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Neill R, Zia N, Ashraf L, Khan Z, Pryor W, Bachani AM. Integration measurement and its applications in low- and middle-income country health systems: a scoping review. BMC Public Health 2023; 23:1876. [PMID: 37770887 PMCID: PMC10537146 DOI: 10.1186/s12889-023-16724-2] [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: 01/05/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use. METHODS Arksey and O'Malley's framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data. RESULTS We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use. CONCLUSION We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.
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Affiliation(s)
- Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Nukhba Zia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Lamisa Ashraf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Zainab Khan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Wesley Pryor
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins International Injury Research Unit, Health Systems Program, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Yao L, Aleya L, Howard SC, Cao Y, Wang CY, Day SW, Graff JC, Sun D, Gu W. Variations of COVID-19 mortality are affected by economic disparities across countries. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 832:154770. [PMID: 35341873 PMCID: PMC8949690 DOI: 10.1016/j.scitotenv.2022.154770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND When the COVID-19 case number reaches a maximum in a country, its capacity and management of health system face greatest challenge. METHODS We performed a cross-sectional study on data of turning points for cases and deaths for the first three waves of COVID-19 in countries with more than 5000 cumulative cases, as reported by Worldometers and WHO Coronavirus (COVID-19) Dashboard. We compared the case fatality rates (CFRs) and time lags (in unit of day) between the turning points of cases and deaths among countries in different development stages and potential influence factors. As of May 10, 2021, 106 out of 222 countries or regions (56%) reported more than 5000 cases. Approximately half of them have experienced all the three waves of COVID-19 disease. The average mortality rate at the disease turning point was 0.038 for the first wave, 0.020 for the second wave, and 0.023 for wave 3. In high-income countries, the mortality rates during the first wave are higher than that of the other income levels. However, the mortality rates during the second and third waves of COVID-19 were much lower than those of the first wave, with a significant reduction from 5.7% to 1.7% approximately 70%. At the same time, high-income countries exhibited a 2-fold increase in time lags during the second and the third waves compared to the first wave, suggesting that the periods between the cases and deaths turning point extended. High rates in the first wave in developed countries are associated to multiple factors including transportation, population density, and aging populations. In upper middle- and lower middle-income countries, the decreasing of mortality rates in the second and third waves were subtle or even reversed, with increased mortality during the following waves. In the upper and lower middle-income countries, the time lags were about 50% of the durations observed from high-income countries. INTERPRETATION Economy and medical resources affect the efficiency of COVID-19 mitigation and the clinical outcomes of the patients. The situation is likely to become even worse in the light of these countries' limited ability to combat COVID-19 and prevent severe outcomes or deaths as the new variant transmission becomes dominant.
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Affiliation(s)
- Lan Yao
- Health Outcomes and Policy Research, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté Université, F-25030 Besançon Cedex, France
| | - Scott C Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Yanhong Cao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, PR China; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618104), 157 Baojian Road, Harbin, Heilongjiang 150081, PR China
| | - Cong-Yi Wang
- The Center for Biomedical Research, Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Sara W Day
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - J Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Dianjun Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, PR China; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618104), 157 Baojian Road, Harbin, Heilongjiang 150081, PR China.
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38163, USA; Research Service, Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104, USA.
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Moise IK, Ortiz-Whittingham LR, Omachonu V, Sheskin IM, Patel R, Meguro JAS, Lucas AG, Bice W, Thompson LM. The impact of COVID-19 on service delivery systems: evidence from a survey of United States refugee resettlement agencies. BMC Health Serv Res 2022; 22:535. [PMID: 35459207 PMCID: PMC9026042 DOI: 10.1186/s12913-022-07909-3] [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: 07/29/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Key to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic. METHODS Using both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ2) tests were used to examine relationships by resettlement agency size (number of employees in each agency). RESULTS Despite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ2 (9.494, n = 101), p < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite (n = 72 agencies, some with multiple offices across the US). CONCLUSIONS US refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.
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Affiliation(s)
- Imelda K Moise
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA.
| | - Lola R Ortiz-Whittingham
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - Vincent Omachonu
- Department of Industrial and Systems Engineering, College of Engineering, University of Miami, 1251 Memorial Drive, Coral Gables, FL, 33146, USA
| | - Ira M Sheskin
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - Roshni Patel
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - Julia Ayumi Schmidt Meguro
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - Alexia Georgina Lucas
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - William Bice
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
| | - Leila Mae Thompson
- Department of Geography & Sustainable Development, College of Arts & Sciences, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, 33124, USA
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Hasan MZ, Neill R, Das P, Venugopal V, Arora D, Bishai D, Jain N, Gupta S. Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2021-005667. [PMID: 34135071 PMCID: PMC8210663 DOI: 10.1136/bmjgh-2021-005667] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Integrated health service delivery (IHSD) is a promising approach to improve health system resilience. However, there is a lack of evidence specific to the low/lower-middle-income country (L-LMIC) health systems on how IHSD is used during disease outbreaks. This scoping review aimed to synthesise the emerging evidence on IHSD approaches adopted in L-LMIC during the COVID-19 pandemic and systematically collate their operational features. METHODS A systematic scoping review of peer-reviewed literature, published in English between 1 December 2019 and 12 June 2020, from seven electronic databases was conducted to explore the evidence of IHSD implemented in L-LMICs during the COVID-19 pandemic. Data were systematically charted, and key features of IHSD systems were presented according to the postulated research questions of the review. RESULTS The literature search retrieved 1487 published articles from which 18 articles met the inclusion criteria and included in this review. Service delivery, health workforce, medicine and technologies were the three most frequently integrated health system building blocks during the COVID-19 pandemic. While responding to COVID-19, the L-LMICs principally implemented the IHSD system via systematic horizontal integration, led by specific policy measures. The government's stewardship, along with the decentralised decision-making capacity of local institutions and multisectoral collaboration, was the critical facilitator for IHSD. Simultaneously, fragmented service delivery structures, fragile supply chain, inadequate diagnostic capacity and insufficient workforce were key barriers towards integration. CONCLUSION A wide array of context-specific IHSD approaches were operationalised in L-LMICs during the early phase of the COVID-19 pandemic. Emerging recommendations emphasise the importance of coordination and integration across building blocks and levels of the health system, supported by a responsive governance structure and stakeholder engagement strategies. Future reviews can revisit this emerging evidence base at subsequent phases of COVID-19 response and recovery in L-LMICs to understand how the approaches highlighted here evolve.
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Affiliation(s)
- Md Zabir Hasan
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada .,Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Priyanka Das
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vasuki Venugopal
- Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India
| | - Dinesh Arora
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nishant Jain
- Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH India Office, New Delhi, India
| | - Shivam Gupta
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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