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Pappas A, Kovats S, Ranganathan M. Extreme weather events and maternal health in low-income and middle-income countries: a scoping review. BMJ Open 2024; 14:e079361. [PMID: 38830734 PMCID: PMC11149126 DOI: 10.1136/bmjopen-2023-079361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/09/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Despite global efforts to improve maternal health and healthcare, women throughout the world endure poor health during pregnancy. Extreme weather events (EWE) disrupt infrastructure and access to medical services, however little is known about their impact on the health of women during pregnancy in resource-poor settings. OBJECTIVES This review aims to examine the current literature on the impact of EWE on maternal health to identify the pathways between EWE and maternal health in low-income and middle-income countries to identify gaps. ELIGIBILITY CRITERIA Studies were eligible for inclusion if they were published before 15 December 2022 and the population of the studies included pregnant and postpartum women (defined at up to 6 weeks postpartum) who were living in low-income and middle-income countries. The exposure of the included study must be related to EWE and the result to maternal health outcomes. SOURCES OF EVIDENCE We searched the literature using five databases, Medline, Global Health, Embase, Web of Science and CINAHL in December 2022. We assessed the results using predetermined criteria that defined the scope of the population, exposures and outcomes. In total, 15 studies were included. CHARTING METHODS We identified studies that fit the criteria and extracted key themes. We extracted population demographics and sampling methodologies, assessed the quality of the studies and conducted a narrative synthesis to summarise the key findings. RESULTS Fifteen studies met the inclusion criteria. The quantitative studies (n=4) and qualitative (n=11) demonstrated an association between EWE and malnutrition, mental health, mortality and access to maternal health services. CONCLUSION EWE negatively impact maternal health through various mechanisms including access to services, stress and mortality. The results have demonstrated concerning effects, but there is also limited evidence surrounding these broad topics in low-resource settings. Research is necessary to determine the mechanisms by which EWE affect maternal health. PROSPERO REGISTRATION NUMBER CRD42022352915.
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Affiliation(s)
- Anna Pappas
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sari Kovats
- Centre on Climate Change and Planetary Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Meghna Ranganathan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Saulnier DD, Topp SM. We need to talk about 'bad' resilience. BMJ Glob Health 2024; 9:e014041. [PMID: 38320804 PMCID: PMC10859976 DOI: 10.1136/bmjgh-2023-014041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
In this analysis, we argue against seeing health system resilience as an inherently positive concept. The rise in the popularity of health system resilience has led to its increasingly normative framing. We question this widely accepted perspective by examining the underlying assumptions associated with this normative framing of 'good' resilience. Our focus is on the risks of accepting the assumption, which can lead us to ignore the social nature of health systems and overlook the consequences of change if resilience is seen as a positive, achievable objective. Finally, we suggest that seeing resilience as a normative concept can be detrimental to health system policy and research, and encourage a critical rethinking of these assumptions so that we can maintain resilience's usefulness for health systems.
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Affiliation(s)
- Dell D Saulnier
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- The University of Melbourne Nossal Institute for Global Health, Melbourne, Victoria, Australia
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Baličević SA, Elimian KO, King C, Diaconu K, Akande OW, Ihekweazu V, Trolle H, Gaudenzi G, Forsberg B, Alfven T. Influences of community engagement and health system strengthening for cholera control in cholera reporting countries. BMJ Glob Health 2023; 8:e013788. [PMID: 38084475 PMCID: PMC10711916 DOI: 10.1136/bmjgh-2023-013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
The 2030 Global Task Force on Cholera Control Roadmap hinges on strengthening the implementation of multistranded cholera interventions, including community engagement and health system strengthening. However, a composite picture of specific facilitators and barriers for these interventions and any overlapping factors existing between the two, is lacking. Therefore, this study aims to address this shortcoming, focusing on cholera-reporting countries, which are disproportionately affected by cholera and may be cholera endemic. A scoping methodology was chosen to allow for iterative mapping, synthesis of the available research and to pinpoint research activity for global and local cholera policy-makers and shareholders. Using the Arksey and O'Malley framework for scoping reviews, we searched PubMed, Web of Science and CINAHL. Inclusion criteria included publication in English between 1990 and 2021 and cholera as the primary document focus in an epidemic or endemic setting. Data charting was completed through narrative descriptive and thematic analysis. Forty-four documents were included, with half relating to sub-Saharan African countries, 68% (30/44) to cholera endemic settings and 21% (9/44) to insecure settings. We identified four themes of facilitators and barriers to health systems strengthening: health system cooperation and agreement with external actors; maintaining functional capacity in the face of change; good governance, focused political will and sociopolitical influences on the cholera response and insecurity and targeted destruction. Community engagement had two themes: trust building in the health system and growing social cohesion. Insecurity and the community; cooperation and agreement; and sociopolitical influences on trust building were themes of factors acting at the interface between community engagement and health system. Given the decisive role of the community-health system interface for both sustained health system strengthening and community engagement, there is a need to advocate for conflict resolution, trust building and good governance for long-term cholera prevention and control in cholera reporting countries.
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Affiliation(s)
| | - Kelly Osezele Elimian
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Exhale Health Foundation, Abuja, Nigeria
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Diaconu
- Institute of Global Health, Queen Margaret University, Edinburgh, UK
| | - Oluwatosin Wuraola Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Hanna Trolle
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Gaudenzi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Protein Science, SciLifeLab, Stockholm, Sweden
| | - Birger Forsberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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Accoe K, Criel B, Ag Ahmed MA, Buitrago VT, Marchal B. Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania. BMJ Glob Health 2023; 8:e013943. [PMID: 38050409 PMCID: PMC10693853 DOI: 10.1136/bmjgh-2023-013943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic. METHODS We used a single case study with two health districts as units of analysis. A context analysis, a literature review and 33 semi-structured interviews were conducted. The data were analysed using a resilience conceptual framework. RESULTS The analysis indicates a certain capacity to manage the crisis, but significant gaps and challenges remain. The management of many uncertainties is largely dependent on the quality of the alignment of decision-makers at district level with the national level. Local management of COVID-19 in the context of Mauritania's fragile healthcare system has been skewed to awareness-raising and a surveillance system. Three other elements appear to be particularly important in building a resilient healthcare system: leadership capacity, community dynamics and the existence of a learning culture. CONCLUSION The COVID-19 pandemic has put a great deal of pressure on healthcare systems. Our study has shown the relevance of an in-depth contextual analysis to better identify the enabling environment and the capacities required to develop a certain level of resilience. The translation into practice of the skills required to build a resilient healthcare system remains to be further developed.
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Affiliation(s)
- Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Neill R, Peters MA, Bello S, Dairo MD, Azais V, Samuel Jegede A, Adebowale AS, Nzelu C, Azodo N, Adoghe A, Wang W, Bartlein R, Liu A, Ogunlayi M, Yaradua SU, Shapira G, Hansen PM, Fawole OI, Ahmed T. What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria. BMJ Glob Health 2023; 8:e012700. [PMID: 37984895 PMCID: PMC10660915 DOI: 10.1136/bmjgh-2023-012700] [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: 04/27/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience. METHODS Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework. RESULTS A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps. CONCLUSION Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.
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Affiliation(s)
- Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Michael A Peters
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ngozi Azodo
- Nigeria Federal Ministry of Health, Abuja, Nigeria
| | | | - William Wang
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Rebecca Bartlein
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Anne Liu
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Saudatu Umma Yaradua
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Gil Shapira
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Peter M Hansen
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
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Lerosier T, Touré L, Diabaté S, Diarra Y, Ridde V. Minimal resilience and insurgent conflict: qualitative analysis of the resilience process in six primary health centres in central Mali. BMJ Glob Health 2023; 7:e010683. [PMID: 37185362 PMCID: PMC10580275 DOI: 10.1136/bmjgh-2022-010683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND In the context of universal health coverage in the Sahel, the study focuses on primary health centres and the difficulties of their implementation in the context of insurgency conflicts in central Mali. METHODS This is qualitative research through a multiple case study. We selected six health centres according to a reasoned choice to bring together contrasting situations. We conducted 96 semistructured interviews and consulted secondary quantitative data on attendance. By focusing on community health centres, the conceptual approach focuses on the process of resilience that unfolds in a dual context of chronic health system dysfunctions and armed conflict. RESULTS The resilience strategies deployed by health professionals were relatively basic and uncoordinated. In the end, it was the individuals who showed absorption. However, their room for manoeuvre was limited. In the most isolated health centres, resilience was based on subordinate, poorly trained staff, often from the locality. Degraded working conditions and fear caused a form of resignation among health workers. CONCLUSION The strategies and resources used showed a form of minimal resilience. This form is unfolding in a context marked by two structuring features. On the one hand, the Malian health system was relatively dysfunctional before the crisis, and on the other hand, the type of conflict was relatively low intensity that allowed health centres to remain open.
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Affiliation(s)
| | | | | | | | - Valery Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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Bhamani SS, Arthur D, Van Parys AS, Letourneau N, Wagnild G, Premji SS, Asad N, Degomme O. Resilience and prenatal mental health in Pakistan: a qualitative inquiry. BMC Pregnancy Childbirth 2022; 22:839. [PMID: 36376896 PMCID: PMC9664804 DOI: 10.1186/s12884-022-05176-y] [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: 04/15/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention. Methods The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A total of 17 semi-structured interviews were conducted with pregnant women, purposefully selected with heterogeneous characteristics to explore diverse perspectives, while symptoms of depression were quantified by the Edinburgh Postnatal Depression Scale before the interview. Verbatim transcriptions were coded openly and merged into categories and themes. Result A total of six themes emerged from in-depth thematic analysis: 1) purpose of life, 2) dealing with emotions, 3) believing in yourself, 4) optimistic approach, 5) strengthening support and relationship and 6) spirituality and humanity. Women agreed that these characteristics could help them improve their mental health. Conclusion In conclusion, these themes were the core components of pregnant women’s resilience which ultimately could help to promote prenatal mental health. These pave a pathway towards developing culturally and contextually resilience interventions aimed at enhancing mental health of pregnant women which then may improve neonatal and family mental wellbeing.
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Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag 2022; 11:2155-2165. [PMID: 34814662 PMCID: PMC9808299 DOI: 10.34172/ijhpm.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. METHODS We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. RESULTS The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. CONCLUSION Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.
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Affiliation(s)
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingrid Wolfe
- Institute for Women and Children's Health, King's College London, London, UK
| | - Christine Lau
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Emma Dickins
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Joeanne McSweeney
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Mary McCaskill
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, NSW, Australia
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Neill R, Neel AH, Cardona C, Bishai D, Gupta S, Mohan D, Jain N, Basu S, Closser S. Everyday capabilities were a path to resilience during COVID-19: a case study of five countries. Health Policy Plan 2022; 38:192-204. [PMID: 36222381 PMCID: PMC9619747 DOI: 10.1093/heapol/czac085] [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: 06/15/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/14/2022] Open
Abstract
COVID-19 demanded urgent responses by all countries, with wide variations in the scope and sustainability of those responses. Scholarship on resilience has increasingly emphasized relational considerations such as norms and power and how they influence health systems' responses to evolving challenges. In this study, we explored what influenced countries' national pandemic responses over time considering a country's capacity to test for COVID-19. To identify countries for inclusion, we used daily reports of COVID-19 cases and testing from 184 countries between 21st January 2020 and 31st December 2020. Countries reporting test data consistently and for at least 105 days were included, yielding a sample of 52 countries. We then sampled five countries representing different geographies, income levels and governance structures (Belgium, Ethiopia, India, Israel and Peru) and conducted semi-structured key informant interviews with stakeholders working in, or deeply familiar with, national responses. Across these five countries, we found that existing health systems capacities and political leadership determined how responses unfolded, while emergency plans or pandemic preparedness documents were not fit-for-purpose. While all five countries were successful at reducing COVID-19 infections at a specific moment in the pandemic, political economy factors complicated the ability to sustain responses, with all countries experiencing larger waves of the virus in 2021 or 2022. Our findings emphasize the continued importance of foundational public health and health systems capacities, bolstered by clear leadership and multisectoral coordination functions. Even in settings with high-level political leadership and a strong multisectoral response, informants wished that they-and their country's health system-were more prepared to address the pandemic and maintain an effective response over time. Our findings challenge emergency preparedness as the dominant frame in pandemic preparedness and call for a continued emphasis on health systems strengthening to respond to future health shocks and a pandemic moving to endemic status.
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Affiliation(s)
- Rachel Neill
- Corresponding author. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. E-mail:
| | - Abigail H Neel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nishant Jain
- Indo-German Social Security Program, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, 5/1, Second Floor, Safdarjung Enclave, New Delhi 110029, India
| | - Sharmishtha Basu
- Indo German Programme on Universal Health Coverage ((IGUHC), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, 5/1, Second Floor, Safdarjung Enclave, New Delhi 110029, India
| | - Svea Closser
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Forsgren L, Tediosi F, Blanchet K, Saulnier DD. Health systems resilience in practice: a scoping review to identify strategies for building resilience. BMC Health Serv Res 2022; 22:1173. [PMID: 36123669 PMCID: PMC9483892 DOI: 10.1186/s12913-022-08544-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background Research on health systems resilience has focused primarily on the theoretical development of the concept and its dimensions. There is an identified knowledge gap in the research on how to build resilience in health systems in practice and ‘what works’ in different contexts. The aim of this study is to identify practical strategies for building resilient health systems from the empirical research on health systems resilience. Methods A scoping review included empirical research on health systems resilience from peer-reviewed literature. The search in the electronic databases PubMed, Web of Science, Global Health was conducted during January to March 2021 for articles published in English between 2013 to February 2021. A total of 1771 articles were screened, and data was extracted from 22 articles. The articles included empirical, applied research on strategies for resilience, that observed or measured resilience during shocks or chronic stress through collection of primary data or analysis of secondary data, or if they were a review study of empirical research. A narrative summary was done by identifying action-oriented strategies, comparing them, and presenting them by main thematic areas. Results The results demonstrate examples of strategies used or recommended within nine identified thematic areas; use of community resources, governance and financing, leadership, surveillance, human resources, communication and collaboration, preparedness, organizational capacity and learning and finally health system strengthening. Conclusions The findings emphasize the importance of improved governance and financing, empowered middle-level leadership, improved surveillance systems and strengthened human resources. A re-emphasized focus on health systems strengthening with better mainstreaming of health security and international health regulations are demonstrated in the results as a crucial strategy for building resilience. A lack of strategies for recovery and lessons learnt from crises are identified as gaps for resilience in future. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08544-8.
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Affiliation(s)
- Lena Forsgren
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, P. O. Box, 4001, Basel, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, 28, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland
| | - Dell D Saulnier
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden. .,Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
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Saulnier DD, Thol D, Por I, Hanson C, von Schreeb J, Alvesson HM. 'We have a plan for that': a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia. BMJ Open 2022; 12:e054145. [PMID: 34980624 PMCID: PMC8724583 DOI: 10.1136/bmjopen-2021-054145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Health system resilience can increase a system's ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods. DESIGN A qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework. SETTING Public sector healthcare facilities and health departments in two districts exposed to flooding. PARTICIPANTS Twenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding. RESULTS The theme 'Collaboration across the system creates adaptability in the response' reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response. CONCLUSION The capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.
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Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dawin Thol
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Johan von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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12
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Hanson C, Luedtke S, Spicer N, Stilhoff Sörensen J, Mayhew S, Mounier-Jack S. National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020. BMJ Glob Health 2021; 6:bmjgh-2021-006691. [PMID: 34872972 PMCID: PMC8764706 DOI: 10.1136/bmjgh-2021-006691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 response of Germany, Sweden and the UK in 2020. We mapped legitimacy, interdependence, knowledge generation and the capacity to deal with uncertainty. Our analysis revealed stark differences which were linked to pre-existing governing structures, the traditional role of academia, experience of crisis management and the communication of uncertainty—all of which impacted on how much people trusted their government. Germany leveraged diversity and inclusiveness, a ‘patchwork quilt’, for which it was heavily criticised during the second wave. The Swedish approach avoided plurality and largely excluded academia, while in the UK’s academia played an important role in knowledge generation and in forcing the government to review its strategies. However, the vivant debate left the public with confusing and rapidly changing public health messages. Uncertainty and the lack of evidence on how best to manage the COVID-19 pandemic—the main feature during the first wave—was only communicated explicitly in Germany. All country governments lost trust of their populations during the epidemic due to a mix of communication and transparency failures, and increased questioning of government legitimacy and technical capacity by the public.
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Affiliation(s)
- Claudia Hanson
- Global Public Health, Karolinska Institutet, Stockholm, Sweden .,Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Susanne Luedtke
- Institute for risk and disaster reduction, University College London, London, UK.,Gesundheitsamt Nuremberg, Nuremberg, Germany
| | - Neil Spicer
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Susannah Mayhew
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Ireland H, Tran NT, Dawson A. The role of social capital in women's sexual and reproductive health and rights in humanitarian settings: a systematic review of qualitative studies. Confl Health 2021; 15:87. [PMID: 34819110 PMCID: PMC8611620 DOI: 10.1186/s13031-021-00421-1] [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: 08/04/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Social capital is an important social determinant of women's sexual and reproductive health and rights. Little research has been conducted to understand the role of social capital in women's sexual and reproductive health and how this can be harnessed to improve health in humanitarian settings. We synthesised the evidence to examine the nexus of women's sexual and reproductive health and rights and social capital in humanitarian contexts. METHODS We undertook a systematic review of qualitative studies. The preferred reporting items for systematic review and meta-analysis guidelines were used to identify peer-reviewed, qualitative studies conducted in humanitarian settings published since 1999. We searched CINAHL, MEDLINE, ProQuest Health & Medicine, PubMed, Embase and Web of science core collection and assessed quality using the Critical Appraisal Skills Programme tool. We used a meta-ethnographic approach to synthesise and analyse the data. FINDINGS Of 6749 initially identified studies, we included 19 studies, of which 18 were in conflict-related humanitarian settings and one in a natural disaster setting. The analysis revealed that the main form of social capital available to women was bonding social capital or strong links between people within groups of similar characteristics. There was limited use of bridging social capital, consisting of weaker connections between people of approximately equal status and power but with different characteristics. The primary social capital mechanisms that played a role in women's sexual and reproductive health and rights were social support, informal social control and collective action. Depending on the nature of the values, norms and traditions shared by network members, these social capital mechanisms had the potential to both facilitate and hinder positive health outcomes for women. CONCLUSIONS These findings demonstrate the importance of understanding social capital in planning sexual and reproductive health responses in humanitarian settings. The analysis highlights the need to investigate social capital from an individual perspective to expose the intra-network dynamics that shape women's experiences. Insights could help inform community-based preparedness and response programs aimed at improving the demand for and access to quality sexual and reproductive health services in humanitarian settings.
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Affiliation(s)
- Hannah Ireland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Saulnier DD, Blanchet K, Canila C, Cobos Muñoz D, Dal Zennaro L, de Savigny D, Durski KN, Garcia F, Grimm PY, Kwamie A, Maceira D, Marten R, Peytremann-Bridevaux I, Poroes C, Ridde V, Seematter L, Stern B, Suarez P, Teddy G, Wernli D, Wyss K, Tediosi F. A health systems resilience research agenda: moving from concept to practice. BMJ Glob Health 2021; 6:e006779. [PMID: 34353820 PMCID: PMC8344286 DOI: 10.1136/bmjgh-2021-006779] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
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Affiliation(s)
- Dell D Saulnier
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva and Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Carmelita Canila
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kara N Durski
- World Health Organization, Geneva, Switzerland
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
| | - Fernando Garcia
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
| | | | - Aku Kwamie
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Daniel Maceira
- Department of Economics, University of Buenos Aires, Buenos Aires, Argentina
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Camille Poroes
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Valery Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Laurence Seematter
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Barbara Stern
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Patricia Suarez
- Center for the Study of State and Society (CEDES), Buenos Aires, Argentina
| | - Gina Teddy
- Centre for Health Systems and Policy Research, Ghana Institute of Management and Public Administration, Accra, Ghana
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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15
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Reyes E. Born in Captivity: The Experiences of Puerto Rican Birth Workers and Their Clients in Quarantine. FRONTIERS IN SOCIOLOGY 2021; 6:613831. [PMID: 33869565 PMCID: PMC8022455 DOI: 10.3389/fsoc.2021.613831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/09/2021] [Indexed: 05/06/2023]
Abstract
In this article, I seek to understand how the COVID-19 pandemic has impacted childbirth in Puerto Rico, an island that was already in recovery following the occurrence of two devastating hurricanes in the fall of 2017 and a major earthquake in the winter of 2020. Thus, I argue that it is important to discuss not only how individual disasters impact birth, but also how their compounding effects do so. In order to address these research questions, I conducted remote interviews with Puerto Rican birth workers and researchers. During times of crisis, this pandemic included, home and midwife-attended births have become increasingly more popular. However, Puerto Rican midwives and doulas currently have less institutional support than ever. In a time of quarantine when home births are rising, we need to consider whether society is designed to facilitate these models of care. In Puerto Rico, pre-pandemic, there was a less than 1% home birth rate and there still is a lack of legal recognition and protections for homebirth midwives. As this article demonstrates, an acknowledgment of the near-invisible labors of these birth workers is needed, in addition to supplies, support, and protections for them-and not just in times of "crisis."
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Hanson C, Waiswa P, Pembe A, Sandall J, Schellenberg J. Health system redesign for equity in maternal and newborn health must be codesigned, country led, adapted to context and fit for purpose. BMJ Glob Health 2020; 5:e003748. [PMID: 33055095 PMCID: PMC7559045 DOI: 10.1136/bmjgh-2020-003748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023] Open
Affiliation(s)
- Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Andrea Pembe
- Obstetric and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jane Sandall
- Department of Women and Children's Health, King's College London, London, Greater London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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17
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Rossnerova A, Izzotti A, Pulliero A, Bast A, Rattan SIS, Rossner P. The Molecular Mechanisms of Adaptive Response Related to Environmental Stress. Int J Mol Sci 2020; 21:ijms21197053. [PMID: 32992730 PMCID: PMC7582272 DOI: 10.3390/ijms21197053] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
The exposure of living organisms to environmental stress triggers defensive responses resulting in the activation of protective processes. Whenever the exposure occurs at low doses, defensive effects overwhelm the adverse effects of the exposure; this adaptive situation is referred to as “hormesis”. Environmental, physical, and nutritional hormetins lead to the stimulation and strengthening of the maintenance and repair systems in cells and tissues. Exercise, heat, and irradiation are examples of physical hormetins, which activate heat shock-, DNA repair-, and anti-oxidative-stress responses. The health promoting effect of many bio-actives in fruits and vegetables can be seen as the effect of mildly toxic compounds triggering this adaptive stimulus. Numerous studies indicate that living organisms possess the ability to adapt to adverse environmental conditions, as exemplified by the fact that DNA damage and gene expression profiling in populations living in the environment with high levels of air pollution do not correspond to the concentrations of pollutants. The molecular mechanisms of the hormetic response include modulation of (a) transcription factor Nrf2 activating the synthesis of glutathione and the subsequent protection of the cell; (b) DNA methylation; and (c) microRNA. These findings provide evidence that hormesis is a toxicological event, occurring at low exposure doses to environmental stressors, having the benefit for the maintenance of a healthy status.
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Affiliation(s)
- Andrea Rossnerova
- Department of Genetic Toxicology and Epigenetics, Institute of Experimental Medicine, 14220 Prague, Czech Republic;
| | - Alberto Izzotti
- Department of Experimental Medicine, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandra Pulliero
- Department of Health Science, University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Aalt Bast
- Department of Pharmacology and Toxicology, Maastricht University, 6200 MD Maastricht, The Netherlands;
- Campus Venlo, Maastricht University, 5900 AA Venlo, The Netherlands
| | - S. I. S. Rattan
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus, Denmark;
| | - Pavel Rossner
- Department of Nanotoxicology and Molecular Epidemiology, Institute of Experimental Medicine, 14220 Prague, Czech Republic;
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18
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Topp SM. Power and politics: the case for linking resilience to health system governance. BMJ Glob Health 2020; 5:bmjgh-2020-002891. [PMID: 32546590 PMCID: PMC7299011 DOI: 10.1136/bmjgh-2020-002891] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia .,Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia
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