across the health system building blocks was partial at; service delivery (3.8), health work force (3.7), health information (3.3), community support system (3.0), governance and leadership (3.0) signifying that NACS activities are provided by Ministry of Health but sub-optimal due to weak capacities. Health financing (2.2) and Health supplies (1.5) were the least integrated due to partner dependence. Under service delivery, deworming (5) was fully integrated and provided by Ministry of Health. The key drivers for integration were; good leadership, financing, competent staff, quality improvement approaches, nutrition talks, community dialogues, nutrition logistics and supplies. CONCLUSION The NACS integration in the health system was generally low and lacked adequate support. Governance, financing and community follow-up under service delivery require more government investment for enhanced integration.
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Affiliation(s)
- Samalie Namukose
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gakenia Wamuyu Maina
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Percival V, Thoms OT, Oppenheim B, Rowlands D, Chisadza C, Fewer S, Yamey G, Alexander AC, Allaham CL, Causevic S, Daudelin F, Gloppen S, Guha-Sapir D, Hadaf M, Henderson S, Hoffman SJ, Langer A, Lebbos TJ, Leomil L, Lyytikäinen M, Malhotra A, Mkandawire P, Norris HA, Ottersen OP, Phillips J, Rawet S, Salikova A, Shekh Mohamed I, Zazai G, Halonen T, Kyobutungi C, Bhutta ZA, Friberg P. The Lancet Commission on peaceful societies through health equity and gender equality. Lancet 2023; 402:1661-1722. [PMID: 37689077 DOI: 10.1016/s0140-6736(23)01348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Valerie Percival
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada; The Wilson Center, Washington DC, USA.
| | - Oskar T Thoms
- Department of Political Science, University of Toronto, Mississauga, ON, Canada
| | - Ben Oppenheim
- Ginkgo Bioworks, Boston, MA, USA; New York University Center on International Cooperation, New York, NY, USA
| | - Dane Rowlands
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Carolyn Chisadza
- Department of Economics, University of Pretoria, Pretoria, South Africa
| | - Sara Fewer
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amy C Alexander
- Quality of Government Institute, Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Chloe L Allaham
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sara Causevic
- Department of Global Public Health, Stockholm, Sweden; Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - François Daudelin
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siri Gloppen
- University of Bergen, Bergen, Norway; LawTransform, CMI-UiB Centre on Law and Social Transformation, Bergen, Norway
| | - Debarati Guha-Sapir
- Institute of Health and Society, UC Louvain, Brussels, Belgium; Johns Hopkins Center for Humanitarian Health, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maseh Hadaf
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Samuel Henderson
- Department of Political Science, University of Toronto, Toronto, ON, Canada
| | | | - Ana Langer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Toni Joe Lebbos
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Luiz Leomil
- Department of Political Science, Carleton University, Ottawa, ON, Canada
| | | | - Anju Malhotra
- Center for Women's Health and Gender Equality, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Mkandawire
- Human Rights and Social Justice Program, Carleton University, Ottawa, ON, Canada
| | - Holly A Norris
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Ole Petter Ottersen
- Office of the President, Karolinska Institutet, Stockholm, Sweden; University of Oslo, Oslo, Norway
| | - Jason Phillips
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | - Sigrún Rawet
- Department for Multilateral Development Banks, Sustainability and Climate, Ministry for Foreign Affairs, Stockholm, Sweden
| | | | - Idil Shekh Mohamed
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
| | - Ghazal Zazai
- Norman Paterson School of International Affairs, Carleton University, Ottawa, ON, Canada
| | | | | | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; The Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan; SickKids Centre for Global Child Health, Toronto, ON, Canada
| | - Peter Friberg
- Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden; School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Kirira P, Oyatsi F, Waudo A, Mbugua S. Improving Access to Safe Water in Rural Schools of Kenya: Qualitative Multisectoral Insights. Cureus 2023; 15:e49174. [PMID: 38130509 PMCID: PMC10734557 DOI: 10.7759/cureus.49174] [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] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Comprehensive strategies in water, sanitation, and appropriate hygiene behaviors can improve school enrolment and improve gender parity disparities. Lack of safe drinking water negatively impacts the social capital of people, especially school-going children in rural areas. In this study, we systematically evaluated and documented evidence on the barriers and facilitators in the access and adoption of safe water practices in rural schools in Laikipia County, Kenya. METHODS An ethnographic formative, collaborative implementation research design was used in an iterative and participatory process to evaluate community, socio-economic, and health system-related factors affecting water, hygiene, and sanitation strategies. Qualitative data was collected using key informant interviews (n=5) and focus groups (n=3) from various multisectoral participants. Directed content analysis was used to develop codes, categories, and themes from textual data. Data was organized according to the Promoting Action on Research Implementation in Health Services framework. RESULTS The findings were classified and described under three key elements: context, evidence, and facilitation. Contextual elements showed an association of diarrhea outbreaks with unsafe hygiene practices compounded by water scarcity. The evidence elements were indicative of the applicability of water backpacks in strengthening handwashing, storage, and transport of water. Facilitation elements indicated evidence of gaps in synergy between the school health and public health systems, necessitating multisectoral collaboration and social capital capacity building. CONCLUSION The national and county governments play an imperative role in ensuring access and continuous supply of safe drinking water in schools. This is fundamental in efforts towards reducing social inequalities of health among school-going children and building their social capital. Participatory, collaborative, multisectoral interventions and decision-making are crucial, leveraging on creating local ownership, in meeting the water consumption needs of children and communities in water-scarce regions.
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Affiliation(s)
- Peter Kirira
- Pharmaceutical Chemistry, Mount Kenya University, Thika, KEN
| | - Fiona Oyatsi
- Biochemistry, Strathmore University, Nairobi, KEN
| | - Ashley Waudo
- Water Backpack Program, Partners for Care, Nairobi, KEN
| | - Samuel Mbugua
- Community Health Nursing, Mount Kenya University, Thika, KEN
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12
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Katena NA, Shamu S, Fana GT, Rusakaniko S. Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47512. [PMID: 37788044 PMCID: PMC10582805 DOI: 10.2196/47512] [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: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. OBJECTIVE This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. METHODS This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. RESULTS Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. CONCLUSIONS There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47512.
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Affiliation(s)
- Nyaradzai Arster Katena
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shepherd Shamu
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Golden Tafadzwa Fana
- Internal Medicine Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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13
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Noeske J, Ndi NF, Nga FHM, Mely G, Kuaban C. Prison health services across ten central prisons in Cameroon. J Public Health Afr 2023; 14:2600. [PMID: 37908390 PMCID: PMC10615162 DOI: 10.4081/jphia.2023.2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/15/2023] [Indexed: 11/02/2023] Open
Abstract
In 2021, Cameroon held approximately 26,300 inmates in 84 prisons. The Ministry of Justice manages health services in prisons. Conclusive data concerning health care in prisons are lacking. Herein, we present the results of an assessment of health care provision and delivery in 10 central prisons. We adopted mixed methods, including document review, observations, interviews with the Ministry of Justice and prison facility officials, and inmate focus group discussions (FGDs). The 6 building blocks of the World Health Organization's health system framework guided the data collection. Moreover, we collected data on imprisonment conditions. Ministerial authorisation and verbal informed consent were obtained for all activities. There were a total of 17,126 inmates, with the prison populations ranging from 353 inmates to 4,576 inmates. The majority of prisons were characterised by huge overcrowding (mean 301%). The 10 central prisons operated infirmaries with insufficient space and equipment. Compared with the civilian health sector, the numeric ratio of paramedical personnel/inmates was favourable (1:3.4 vs. 1:0.5 p. 1,000 pop, respectively). Recent admissions were screened for the coronavirus disease 2019, tuberculosis (TB), and human immunodeficiency virus (HIV). Moreover, the inmates were diagnosed for current pathologies and lesions. For the treatment of chronic diseases and medical emergencies, the prison health services bridged service gaps on a case-by-case basis through informal arrangements with the civilian health sector. The service quality control was limited to those performed by the TB and HIV/acquired immune deficiency syndrome control programmes. Health data was collected and transmitted with a multitude of data collection tools, without standardisation and systematic verification. The primarily reported problems comprised the scarcity of resources and the absence of an effective oversight of resource management and service quality performance entailing governance problems. Participants in FDGs esteemed the quality of treatment as poor unless paid for in cash, and denounced severe difficulties for access to care outside the prisons when required. For meeting the standard minimum rules for the treatment of inmates, prison health care in Cameroon should fill the crucial gaps involving imprisonment conditions, access to health services, and accountability. Regarding chronic underfunding, intensifying collaboration with the civil health sector may partially address the problem.
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Affiliation(s)
| | - Norbert Francis Ndi
- Focal Point for the Global Fund Grant for Prisons, Ministry of Justice, Yaoundé
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14
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Poroes C, Seematter-Bagnoud L, Wyss K, Peytremann-Bridevaux I. Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6666. [PMID: 37681806 PMCID: PMC10487449 DOI: 10.3390/ijerph20176666] [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: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.
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Affiliation(s)
- Camille Poroes
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Natural Science, University of Basel, 4001 Basel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
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15
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Kumar A, Tiwari M, Krishna R, Singh PK, Sahu A, Singh V, Mishra A, Kumar P, Kumar A, Darmstadt GL, Kumar V. A scalable health system model to achieve high coverage and quality of Kangaroo mother care in Uttar Pradesh, India. Acta Paediatr 2023; 112 Suppl 473:27-41. [PMID: 36184883 DOI: 10.1111/apa.16534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
AIM To design a health system model for scaling-up Kangaroo mother care (KMC) and assess its impact on the population-level coverage and quality of KMC in Uttar Pradesh, India. METHODS We co-developed the model with mothers and health system stakeholders using human-centred design over multiple cycles of implementation, learning and data-driven refinement. Infants with birthweight <2000 g in the study district were prospectively followed to assess the 'effective coverage' of KMC. Effective coverage referred to the proportion of eligible infants receiving ≥8 h of daily skin-to-skin contact and exclusive breastfeeding. RESULTS High delivery load facilities were equipped with a KMC Lounge to ensure comfort, respectful care of mothers and high-quality KMC over prolonged periods. Systems to ensure weighing at birth, referral of infants with birthweight <2000 g to KMC facilities, initiation of KMC for all stable low birthweight infants, improving quality of care within KMC facilities and supporting families to continue KMC at home post discharge, were integrated into existing services. KMC was initiated in 93.3% of eligible infants with effective coverage of 52.7% and 64.8% at discharge and 7 days post discharge, respectively. CONCLUSION The model addressed critical barriers to KMC implementation and adoption, contributing to its scale-up across the state.
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Affiliation(s)
- Aarti Kumar
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Madhuri Tiwari
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Raghav Krishna
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Pramod Kumar Singh
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Arti Sahu
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Vivek Singh
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Aman Mishra
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | | | - Alok Kumar
- Government of Uttar Pradesh, Lucknow, India
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Vishwajeet Kumar
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
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16
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Al Waziza R, Sheikh R, Ahmed I, Al-Masbhi G, Dureab F. Analyzing Yemen's health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate. DISCOVER HEALTH SYSTEMS 2023; 2:15. [PMID: 37520515 PMCID: PMC10169293 DOI: 10.1007/s44250-023-00026-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/27/2023] [Indexed: 08/01/2023]
Abstract
Background Yemen is regarded as one of the Middle East's poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen's health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement. Methods The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO's health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results. Results According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate's health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals. Conclusion Yemen's frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen's health system's operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen's health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.
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Affiliation(s)
- Raof Al Waziza
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
| | | | - Iman Ahmed
- World Health Organization, Gaziantep, Turkey
| | | | - Fekri Dureab
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
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17
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Story WT, Pyle DF. A blueprint for engaging communities to reduce inequities in maternal and child health: evidence from rural Guatemala. Int J Equity Health 2023; 21:151. [PMID: 36855138 PMCID: PMC9976359 DOI: 10.1186/s12939-022-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- William T Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA.
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18
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Jacobs C, Musukuma M, Sikapande B, Chooye O, Wehrmeister FC, Boerma T, Michelo C, Blanchard AK. How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study. BMC Health Serv Res 2023; 23:170. [PMID: 36805693 PMCID: PMC9940360 DOI: 10.1186/s12913-023-09086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/19/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Zambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000. METHODS Using nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020. RESULTS The under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban-rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels. Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers. CONCLUSION Zambia's major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.
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Affiliation(s)
- Choolwe Jacobs
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia.
| | - Mwiche Musukuma
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia
| | | | | | | | | | - Charles Michelo
- School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia
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19
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Adam S, McIntyre HD, Tsoi KY, Kapur A, Ma RC, Dias S, Okong P, Hod M, Poon LC, Smith GN, Bergman L, Algurjia E, O'Brien P, Medina VP, Maxwell CV, Regan L, Rosser ML, Jacobsson B, Hanson MA, O'Reilly SL, McAuliffe FM. Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:56-67. [PMID: 36635082 PMCID: PMC10107137 DOI: 10.1002/ijgo.14537] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
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Affiliation(s)
- Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Cape Town, South Africa
| | - Pius Okong
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala City, Uganda
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Esraa Algurjia
- The World Association of Trainees in Obstetrics and Gynecology (WATOG), Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of Health, Universidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital University of Toronto, Ontario, Canada
| | | | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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20
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van Immerzeel TD, Diagne M, Deme/Ly I, Murungi AE, Diouf S, Kerac M, Grijalva-Eternod CS, Day LT. Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country stakeholder consultation. MATERNAL & CHILD NUTRITION 2023; 19:e13455. [PMID: 36373777 PMCID: PMC9749585 DOI: 10.1111/mcn.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.
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Affiliation(s)
- Tabitha D van Immerzeel
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Indou Deme/Ly
- University Cheick Anta Diop, Dakar, Senegal.,Centre Hospitalier National D'Enfants Albert Royer, Dakar, Senegal
| | | | | | - Marko Kerac
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Carlos S Grijalva-Eternod
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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21
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Colombini M, Mayhew SH, García-Moreno C, d'Oliveira AF, Feder G, Bacchus LJ. Improving health system readiness to address violence against women and girls: a conceptual framework. BMC Health Serv Res 2022; 22:1429. [PMID: 36443825 PMCID: PMC9703415 DOI: 10.1186/s12913-022-08826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing focus on readiness of health systems to respond to survivors of violence against women (VAW), a global human rights violation damaging women's health. Health system readiness focuses on how prepared healthcare systems and institutions, including providers and potential users, are to adopt changes brought about by the integration of VAW care into services. In VAW research, such assessment is often limited to individual provider readiness or facility-level factors that need to be strengthened, with less attention to health system dimensions. The paper presents a framework for health system readiness assessment to improve quality of care for intimate partner violence (IPV), which was tested in Brazil and Palestinian territories (oPT). METHODS Data synthesis of primary data from 43 qualitative interviews with healthcare providers and health managers in Brazil and oPT to explore readiness in health systems. RESULTS The application of the framework showed that it had significant added value in capturing system capabilities - beyond the availability of material and technical capacity - to encompass stakeholder values, confidence, motivation and connection with clients and communities. Our analysis highlighted two missing elements within the initial framework: client and community engagement and gender equality issues. Subsequently, the framework was finalised and organised around three levels of analysis: macro, meso and micro. The micro level highlighted the need to also consider how the system can sustainably involve and interact with clients (women) and communities to ensure and promote readiness for integrating (and participating in) change. Addressing cultural and gender norms around IPV and enhancing support and commitment from health managers was also shown to be necessary for a health system environment that enables the integration of IPV care. CONCLUSION The proposed framework helps identify a) system capabilities and pre-conditions for system readiness; b) system changes required for delivering quality care for IPV; and c) connections between and across system levels and capabilities.
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Affiliation(s)
| | | | - Claudia García-Moreno
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Gene Feder
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Yahner M, Muriuki A, Mangieri A, Nitu SNA, Shafinaz S, Sarriot E. Designing for Impact and Institutionalization: Applying Systems Thinking to Sustainable Postpartum Family Planning Approaches for First-Time Mothers in Bangladesh. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200023. [PMID: 36316131 PMCID: PMC9622282 DOI: 10.9745/ghsp-d-22-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 09/13/2022] [Indexed: 12/04/2022]
Abstract
Integrated service delivery approaches have shown promise to increase use of services including postpartum family planning (PPFP) by young, first-time mothers (FTMs) but have proven challenging to scale and institutionalize. Integration adds complexity, requiring careful assessment of effects on a range of key system functions from demand creation and service delivery to oversight and governance. Through an innovative design process, we selected approaches to increase FTMs' PPFP use through existing health systems. We generated programmatic options and then sought to select approaches based on (1) potential impact on FTMs' PPFP uptake and (2) potential to institutionalize in the health system. The latter represented an innovation in addressing management systems' drivers of scalability and sustainability; to accomplish it, we developed a participatory design process to assess the potential of an approach to be institutionalized in a specific context.We adapted a management systems theory, the Viable System Model (VSM), which presents 5 essential organizational functions and the relations required between them to improve the viability (performance and institutionalization) of organizational systems. Drawing from the VSM, we developed a process for reviewing the effects of proposed approaches on provider workload, client flow, infrastructure, revisions to guidelines and job descriptions, coordination and management, and information systems. The VSM provided a structure to identify potential displacement of capacity in the health system and mitigate often neglected organizational challenges that compromise institutionalization. The process informed the elimination of approaches with potential for impact but that had deal-breakers to institutionalization, such as increased workload or shifted job descriptions, in the Bangladeshi context. For the selected approaches, consideration of systems elements fostered discussion of expected risks to institutionalization, highlighting needed mitigation efforts and monitoring during implementation.
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Affiliation(s)
| | - Angela Muriuki
- Independent consultant; formerly of Save the Children Kenya, Nairobi, Kenya
| | | | | | - Shumona Shafinaz
- Independent consultant; formerly of Save the Children Bangladesh, Dhaka, Bangladesh
| | - Eric Sarriot
- Gavi, the Vaccine Alliance, Geneva, Switzerland; formerly of Save the Children US, Washington, DC, USA
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23
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Ousman K, Thumath M, McKay G, Niyukuri D, Mwesha Ombeni D, Kabego L, Banzua B, Mangala S, Tatabod R, Mirindi N. P, Talisuna A, Houndjo B, Kieta M, Baller A. Evaluation of a health systems strengthening intervention to improve Ebola Virus Disease infection prevention and control in the Democratic Republic of the Congo. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.36558] [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 The Democratic Republic of Congo declared their tenth outbreak of Ebola in North Kivu in 2018, which was the second-largest in the world and took place in an active conflict zone. Transmission of Ebola occurs by direct contact with infected bodily fluids and can occur within facilities when infection prevention and control (IPC) precautions are not strictly practised. Methods To develop infection prevention and control (IPC) standards in health facilities, 45 medical students were trained and placed in 101 health facilities to mentor healthcare workers and support IPC practices between February and October 2019. A mixed-methods retrospective evaluation of quality improvement in North Kivu was conducted in October and November 2019 to capture key lessons from such a pilot IPC project. Five focus groups (N=49) and 42 key-informant interviews were conducted in addition to a secondary analysis of surveillance and programmatic data collected during the intervention. Results The intervention contributed 1.83 times (95% confidence interval, CI=1.10-3.06) to increased the likelihood of health facilities achieving an IPC score of 80% or above compared with facilities that did not receive the intervention. Overall, we found the odds of Ebola cases declining three times more likely in Butembo and Katwa (odds ratio, OR=3.00, 95% CI=1.87-5.62) relative to ten health zones in the region that were not reached by the intervention. Conclusions The results are difficult to attribute to any one type of intervention, given the number of other interventions implemented concurrently during the outbreak response. Further evaluations should be conducted to assess the cost-effectiveness of using medical students in conflict resolution and IPC, and to assess the suitability of scaling these approaches to other settings and diseases.
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24
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Tomblin Murphy G, Mtey G, Nyamtema A, LeBlanc J, Rigby J, Abel Z, Mselle LT. Building leadership and managerial capacity for maternal and newborn health services. BMC Health Serv Res 2022; 22:1129. [PMID: 36071415 PMCID: PMC9450380 DOI: 10.1186/s12913-022-08448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania. Methods The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team-developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings. Results Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building. Conclusion Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.
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Affiliation(s)
- Gail Tomblin Murphy
- Nova Scotia Health and Dalhousie University WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, 90 Lovett Lake Ct., Suite 201, Halifax, NS, B3S 0H6, Canada.
| | - Godfrey Mtey
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Angelo Nyamtema
- Tanzanian Training Centre for International Health, Ifakara, Tanzania.,St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - John LeBlanc
- Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Janet Rigby
- Nova Scotia Health and Dalhousie University WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, 90 Lovett Lake Ct., Suite 201, Halifax, NS, B3S 0H6, Canada
| | - Zabron Abel
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Lilian Teddy Mselle
- School of Nursing, Muhimbili University for Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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25
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Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage. PLoS One 2022; 17:e0269546. [PMID: 35657970 PMCID: PMC9165875 DOI: 10.1371/journal.pone.0269546] [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: 09/01/2021] [Accepted: 05/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Service availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities.
Methods
We analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05.
Results
The average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas.
Conclusion
Overall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.
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Karim A, de Savigny D, Awor P, Cobos Muñoz D, Mäusezahl D, Kitoto Tshefu A, Ngaima JS, Enebeli U, Isiguzo C, Nsona H, Ogbonnaya I, Ngoy P, Alegbeleye A. The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008493. [PMID: 35772810 PMCID: PMC9247653 DOI: 10.1136/bmjgh-2022-008493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and methods exist to support the design and implementation of iCCM and measure its progress, these may not holistically consider some of its key components, which can include program structure, setting context and the interplay between community, human resources, program inputs and health system processes. Methods We propose a Global South-driven, systems-based framework that aims to capture these different elements and expand on the fundamental domains of iCCM program implementation. We conducted a content analysis developing a code frame based on iCCM literature, a review of policy documents and discussions with key informants. The framework development was guided by a combination of health systems conceptual frameworks and iCCM indices. Results The resulting framework yielded 10 thematic domains comprising 106 categories. These are complemented by a catalogue of critical questions that program designers, implementers and evaluators can ask at various stages of program development to stimulate meaningful discussion and explore the potential implications of implementation in decentralised settings. Conclusion The iCCM Systems Framework proposed here aims to complement existing intervention benchmarks and indicators by expanding the scope and depth of the thematic components that comprise it. Its elements can also be adapted for other complex community interventions. While not exhaustive, the framework is intended to highlight the many forces involved in iCCM to help managers better harmonise the organisation and evaluation of their programs and examine their interactions within the larger health system.
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Affiliation(s)
- Aliya Karim
- University of Basel, Basel, Switzerland .,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Don de Savigny
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Cobos Muñoz
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Jean Serge Ngaima
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ugo Enebeli
- Department of Community Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Chinwoke Isiguzo
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Society for Family Health Nigeria, Abuja, Nigeria
| | - Humphreys Nsona
- IMCI, Malawi Ministry of Health, Lilongwe, Central Region, Malawi
| | - Ikechi Ogbonnaya
- Department of Health, Planning, Research & Statistics, Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Pascal Ngoy
- PROSANI, USAID, Washington, District of Columbia, USA
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D’Apice C, Ghirotto L, Bassi MC, Artioli G, Sarli L. A realist synthesis of staff-based primary health care interventions addressing universal health coverage. J Glob Health 2022; 12:04035. [PMID: 35569053 PMCID: PMC9107778 DOI: 10.7189/jogh.12.04035] [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] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Clelia D’Apice
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda USL – IRCCS, Reggio Emilia, Italy
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Hutchinson E, Mundua S, Ochero L, Mbonye A, Clarke SE. Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector. Soc Sci Med 2022; 300:113941. [PMID: 33926753 PMCID: PMC9077325 DOI: 10.1016/j.socscimed.2021.113941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Abstract
In many countries, when health systems are examined from the bottom up medicine sellers emerge as critical actors providing care and access to commodities. Despite this, these actors are for the most part excluded from health systems and policy research. In this paper, we ask 'what happens to the conceptualisations of a health system when medicine sellers and their practices are foregrounded in research?' We respond by arguing that these sellers sit uncomfortably in the mechanical logic in which health systems are imagined as bounded institutions, tightly integrated and made up of intertwined and interconnected spaces, through which policies, ideas, capital and commodities flow. They challenge the functionalist holism that runs through the complex adaptive systems (CAS) approach. We propose that health systems are better understood as social fields in which unequally positioned social agents (the health worker, managers, patients, carers, citizens, politicians) compete and cooperate over the same limited resources. We draw on ethnographic research from Uganda (2018-2019) to analyse the responses of different actors to a new policy that sought to rationalise the medicines retail sector and exclude drug shops from urban centres. We examine the emergence of new lobby groups who contested the policy and secured the rights of 'drug shop vendors' to trade on the basis that these shops are increasingly populated by trained nurses and clinical officers, who are surplus to the capacity of the formal health system and so look to markets to make a living. The paper adds to the growing anthropological literature on health systems that allows for a focus on social change and a form of holism that enables phenomena to be connected to diverse elements of the context in which they emerge.
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Affiliation(s)
- Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1E 9SH, UK.
| | - Sunday Mundua
- College of Health Sciences, School of Public Health Makerere University, UK
| | - Lydia Ochero
- College of Health Sciences, School of Public Health Makerere University, UK
| | - Anthony Mbonye
- College of Health Sciences, School of Public Health Makerere University, UK
| | - Sian E Clarke
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
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29
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Borghi J, Brown GW. Taking Systems Thinking to the Global Level: Using the WHO Building Blocks to Describe and Appraise the Global Health System in Relation to COVID-19. GLOBAL POLICY 2022; 13:193-207. [PMID: 35601655 PMCID: PMC9111126 DOI: 10.1111/1758-5899.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 06/15/2023]
Abstract
Adequately preparing for and containing global shocks, such as COVID-19, is a key challenge facing health systems globally. COVID-19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system-the global health actors and the governance, finance, and delivery arrangements within which they operate-is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID-19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non-transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.
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30
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Pillay Y. The role of non-governmental organisations in strengthening the South African health system: a commentary. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221083062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yogan Pillay
- Division of Public Health and Health Systems, Stellenbosch University, South Africa
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[COVID-19 assessment matrix for health system: considering community participation]. GACETA SANITARIA 2022; 36:561-562. [PMID: 35581047 PMCID: PMC9020487 DOI: 10.1016/j.gaceta.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
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32
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Oliphant NP, Sy Z, Koné B, Berthé M, Beebe M, Samake M, Diabaté M, Tounkara S, Diarra B, Diarra AB, Diawara CH, Yakimova T, Florisse S, Jackson D, Ray N, Doherty T. Improving the efficiency of scale-up and deployment of community health workers in Mali: A geospatial analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000626. [PMID: 36962591 PMCID: PMC10021816 DOI: 10.1371/journal.pgph.0000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Optimising the scale and deployment of community health workers (CHWs) is important for maximizing geographical accessibility of integrated primary health care (PHC) services. Yet little is known about approaches for doing so. We used geospatial analysis to model optimised scale-up and deployment of CHWs in Mali, to inform strategic and operational planning by the Ministry of Health and Social Development. Accessibility catchments were modelled based on travel time, accounting for barriers to movement. We compared geographic coverage of the estimated population, under-five deaths, and plasmodium falciparum (Pf) malaria cases across different hypothetical optimised CHW networks and identified surpluses and deficits of CHWs compared to the existing CHW network. A network of 15 843 CHW, if optimally deployed, would ensure that 77.3% of the population beyond 5 km of the CSCom (community health centre) and CSRef (referral health facility) network would be within a 30-minute walk of a CHW. The same network would cover an estimated 59.5% of U5 deaths and 58.5% of Pf malaria cases. As an intermediary step, an optimised network of 4 500 CHW, primarily filling deficits of CHW in the regions of Kayes, Koulikoro, Sikasso, and Ségou would ensure geographic coverage for 31.3% of the estimated population. There were no important differences in geographic coverage percentage when prioritizing CHW scale-up and deployment based on the estimated population, U5 deaths, or Pf malaria cases. Our geospatial analysis provides useful information to policymakers and planners in Mali for optimising the scale-up and deployment of CHW and, in turn, for maximizing the value-for-money of resources of investment in CHWs in the context of the country's health sector reform. Countries with similar interests in optimising the scale and deployment of their CHW workforce may look to Mali as an exemplar model from which to learn.
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Affiliation(s)
- Nicholas P Oliphant
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Zeynabou Sy
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Brehima Koné
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Mohamed Berthé
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Madeleine Beebe
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Moussa Samake
- Ministère de la Santé et du Développement Social du Mali, Cellule de Planification et de Statistique Secteur Santé, Développment Social et Promotion de la Famille, Bamako, Mali
| | - Mamoutou Diabaté
- Ministère de la Santé et du Développement Social du Mali, Direction National de la Santé, Bamako, Mali
| | - Salimata Tounkara
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Borodjan Diarra
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l'Hygiène Publique, Bamako, Mali
| | - Amadou B Diarra
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Cheickna H Diawara
- Ministère de la Santé et du Développement Social du Mali, L'Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Tsvetana Yakimova
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Sonia Florisse
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Debra Jackson
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- London School of Hygiene and Tropical Medicine (LSHTM), Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London, United Kingdom
| | - Nicolas Ray
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Tanya Doherty
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- South African Medical Research Council, Health Systems Research Unit, Tygerberg, Republic of South Africa
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van Pinxteren M, Colvin CJ, Cooper S. Using health information for community activism: A case study of the movement for change and social justice in South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000664. [PMID: 36962538 PMCID: PMC10022230 DOI: 10.1371/journal.pgph.0000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
The access to, use, and exchange of health information is crucial when strengthening public health services and improving access to care. However, many health system stakeholders, including community groups are perpetually excluded from accessing and using health information. This is problematic as community groups, themselves end-users of care, are well-positioned to keep the health system accountable, provide feedback on the quality of services, and identify emerging health concerns. Using qualitative, ethnographic methods, this paper investigates different strategies used by the Movement for Change and Social Justice (MCSJ)-a local health activism group-to collect, use and distribute health information to improve health care in Gugulethu, a low-income neighbourhood in Cape Town, South Africa. Through participant observation, shadowing, informal conversations and semi-structured interviews that were analysed using iterative thematic analysis, findings revealed that MCSJ effectively collected, used and exchanged health information to develop short-term health campaigns. To get access to the needed health information, they used innovative strategies, including cultivating allies in the health system, finding safe spaces, and using community brokers to effectively mobilise community members to keep the health system accountable. MCSJ's strategies highlight that stakeholders' engagement with health information is not only a technical exercise, but a complex social process that requires constant negotiation and relationship building. Therefore, to make meaningful improvements to health services and create adaptive and responsive health systems, we need to include community groups as active stakeholders in the health system, provide relevant, up-to-date and locally relevant health information, and facilitate opportunities to socially engage with health information and those who produce it.
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Affiliation(s)
- Myrna van Pinxteren
- Department of Medicine, Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Gitaka J, Mbugua S, Mwaura P, Gatungu D, Githanga D, Ndwiga C, Abuya T, K'Oduol K, Liambila W, Were F. Devolved health system capacity in the provision of care for sick newborns and young infants in four counties serving vulnerable populations in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000183. [PMID: 36962529 PMCID: PMC10022333 DOI: 10.1371/journal.pgph.0000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2022] [Indexed: 03/26/2023]
Abstract
Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems' preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization's Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61-64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.
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Affiliation(s)
- Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Samuel Mbugua
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Daniel Gatungu
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya
| | | | | | | | | | | | - Fred Were
- Kenya Paediatric Research Consortium, Nairobi, Kenya
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Sarriot E, Davis T, Morrow M, Kabore T, Perry H. Motivation and Performance of Community Health Workers: Nothing New Under the Sun, and Yet…. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:716-724. [PMID: 34933969 PMCID: PMC8691878 DOI: 10.9745/ghsp-d-21-00627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
We know that both financial and nonfinancial incentives matter if we want community health workers (CHWs) who are motivated and performing. What are the practical implications for CHWs themselves and for effective management of viable CHW programs?
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Affiliation(s)
- Eric Sarriot
- Gavi, The Vaccine Alliance, Geneva, Switzerland.
| | - Tom Davis
- World Vision International, Geneva, Switzerland
| | | | | | - Henry Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ayala G, Sprague L, van der Merwe LLA, Thomas RM, Chang J, Arreola S, Davis SLM, Taslim A, Mienies K, Nilo A, Mworeko L, Hikuam F, de Leon Moreno CG, Izazola-Licea JA. Peer- and community-led responses to HIV: A scoping review. PLoS One 2021; 16:e0260555. [PMID: 34852001 PMCID: PMC8635382 DOI: 10.1371/journal.pone.0260555] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. METHODS We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. FINDINGS Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. CONCLUSIONS AND RECOMMENDATIONS Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.
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Affiliation(s)
- George Ayala
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Alameda County Department of Public Health, Oakland, CA, United States of America
- * E-mail:
| | - Laurel Sprague
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - L. Leigh-Ann van der Merwe
- Social, Health and Empowerment Feminist Collective of Transgender Women in Africa, East London, South Africa
- Innovative Response Globally to Transgender Women and HIV (IRGT), Oakland, CA, United States of America
| | | | - Judy Chang
- International Network of People Who Use Drugs, London, United Kingdom
| | - Sonya Arreola
- MPact Global Action for Gay Men’s Health and Rights, Oakland, CA, United States of America
- Arreola Research, San Francisco, CA, United States of America
| | | | | | - Keith Mienies
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern Africa, Kampala, Uganda
| | - Felicita Hikuam
- AIDS and Rights Alliance for Southern Africa, Windhoek, Namibia
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Haenssgen MJ, Charoenboon N, Thavethanutthanawin P, Wibunjak K. Tales of treatment and new perspectives for global health research on antimicrobial resistance. MEDICAL HUMANITIES 2021; 47:e10. [PMID: 32948667 PMCID: PMC8639946 DOI: 10.1136/medhum-2020-011894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 05/06/2023]
Abstract
Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential-in particular, through the field's emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public.We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance.Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and 'lay' sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.
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Affiliation(s)
- Marco J Haenssgen
- Global Sustainable Development, University of Warwick, Coventry, UK
- Institute of Advanced Study, University of Warwick, Coventry, West Midlands, UK
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Tran NT, Meyers J, Malilo B, Chabo J, Muselemu JB, Riziki B, Libonga P, Shire A, Had H, Ali M, Arab MA, Da'ar JM, Kahow MH, Adive JE, Gebru B, Monaghan E, Morris CN, Gallagher M, Jouanicot V, Pougnier N, Amsalu R. Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia. Front Glob Womens Health 2021; 2:671058. [PMID: 34816224 PMCID: PMC8593961 DOI: 10.3389/fgwh.2021.671058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In humanitarian settings, strengthening health systems while responding to the health needs of crisis-affected populations is challenging and marked with evidence gaps. Drawing from a decade of family planning and postabortion care programming in humanitarian settings, this paper aims to identify strategic components that contribute to health system strengthening in such contexts. Materials and Methods: A diverse range of key informants from North Kivu (Democratic Republic of Congo, DRC) and Puntland (Somalia), including female and male community members, adolescents and adults, healthcare providers, government and community leaders, participated in qualitative interviews, which applied the World Health Organization health system building blocks framework. Data were thematically analyzed according to this framework. Results: Findings from the focus group discussions (11 in DRC, 7 in Somalia) and key informant interviews (seven in DRC, four in Somalia) involving in total 54 female and 72 male participants across both countries indicate that health programs in humanitarian settings, such as Save the Children's initiative on family planning and postabortion care, could contribute to strengthening health systems by positively influencing national policies and guidance, strengthening local coordination mechanisms, capacitating the healthcare workforce with competency-based training and supportive supervision (benefiting facilities supported by the project and beyond), developing the capacity of Ministry of Health staff in the effective management of the supply chain, actively and creatively mobilizing the community to raise awareness and create demand, and providing quality and affordable services. Financial sustainability is challenged by the chronically limited healthcare expenditure experienced in both humanitarian contexts. Conclusions: In humanitarian settings, carefully designed healthcare interventions, such as those that address the family planning and postabortion care needs of crisis-affected populations, have the potential not only to increase access to essential services but also contribute to strengthening several components of the health system while increasing the government capacity, ownership, and accountability.
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Affiliation(s)
- Nguyen Toan Tran
- Faculty of Health, Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Janet Meyers
- Save the Children, Washington, DC, United States
| | - Bibiche Malilo
- Save the Children International Democratic Republic of Congo (DRC), Goma, Democratic Republic of Congo
| | - Julien Chabo
- Save the Children International Democratic Republic of Congo (DRC), Goma, Democratic Republic of Congo
| | - Jean-Baptiste Muselemu
- Save the Children International Democratic Republic of Congo (DRC), Goma, Democratic Republic of Congo
| | - Bienvenu Riziki
- Save the Children International Democratic Republic of Congo (DRC), Goma, Democratic Republic of Congo
| | - Patrick Libonga
- Save the Children International Democratic Republic of Congo (DRC), Goma, Democratic Republic of Congo
| | | | - Hussein Had
- Save the Children International Somalia, Gardo, Somalia
| | - Mohamed Ali
- Save the Children International Somalia, Gardo, Somalia
| | | | | | | | | | - Binyam Gebru
- Save the Children International Somalia, Gardo, Somalia
| | | | | | | | | | | | - Ribka Amsalu
- Save the Children, Washington, DC, United States.,Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, United States
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Perry HB, Chowdhury M, Were M, LeBan K, Crigler L, Lewin S, Musoke D, Kok M, Scott K, Ballard M, Hodgins S. Community health workers at the dawn of a new era: 11. CHWs leading the way to "Health for All". Health Res Policy Syst 2021; 19:111. [PMID: 34641891 PMCID: PMC8506098 DOI: 10.1186/s12961-021-00755-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This is the concluding paper of our 11-paper supplement, "Community health workers at the dawn of a new era". METHODS We relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes. RESULTS CHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness. CONCLUSION A marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.
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Affiliation(s)
- Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway and Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Independent Consultant, Toronto, Canada
| | - Madeleine Ballard
- Community Health Impact Coalition, New York, NY, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Steve Hodgins
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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LeBan K, Kok M, Perry HB. Community health workers at the dawn of a new era: 9. CHWs' relationships with the health system and communities. Health Res Policy Syst 2021; 19:116. [PMID: 34641902 PMCID: PMC8506091 DOI: 10.1186/s12961-021-00756-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This is the ninth paper in our series, "Community Health Workers at the Dawn of a New Era". Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. METHODS The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. RESULTS The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. CONCLUSION To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.
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Affiliation(s)
| | - Maryse Kok
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Henry B Perry
- Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Sacks E, Yangchen S, Marten R. COVID-19, climate change, and communities. Lancet Planet Health 2021; 5:e663-e664. [PMID: 34627466 PMCID: PMC8497025 DOI: 10.1016/s2542-5196(21)00257-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 05/26/2023]
Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
| | - Sonam Yangchen
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Mulderij-Jansen V, Gerstenbluth I, Duits A, Tami A, Bailey A. Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases. Parasit Vectors 2021; 14:500. [PMID: 34565464 PMCID: PMC8474927 DOI: 10.1186/s13071-021-05011-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks. Methods From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data. Results This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance). Conclusions This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05011-x.
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Affiliation(s)
- Vaitiare Mulderij-Jansen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,International Development Studies, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands. .,Department of Epidemiology, Curaçao Biomedical & Health Research Institute, Willemstad, Curaçao.
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical & Health Research Institute, Willemstad, Curaçao.,Epidemiology and Research Unit, Ministry of Health Environment and Nature of Curaçao, Willemstad, Curaçao
| | - Ashley Duits
- Red Cross Blood Bank Foundation, Willemstad, Curaçao.,Department of Immunology, Curaçao Biomedical & Health Research Institute, Willemstad, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- International Development Studies, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
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Story WT, Pritchard S, Hejna E, Olivas E, Sarriot E. The role of integrated community case management projects in strengthening health systems: case study analysis in Ethiopia, Malawi and Mozambique. Health Policy Plan 2021; 36:900-912. [PMID: 33930137 DOI: 10.1093/heapol/czaa177] [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] [Accepted: 11/24/2020] [Indexed: 11/14/2022] Open
Abstract
Integrated community case management (iCCM) has now been implemented at scale globally. Literature to-date has focused primarily on the effectiveness of iCCM and the systems conditions required to sustain iCCM. In this study, we sought to explore opportunities taken and lost for strengthening health systems through successive iCCM programmes. We employed a systematic, embedded, multiple case study design for three countries-Ethiopia, Malawi and Mozambique-where Save the Children implemented iCCM programmes between 2009 and 2017. We used textual analysis to code 62 project documents on nine categories of functions of health systems using NVivo 11.0. The document review was supplemented by four key informant interviews. This study makes important contributions to the theoretical understanding of the role of projects in health systems strengthening by not only documenting evidence of systems strengthening in multi-year iCCM projects, but also emphasizing important deficiencies in systems strengthening efforts. Projects operated on a spectrum, ranging from gap-filling interventions, to support, to actual strengthening. While there were natural limits to the influence of a project on the health system, all successive projects found constructive opportunities to try to strengthen systems. Alignment with the Ministry of Health was not always static and simple, and ministries themselves have shown pluralism in their perspectives and orientations. We conclude that systems strengthening remains 'everybody's business' and places demands for realism and transparency on government and the development architecture. While mid-size projects have limited decision space, there is value in better defining where systems strengthening contributions can actually be made. Furthermore, systems strengthening is not solely about macro-level changes, as operational and efficiency gains at meso and micro levels can have value to the system. Claims of 'systems strengthening' are, however, bounded within the quality of evaluation and learning investments.
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Affiliation(s)
- William T Story
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Susannah Pritchard
- Formerly Save the Children, Health Department, 1 St. John's Lane, London EC1M 4AR, UK
| | - Emily Hejna
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Elijah Olivas
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Eric Sarriot
- Formerly Save the Children, Department of Global Health, 899 North Capitol St NE #900, Washington, DC 20002, USA
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Schneiders ML, Phou M, Tun V, Kelley M, Parker M, Turner C. Grandparent caregiving in Cambodian skip-generation households: Roles and impact on child nutrition. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13169. [PMID: 34241960 PMCID: PMC8269139 DOI: 10.1111/mcn.13169] [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] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
This study aims to understand nutrition-related roles, responsibilities and ethical issues of grandparents caring for their grandchildren in skip-generation households in rural Cambodia. Over the past decade, Cambodia has experienced a rise in economic migration of working age populations. This has resulted in increasing numbers of 'skip-generation' households, in which grandparents and grandchildren co-reside without parents, reflecting potential household vulnerability. This qualitative study involved in-depth interviews and focus group discussions with Cambodian grandparents who were primary caregivers to grandchildren for six months or longer. A total of 39 grandparents were recruited at two sites in north-west Cambodia. Interviews and focus group discussions were conducted in Khmer and were recorded, transcribed and translated into English. Data were analysed using thematic analysis. Grandparents in this study looked after an average of three children, aged between two months and 18 years old. Overall, 40% were sole caregivers. Analysis showed that grandparents, particularly grandmothers, played a central role in their grandchildren's health and nutrition. Although grandchildren's health and nutrition were a major priority to grandparents, they reported facing significant challenges to safeguard their grandchildren's and their own nutritional needs. As a result, grandparents frequently faced difficult ethical trade-offs and prioritised their grandchildren's health and nutrition over their own. This study highlights that in order to improve child nutrition, policies and interventions need to be designed in ways that support and enable grandparent caregivers to meet their grandchildren's health and nutritional needs without neglecting their own.
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Affiliation(s)
- Mira Leonie Schneiders
- Ethox Centre, Big Data Institute, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research BuildingUniversity of OxfordOxfordUK
| | - Maly Phou
- FHI 360 Cambodia OfficePhnom PenhCambodia
| | - Vira Tun
- HelpAge CambodiaBattambangCambodia
| | - Maureen Kelley
- Ethox Centre, Big Data Institute, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Michael Parker
- Ethox Centre, Big Data Institute, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research BuildingUniversity of OxfordOxfordUK
- Angkor Hospital for ChildrenSiem ReapCambodia
- Cambodia Oxford Medical Research UnitAngkor Hospital for ChildrenSiem ReapCambodia
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45
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Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson C, Majowicz S, Troell M, Parmley EJ, Jørgensen PS, Wernli D. AMR-Intervene: a social-ecological framework to capture the diversity of actions to tackle antimicrobial resistance from a One Health perspective. J Antimicrob Chemother 2021; 76:1-21. [PMID: 33057678 DOI: 10.1093/jac/dkaa394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The global threat of antimicrobial resistance (AMR) requires coordinated actions by and across different sectors. Increasing attention at the global and national levels has led to different strategies to tackle the challenge. The diversity of possible actions to address AMR is currently not well understood from a One Health perspective. AMR-Intervene, an interdisciplinary social-ecological framework, describes interventions to tackle AMR in terms of six components: (i) core information about the publication; (ii) social system; (iii) bio-ecological system; (iv) triggers and goals; (v) implementation and governance; and (vi) assessment. AMR-Intervene provides a broadly applicable framework, which can inform the design, implementation, assessment and reporting of interventions to tackle AMR and, in turn, enable faster uptake of successful interventions to build societal resilience to AMR.
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Affiliation(s)
- Anaïs Léger
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
| | - Irene Lambraki
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Melanie Cousins
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Patrik J G Henriksson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden.,WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carolee Carson
- Canadian Integrated Program for Antimicrobial Resistance Surveillance; Public Health Agency of Canada, Guelph, Canada
| | - Shannon Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Peter S Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
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46
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Stockton DA, Fowler C, Debono D, Travaglia J. World Health Organization building blocks in rural community health services: An integrative review. Health Sci Rep 2021; 4:e254. [PMID: 33732894 PMCID: PMC7942400 DOI: 10.1002/hsr2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Developing and adapting health service models to effectively meet the needs of rural and remote communities is an international priority given inequities in health outcomes compared with metropolitan counterparts. This integrative review aims to inform rural and remote health service delivery systems by drawing on the WHO Framework building blocks to identify lessons learned from the literature describing experiences of rural and remote community health service planning and implementation; and inform recommendations to strengthen often disadvantaged rural and remote health systems for policy makers, health service managers, and those implementing international healthcare initiatives within these contexts. METHODS The integrative review examined the literature reporting rural and remote community health service delivery published from 2007 to 2017 (the decade following the release of the WHO Framework). Using an analytic frame, a structured template was developed to extract data and categorized against the WHO building blocks, followed by a synthesis of the key findings. RESULTS This integrative review identified that WHO Framework building blocks such as "Service Delivery" and "Health Workforce" are commonly reflected in rural and remote community health service delivery literature in the decade since the Framework's release. However, others such as "Sustainable Funding and Social Protection" are less commonly reported in the literature despite these elements being identified by the WHO as being integral to successful, sustainable health service delivery systems. CONCLUSIONS We found that collaboration across the health system governance continuum from local to policy level is an essential enabler for rural and remote health service delivery. Community-based participatory action research provides an opportunity to learn from one another, build capacity, optimize service model suitability, and promotes cultural safety by demonstrating respect and inclusivity in decision-making. Policy makers and funders need to acknowledge the time and resources required to build trust and community coalitions to inform effective planning and implementation.
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Affiliation(s)
- Deborah A. Stockton
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing and MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Deborah Debono
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Joanne Travaglia
- Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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Rogers HL, Barros PP, Maeseneer JD, Lehtonen L, Lionis C, McKee M, Siciliani L, Stahl D, Zaletel J, Kringos D. Resilience Testing of Health Systems: How Can It Be Done? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094742. [PMID: 33946804 PMCID: PMC8124463 DOI: 10.3390/ijerph18094742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022]
Abstract
The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation.
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Affiliation(s)
- Heather L. Rogers
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
- IKERBASQUE Basque Foundation for Science, 48009 Bilbao, Spain
- Correspondence:
| | - Pedro Pita Barros
- Nova School of Business and Economics, Universidade Nova de Lisboa, 2775-405 Lisbon, Portugal;
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
| | - Lasse Lehtonen
- Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland;
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Martin McKee
- Department of Health Services and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK;
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York YO10 5DD, UK;
| | - Dorothea Stahl
- Klinikum Bielefeld, Universitätsklinikum OWL der Universität Bielefeld, 33604 Bielefeld, Germany;
| | - Jelka Zaletel
- National Insitute of Public Health Slovenia and University Medical Center, 1000 Ljubljana, Slovenia;
| | - Dionne Kringos
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
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48
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Basu A, Kuziemsky C, de Araújo Novaes M, Kleber A, Sales F, Al-Shorbaji N, Flórez-Arango JF, Gogia SB, Ho K, Hunter I, Iyengar S, John O, John S, Kulatunga G, Rajput VK, Ranatunga P, Udayasankaran JG. Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response. Yearb Med Inform 2021; 30:126-133. [PMID: 33882598 PMCID: PMC8416231 DOI: 10.1055/s-0041-1726484] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response. METHODS We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems. RESULTS Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response. CONCLUSION COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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Affiliation(s)
- Arindam Basu
- University of Canterbury, Christchurch, New Zealand
| | | | - Magdala de Araújo Novaes
- Medical Sciences Center, Telehealth Center, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil
| | - Araujo Kleber
- Telehealth Center (NUTES), Federal University of Pernambuco, Recife, Brazil
| | - Fernando Sales
- Technology and Geosciences Center, Telehealth Center, Federal University of Pernambuco, Recife, Brazil
| | | | | | - Shashi B Gogia
- Society for Administration of Telemedicine and Healthcare Informatics, New Delhi, India
| | - Kendall Ho
- University of British Columbia, Vancouver, Canada
| | - Inga Hunter
- Massey University, Palmerston North, New Zealand
| | - Sriram Iyengar
- University of Arizona, Phoenix, United States of America
| | - Oommen John
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Gumindu Kulatunga
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,University of Southampton, Southampton, UK
| | | | - Prasad Ranatunga
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.,University of Southampton, Southampton, UK
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49
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Simen-Kapeu A, Reserva ME, Ekpini RE. Galvanizing Action on Primary Health Care: Analyzing Bottlenecks and Strategies to Strengthen Community Health Systems in West and Central Africa. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:S47-S64. [PMID: 33727320 PMCID: PMC7971379 DOI: 10.9745/ghsp-d-20-00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA). Though evidence-based cost-effective interventions that are predicted to prevent up to one-third of maternal, newborn, and child health complications and deaths with universal coverage have been identified, more than 50% of people living in rural areas or from poor families still do not have access to these interventions in resource-constrained settings. METHODS We conducted a multicountry systematic analysis of bottlenecks and proposed solutions to strengthen community health systems through a series of collaborative workshops in 22 countries in WCA. Countries were categorized by their under-5 mortality rate (U5MR) to assess specificities related to reported challenges. We also reviewed existing data on selected health system tracer interventions to analyze country profiles. RESULTS The bottlenecks identified as severe or very severe were related to health financing (19 countries, 86%), essential medical technology and products (16 countries, 73%), integrated health service delivery (14 countries, 64%), and community ownership and partnerships (self-reported by 14 countries, 64%). Only the integrated service delivery was self-reported as a severe challenge by countries with high U5MR. The issue of human resources for community health was one of the least reported challenges. CONCLUSION In WCA, strengthening community health systems as part of PHC revitalization efforts should focus on increasing health financing and innovative investments, strengthening the logistics management system, and fostering community ownership and partnerships. Countries with high U5MR should also reinforce integrated service delivery approaches through innovation. Government actions galvanized by global and regional ongoing initiatives should be sustained to ensure that no one is left behind.
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Affiliation(s)
- Aline Simen-Kapeu
- United Nations Children's Fund, West and Central Regional Office, Dakar, Senegal.
| | | | - Rene Ehounou Ekpini
- United Nations Children's Fund, West and Central Regional Office, Dakar, Senegal
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50
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Baptiste S, Manouan A, Garcia P, Etya'ale H, Swan T, Jallow W. Community-Led Monitoring: When Community Data Drives Implementation Strategies. Curr HIV/AIDS Rep 2021; 17:415-421. [PMID: 32734363 PMCID: PMC7497354 DOI: 10.1007/s11904-020-00521-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Communities occupy a central position in effective health systems, notably through monitoring of health service quality and by giving recipients of care a voice. Our review identifies community-led monitoring mechanisms and best practices. RECENT FINDINGS Implementation of community-led monitoring mechanisms improved service delivery at facility-level, health system-wide infrastructure and health outcomes among recipients of care. Successful models were community-led, collaborative, continuous and systematic, and incorporated advocacy and community education. Identifying and replicating successful community-led monitoring practices is a key pathway to equitable access to HIV and health services overall.
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Affiliation(s)
- Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | - Alain Manouan
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | - Pedro Garcia
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | - Helen Etya'ale
- International Treatment Preparedness Coalition, Johannesburg, South Africa.
| | - Tracy Swan
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | - Wame Jallow
- International Treatment Preparedness Coalition, Johannesburg, South Africa
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