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Odii A, Arize I, Agwu P, Mbachu C, Onwujekwe O. To What Extent Are Informal Healthcare Providers in Slums Linked to the Formal Health System in Providing Services in Sub-Sahara Africa? A 12-Year Scoping Review. J Urban Health 2024:10.1007/s11524-024-00885-5. [PMID: 38874863 DOI: 10.1007/s11524-024-00885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
The contributions of informal providers to the urban health system and their linkage to the formal health system require more evidence. This paper highlights the collaborations that exist between informal providers and the formal health system and examines how these collaborations have contributed to strengthening urban health systems in sub-Sahara Africa. The study is based on a scoping review of literature that was published from 2011 to 2023 with a focus on slums in sub-Sahara Africa. Electronic search for articles was performed in Google, Google Scholar, PubMed, African Journal Online (AJOL), Directory of Open Access Journals (DOAJ), ScienceDirect, Web of Science, Hinari, ResearchGate, and yippy.com. Data extraction was done using the WHO health systems building blocks. The review identified 26 publications that referred to collaborations between informal providers and formal health systems in healthcare delivery. The collaboration is manifested through formal health providers registering and standardizing the practice of informal health providers. They also participate in training informal providers and providing free medical commodities for them. Additionally, there were numerous instances of client referrals, either from informal to formal providers or from formal to informal providers. However, the review also indicates that these collaborations are unformalized, unsystematic, and largely undocumented. This undermines the potential contributions of informal providers to the urban health system.
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Affiliation(s)
- Aloysius Odii
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Sociology/Anthropology Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Ifeyinwa Arize
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.
| | - Prince Agwu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Social Work Department, Faculty of the Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Administration and Management Department, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria
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Mukala Mayoyo E, Chenge F, Sow A, Criel B, Michielsen J, Van den Broeck K, Coppieters Y. Health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo: a multimethod study. BMC PRIMARY CARE 2024; 25:214. [PMID: 38872119 PMCID: PMC11170818 DOI: 10.1186/s12875-024-02460-y] [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: 02/25/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The integration of mental health into primary care-i.e., the process by which a range of essential mental health care and services are made available in existing multipurpose health care settings that did not previously provide them-can be facilitated or hindered by several health system factors that are still poorly understood. This study aimed to identify health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo (DRC) to improve the success rate of integration programs. METHODS We conducted a multimethod, cross-sectional exploratory study. Stakeholders (managers, health service providers, service users, etc.) from sixteen of the twenty-six provinces of the DRC participated. We collected qualitative data through 31 individual, semistructured, face-to-face key informant interviews. We then collected quantitative data through a population-based survey of 413 respondents. We analyzed the interviews via thematic analysis, assigning verbatims to predefined themes and subthemes. For the survey responses, we performed descriptive analysis followed by binomial logistic regression to explore the associations between the variables of interest. RESULTS Strong leadership commitment, positive attitudes toward mental health care, the availability of care protocols, mental health task sharing (p < 0.001), and sufficient numbers of primary care providers (PCPs) (p < 0.001) were identified as key health system facilitators of successful integration. However, barriers to integration are mainly related to a poor understanding of what integration is and what it is not, as well as to the poor functionality and performance of health facilities. In addition, stigma, low prioritization of mental health, lack of mental health referents, low retention rate of trained health professionals, lack of reporting tools, lack of standardized national guidelines for integration (p < 0.001), lack of funding (p < 0.001), shortage of mental health specialists to coach PCPs (p < 0.001), and lack of psychotropic medications (p < 0.001) were identified as health system barriers to integration. CONCLUSION Improving the functionality of primary care settings before integrating mental health care would be beneficial for greater success. In addition, addressing identified barriers, such as lack of funding and mental health-related stigma, requires multistakeholder action across all building blocks of the health system.
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Affiliation(s)
- Erick Mukala Mayoyo
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
- Department of Community Health, Institut Supérieur des Techniques Médicales de Kananga, Kananga, Democratic Republic of the Congo.
- Centre de Connaissances en Santé en RD Congo, Kinshasa, Democratic Republic of the Congo.
| | - Faustin Chenge
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
- Centre de Connaissances en Santé en RD Congo, Kinshasa, Democratic Republic of the Congo
| | - Abdoulaye Sow
- Faculty of Health Science and Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Haar R, Rayes D, Tappis H, Rubenstein L, Rihawi A, Hamze M, Almhawish N, Wais R, Alahmad H, Burbach R, Abbara A. The cascading impacts of attacks on health in Syria: A qualitative study of health system and community impacts. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002967. [PMID: 38870115 PMCID: PMC11175436 DOI: 10.1371/journal.pgph.0002967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/29/2024] [Indexed: 06/15/2024]
Abstract
Syria has experienced over a decade of armed conflict, characterized by targeted violence against healthcare. The impacts of these attacks have resulted in both direct and indirect attacks on health and reverberating effects on local communities. This study aims to explore the perspectives of health workers based in northern Syria who have experienced such attacks on health to understand the impacts on the health system as well as communities served. In-depth interviews were conducted with health workers in the northern regions of Syria where attacks on health have been frequent. Participants were identified using purposive and snowball sampling. Interviews were coded and analyzed using the Framework Method. Our inductive and deductive codes aligned closely with the WHO Health System Building Blocks framework, and we therefore integrated this framing into the presentation of findings. We actively sought to include female and non-physician health workers as both groups have been under-represented in previous research in northern Syria. A total of 40 health workers (32.5% female, 77.5% non-physicians) who experienced attacks in northern Syria between 2013 and 2020 participated in interviews in 2020-2021. Participants characterized attacks on health as frequent, persistent over years, and strategically targeted. The attacks had both direct and indirect impacts on the health system and consequently the wider health of the community. For the health system, participants noted compounded impacts on the delivery of care, health system governance, and challenges to financing, workforce, and infrastructure. Reconstructing health facilities or planning services in the aftermath of attacks on health was challenging due to poor health system governance and resource challenges. These impacts had ripple effects on the health of the community, particularly the most vulnerable. The impacts of attacks on health in Syria are multiple, with both short- and long-term consequences for the health system(s) across Syria as well as the health of communities in these respective areas. Though such attacks against healthcare are illegal under international humanitarian law, this and other legal frameworks have led to little accountability in the face of such attacks both in Syria and elsewhere. Characterizing their impacts is essential to improving our understanding of the consequences of attacks as a public health issue and supporting protection and advocacy efforts.
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Affiliation(s)
- Rohini Haar
- Division of Epidemiology, Berkeley School of Public Health Berkeley, University of California, Berkeley, California, United States of America
| | - Diana Rayes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Syrian Public Health Network, London, United Kingdom
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anas Rihawi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Mohamed Hamze
- Syrian American Medical Society, Washington, District of Columbia, United States of America
| | - Naser Almhawish
- Syrian Public Health Network, London, United Kingdom
- Assistance Coordination Unit, Gaziantep, Turkey
| | - Reham Wais
- Syrian American Medical Society, Gaziantep, Turkey
| | | | - Ryan Burbach
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aula Abbara
- Syrian Public Health Network, London, United Kingdom
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Davies J, Chu K, Tabiri S, Byiringiro JC, Bekele A, Razzak J, D’Ambruoso L, Ignatowicz A, Bojke L, Nkonki L, Laurenzi C, Sitch A, Bagahirwa I, Belli A, Sam NB, Amberbir A, Whitaker J, Ndangurura D, Ghalichi L, MacQuene T, Tshabalala N, Fikadu Berhe D, Nepomuscene NJ, Agbeko AE, Sarfo-Antwi F, Babar Chand Z, Wajidali Z, Sahibjan F, Atiq H, Mali Y, Tshabalala Z, Khalfe F, Nodo O, Umwali G, Twizeyimana E, Mugisha N, Munyura NO, Nakure S, Ishimwe SMC, Nzasabimana P, Dramani A, Acquaye J, Tanweer A. Equitable access to quality injury care; Equi-Injury project protocol for prioritizing interventions in four low- or middle-income countries: a mixed method study. BMC Health Serv Res 2024; 24:429. [PMID: 38576004 PMCID: PMC10996087 DOI: 10.1186/s12913-024-10668-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: 12/07/2023] [Accepted: 01/31/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Equitable access to quality care after injury is an essential step for improved health outcomes in low- and middle-income countries (LMICs). We introduce the Equi-Injury project, in which we will use integrated frameworks to understand how to improve equitable access to quality care after injury in four LMICs: Ghana, Pakistan, Rwanda and South Africa. METHODS This project has 5 work packages (WPs) as well as essential cross-cutting pillars of community engagement, capacity building and cross-country learning. In WP1, we will identify needs, barriers, and facilitators to impactful stakeholder engagement in developing and prioritising policy solutions. In WP2, we will collect data on patient care and outcomes after injuries. In WP3, we will develop an injury pathway model to understand which elements in the pathway of injury response, care and treatment have the biggest impact on health and economic outcomes. In WP4, we will work with stakeholders to gain consensus on solutions to address identified issues; these solutions will be implemented and tested in future research. In WP5, in order to ascertain where learning is transferable across contexts, we will identify which outcomes are shared across countries. The study has received approval from ethical review boards (ERBs) of all partner countries in South Africa, Rwanda, Ghana, Pakistan and the University of Birmingham. DISCUSSION This health system evaluation project aims to provide a deeper understanding of injury care and develop evidence-based interventions within and across partner countries in four diverse LMICs. Strong partnership with multiple stakeholders will facilitate utilisation of the results for the co-development of sustainable interventions.
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Weisz G, Harper J. Investigating the citing communities around three leading health-system frameworks. Health Res Policy Syst 2024; 22:16. [PMID: 38279103 PMCID: PMC10811803 DOI: 10.1186/s12961-023-01075-6] [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: 06/07/2023] [Accepted: 11/14/2023] [Indexed: 01/28/2024] Open
Abstract
Of numerous proposed frameworks for analyzing and impacting health systems, three stand out for the large number of publications that cite them and for their links to influential international institutions: Murray and Frenk (Bull World Health Organ 78:717-31, 2000) connected initially to the World Health Organization (WHO) and then to the Global Burden of Disease Project; Roberts et al. (Getting health reform right: a guide to improving performance and equity, Oxford University Press, Oxford, 2004) sponsored by the World Bank/Harvard Flagship Program; and de Savigny and Adam (Systems thinking for health systems strengthening, WHO, 2009) linked to the WHO and the Alliance for Health Policy and Systems Research. In this paper, we examine the citation communities that form around these works to better understand the underlying logic of these citation grouping as well as the dynamics of Global Health research on health systems. We conclude that these groupings are largely independent of one another, reflecting a range of factors including the goals of each framework and the problems that it was meant to explore, the prestige and authority of institutions and individuals associated with these frameworks, and the intellectual and geographic proximity of the citing researchers to each other and to the framework authors.
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Affiliation(s)
- George Weisz
- Dept. Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, QC, H3A 1X1, Canada.
| | - Jonathan Harper
- Dept. Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, QC, H3A 1X1, Canada
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Ferrinho P, Daniel-Ribeiro CT, Ferrinho R, Fronteira I. Building-blocks to develop one health systems. One Health 2023; 17:100624. [PMID: 38024260 PMCID: PMC10665169 DOI: 10.1016/j.onehlt.2023.100624] [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: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023] Open
Abstract
Notwithstanding the understandable rationale of the logical, expected and natural evolution of human behaviour towards an anthropocentric view of its relationship with other animals and the environment, a shift from this predatory "Ego-centric" behaviour towards an "Eco" conduct, with regard to their view of the world and of the global health, has become mandatory, contributing to the development of the "One Health" and of "One Health Systems" concepts. We contend for the usefulness of a building-blocks approach to facilitate an understanding of the development of One Health Systems. We assert that a building-blocks approach to One Health Systems with strong similarity to WHO's building-blocks for human health systems would help to strengthen the case for robust,resilient and anti-fragile One Health systems.
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Affiliation(s)
- Paulo Ferrinho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária, Fiocruz, Ministério da Saúde, Brazil
- Laboratório de Pesquisa em Malária, Instituto Osvaldo Cruz, Fiocruz, Pavilhão Leónidas Deane, 5° andar, Av Brasil 4365, Rio de Janeiro CEP 21.041-250, RJ, Brazil
| | - Rosa Ferrinho
- Escola Superior de Saúde, Bem Estar e Proteção Animal, Instituto Politécnico para a Lusofonia, R. do Telhal aos Olivais 8, 1950-396 Lisbon, Portugal
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Escola Nacional de Saúde Pública, Avenida Padre Cruz, Lisbon 1600-560, Portugal
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Wasti SP, van Teijlingen E, Rushton S, Subedi M, Simkhada P, Balen J. Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks. Health Res Policy Syst 2023; 21:117. [PMID: 37919769 PMCID: PMC10621174 DOI: 10.1186/s12961-023-01033-2] [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] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/24/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Nepal's move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal's health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal's health system as it adapts to federalisation. METHODS This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders' practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. RESULTS Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. CONCLUSION Our findings suggest that since federalisation, Nepal's health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system.
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Affiliation(s)
- Sharada Prasad Wasti
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.
- School of Human Sciences, University of Greenwich, Greenwich, United Kingdom.
| | | | - Simon Rushton
- Department of Politics and International Relations, University of Sheffield, Sheffield, United Kingdom
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Madhusudan Subedi
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Julie Balen
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, United Kingdom
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Ravi SJ, Potter CM, Paina L, Merritt MW. Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia. PLoS One 2023; 18:e0292793. [PMID: 37847680 PMCID: PMC10581452 DOI: 10.1371/journal.pone.0292793] [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: 12/12/2022] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.
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Affiliation(s)
- Sanjana J. Ravi
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christina M. Potter
- The Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, United States of America
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Solomon-Rakiep T, Olivier J, Amponsah-Dacosta E. Weak Adoption and Performance of Hepatitis B Birth-Dose Vaccination Programs in Africa: Time to Consider Systems Complexity?-A Scoping Review. Trop Med Infect Dis 2023; 8:474. [PMID: 37888602 PMCID: PMC10611266 DOI: 10.3390/tropicalmed8100474] [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: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
The persistent burden of chronic hepatitis B among ≤5-year-old children in Africa suggests missed opportunities for controlling mother-to-child transmission (MTCT) of the hepatitis B virus (HBV). This scoping review maps the evidence base on the risk of HBV MTCT, the status of HBV MTCT mitigation strategies including hepatitis B birth-dose vaccination, and the role of systems complexity on the suboptimal adoption and performance of hepatitis B birth-dose vaccination programs in Africa. Overall, 88 peer-reviewed and grey literature sources published between 2000-2022 were included in this review. The growing evidence base consistently argues for a heightened risk of HBV MTCT amidst the HIV co-epidemic in the region. Without universal HBV screening programs integrated within broader antenatal care services, current selective hepatitis B birth-dose vaccination is unlikely to effectively interrupt HBV MTCT. We underscore critical health systems-related barriers to universal adoption and optimal performance of hepatitis B birth-dose vaccination programs in the region. To better conceptualize the role of complexity and system-wide effects on the observed performance of the program, we propose an adapted systems-based logic model. Ultimately, exploring contextualized complex systems approaches to scaling-up universal hepatitis B birth-dose vaccination programs should form an integral part of the regional research agenda.
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Affiliation(s)
- Tasneem Solomon-Rakiep
- Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Fuentes-Alabí S, Carpenter K, Shea M, Vásquez L, Benitez Majano S, Maza M, Luciani S, Albanti I. Storytelling workshop to encourage stakeholder engagement with the Global Initiative for Childhood Cancer. Rev Panam Salud Publica 2023; 47:e148. [PMID: 37818485 PMCID: PMC10561658 DOI: 10.26633/rpsp.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Storytelling can enhance stakeholder engagement and support the implementation of the World Health Organization and Pan American Health Organization's (PAHO) Global Initiative for Childhood Cancer, which aims to improve care globally for children with cancer. The Initiative aligns with the United Nations Sustainable Development Goals, addressing health, education, inequalities and international collaboration. This report describes the design and implementation of a workshop that used storytelling through film to encourage stakeholders in national cancer control plans to engage with the Initiative in its focal countries in Central America, the Dominican Republic and Haiti. A six-step process was used to develop the virtual workshop hosted by PAHO: (i) define the audience; (ii) define the goals of storytelling; (iii) build an appropriate storyline, including choosing a platform and content, and addressing group dynamics and the length of the film; (iv) guide the workshop's design and implementation with current theoretical frameworks, including the Socioecological Model of Health and the Theory of Change; (v) design interactive group exercises; and (vi) disseminate workshop results. The skills-building component of the day-long workshop included 80 representatives from eight countries in the Region of the Americas, with participants representing pediatric oncology, hospital administration, ministries of health, nonprofit foundations, the scientific community and public health organizations. Outputs from the workshop included (i) a summary report, (ii) an empathy word cloud with live reactions from participants, (iii) qualitative responses (i.e. quotes from participants), (iv) stakeholders' analyses and (v) a prioritization matrix for country-level strategic activities that could be undertaken to strengthen health systems when caring for children with cancer. The workshop used storytelling through film to try to reduce health inequalities and have a regional impact. Combining art, public health and medicine, the workshop created positive change by sharing real-life experiences. Commitment was fostered among stakeholders through their engagement with the workshop, which aimed to increase their awareness of the need and advocacy to improve health systems and enhance access to health care for this vulnerable population.
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Affiliation(s)
- Soad Fuentes-Alabí
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Kendall Carpenter
- Boston Children’s HospitalHarvard Medical SchoolBostonUnited States of AmericaBoston Children’s Hospital, Harvard Medical School, Boston, United States of America
| | - Meghan Shea
- Persistent ProductionsRockportUnited States of AmericaPersistent Productions, Rockport, United States of America
| | - Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Sara Benitez Majano
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Mauricio Maza
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Irini Albanti
- Harvard Humanitarian InitiativeHarvard School of Public HealthBostonUnited States of AmericaHarvard Humanitarian Initiative, Harvard School of Public Health, Boston, United States of America
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ShahAli S, Shahabi S, Etemadi M, Hedayati M, Anne BC, Mojgani P, Behzadifar M, Lankarani KB. Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research. Heliyon 2023; 9:e20736. [PMID: 37860510 PMCID: PMC10582494 DOI: 10.1016/j.heliyon.2023.e20736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.
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Affiliation(s)
- Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maryam Hedayati
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Barth Cornelia Anne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Keshri VR, Peden M, Singh P, Norton R, Abimbola S, Jagnoor J. Health systems research in burn care: an evidence gap map. Inj Prev 2023; 29:446-453. [PMID: 37532304 DOI: 10.1136/ip-2023-044963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care. METHODS An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM. RESULTS A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies. CONCLUSIONS Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Margaret Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Pratishtha Singh
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
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Mensah Abrampah NA, Okwaraji YB, You D, Hug L, Maswime S, Pule C, Blencowe H, Jackson D. Global Stillbirth Policy Review - Outcomes And Implications Ahead of the 2030 Sustainable Development Goal Agenda. Int J Health Policy Manag 2023; 12:7391. [PMID: 38618824 PMCID: PMC10590256 DOI: 10.34172/ijhpm.2023.7391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Globally, data on stillbirth is limited. A call to action has been issued to governments to address the data gap by strengthening national policies and strategies to drive urgent action on stillbirth reduction. This study aims to understand the policy environment for stillbirths to advance stillbirth recording and reporting in data systems. METHODS A systematic three-step process (survey tool examination, identifying relevant study questions, and reviewing country responses to the survey and national documents) was taken to review country responses to the global 2018-2019 World Health Organization (WHO) Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy Survey. Policy Survey responses were reviewed to identify if and how stillbirths were included in national documents. This paper uses descriptive analyses to identify and describe the relationship between multiple variables. RESULTS Responses from 155 countries to the survey were analysed, and over 800 national policy documents submitted by countries in English reviewed. Fewer than one-fifth of countries have an established stillbirth rate (SBR) target, with higher percentages reported for under-5 (71.0%) and neonatal mortality (68.5%). Two-thirds (65.8%) of countries reported a national maternal death review panel. Less than half (43.9%) of countries have a national policy that requires stillbirths to be reviewed. Two-thirds of countries have a national policy requiring review of neonatal deaths. WHO websites and national health statistics reports are the common data sources for stillbirth estimates. Countries that are signatories to global initiatives on stillbirth reduction have established national targets. Globally, nearly all countries (94.8%) have a national policy that requires every death to be registered. However, 45.5% of reviewed national policy documents made mention of registering stillbirths. Only 5 countries had national policy documents recommending training of health workers in filling out death certificates using the International Classification of Diseases (ICD)-10 for stillbirths. CONCLUSION The current policy environment in countries is not supportive for identifying stillbirths and recording causes of death. This is likely to contribute to slow progress in stillbirth reduction. The paper proposes policy recommendations to make every baby count.
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Affiliation(s)
- Nana A. Mensah Abrampah
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yemisrach B. Okwaraji
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, NY, USA
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Caroline Pule
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Debra Jackson
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Goel S. Harnessing Management and Leadership Trainings in Strengthening Health System: Experience from IPHMDP. Indian J Community Med 2023; 48:507-509. [PMID: 37662123 PMCID: PMC10470554 DOI: 10.4103/ijcm.ijcm_329_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Sonu Goel
- Professor of Health Management, Department of Community Medicine and School of Public Health at the Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Adjunct Associate Clinical Professor, University of Limerick, Ireland and Honorary Professor, Swansea University, UK
- Director, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India after International Public Health Management Development Program
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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Ejekam CS, Emeje M, Lukulay P, Uche CR, Odibeli O, Sanusi O, Anyakora C. A call to action: securing an uninterrupted supply of Africa's medical products and technologies post COVID-19. J Public Health Policy 2023:10.1057/s41271-023-00405-w. [PMID: 36997622 DOI: 10.1057/s41271-023-00405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/01/2023]
Abstract
The COVID-19 pandemic unveiled the vulnerability of many African healthcare systems, amplifying inadequacies and constraints in the supply chain for medical products and technologies on the continent. Disruptions in the global supply chain due to the pandemic resulted in the continent's population of over one billion people grappling with shortages in the supply of essential medicines. The shortages and their consequences set back achievement of Sustainable Development Goals and progress towards universal health coverage. A virtual meeting of global experts in medical products and supply chain identified as urgent the need for Africa to build capacity for a self-reliant public health system. Discussants challenged the governments of African countries to turn the continent from its current import driven economy to a continent of indigenous research and development, local production, and an exporter of its medical products and innovations.
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Affiliation(s)
- Chioma Stella Ejekam
- Bloom Public Health, Suite D6, Mazado Plaza, Mongonu Shettima, Utako, Abuja, Nigeria.
| | - Martins Emeje
- National Institute for Pharmaceutical Research & Development, Abuja, Nigeria
- European University of Nigeria, Abuja, Nigeria
| | - Patrick Lukulay
- Technology Solution for Global Health, 3 Park Avenue Motorway Extension, North Dzorwulu, Accra, Ghana
| | - Chukwudi R Uche
- Chartered Institute of Procurement and Supply, Harley Reed, Abuja, Nigeria
| | - Ofure Odibeli
- Bloom Public Health, Suite D6, Mazado Plaza, Mongonu Shettima, Utako, Abuja, Nigeria
| | - Olutoun Sanusi
- Bloom Public Health, Suite D6, Mazado Plaza, Mongonu Shettima, Utako, Abuja, Nigeria
| | - Chimezie Anyakora
- Bloom Public Health, Suite D6, Mazado Plaza, Mongonu Shettima, Utako, Abuja, Nigeria
- School of Science and Technology, Pan Atlantic University, Lekki-Epe Expressway, Lagos, Nigeria
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Ferrinho P, Fronteira I. Developing One Health Systems: A Central Role for the One Health Workforce. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4704. [PMID: 36981612 PMCID: PMC10048843 DOI: 10.3390/ijerph20064704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The health of people, wild and domesticated animals, and natural living systems is syndemically connected, and this interplay is a pillar of the concept of One Health [...].
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El-Mazahy H, Mekky J, Elshaer N. Medical professionals' job satisfaction and telemedicine readiness during the COVID-19 pandemic: solutions to improve medical practice in Egypt. J Egypt Public Health Assoc 2023; 98:5. [PMID: 36878998 PMCID: PMC9988361 DOI: 10.1186/s42506-023-00127-7] [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: 04/01/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted medical professionals' job satisfaction and was a call to adopt telemedicine. Finding out how far medical professionals are satisfied and ready to use telemedicine would be important to improve medical practice. METHODS Data was collected from 959 medical professionals from both the governmental and private health sectors in Egypt in 2021 using a specifically designed online questionnaire, to evaluate job satisfaction, perception of telemedicine, and propose solutions to improve medical practice. RESULTS The study revealed low to moderate job satisfaction at governmental (27.2%) and private (58.7%) sectors. Underpayment was the most reported challenge at both sectors (37.8% and 28.3%, respectively). Dissatisfaction with government salary was independently predicted by working at the Ministry of Health and Population (OR = 5.54, 95%CI = 2.39,12.8; p < 0.001). Wage increase (46.10%), medical training of professionals (18.1%), and management of non-human resources (14.4%) were the most proposed solutions to improve medical practice in Egypt. During the COVID-19 pandemic, 90.7% of medical professionals had practiced telemedicine with moderate level of perception of its benefits (56%). CONCLUSIONS During the COVID-19 pandemic, medical professionals reported low to moderate job satisfaction and a moderate level of perception of telemedicine. It is recommended to analyze the healthcare financing system and provide continuous training of medical professionals to improve medical practice in Egypt.
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Affiliation(s)
| | - Jaidaa Mekky
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Noha Elshaer
- Industrial Medicine and Occupational Health, Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Kiggundu R, Lusaya E, Seni J, Waswa JP, Kakooza F, Tjipura D, Kikule K, Muiva C, Joshi MP, Stergachis A, Kitutu FE, Konduri N. Identifying and addressing challenges to antimicrobial use surveillance in the human health sector in low- and middle-income countries: experiences and lessons learned from Tanzania and Uganda. Antimicrob Resist Infect Control 2023; 12:9. [PMID: 36759872 PMCID: PMC9909883 DOI: 10.1186/s13756-023-01213-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance. METHODS USAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article. RESULTS The team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed. CONCLUSIONS Strengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.
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Affiliation(s)
- Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda.
| | - Edgar Lusaya
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dar Es Salaam, Tanzania
| | - Jeremiah Seni
- grid.411961.a0000 0004 0451 3858Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - J. P. Waswa
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Francis Kakooza
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Dinah Tjipura
- grid.436296.c0000 0001 2203 2044USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA 22203 USA
| | - Kate Kikule
- grid.436296.c0000 0001 2203 2044USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA 22203 USA
| | - Cecilia Muiva
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Nairobi, Kenya
| | - Mohan P. Joshi
- grid.436296.c0000 0001 2203 2044USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA 22203 USA
| | - Andy Stergachis
- grid.34477.330000000122986657Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA 98105 USA ,grid.34477.330000000122986657Department of Global Health, School of Public Health, University of Washington, Seattle, WA 98105 USA
| | - Freddy Eric Kitutu
- grid.11194.3c0000 0004 0620 0548Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, Makerere University School of Health Sciences, P.O. Box 10217, Kampala, Uganda
| | - Niranjan Konduri
- grid.436296.c0000 0001 2203 2044USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA 22203 USA
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Kabir A, Karim MN, Billah B. Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: A qualitative study. Front Public Health 2022; 10:1015245. [PMID: 36438215 PMCID: PMC9682236 DOI: 10.3389/fpubh.2022.1015245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The weak health system is viewed as a major systematic obstacle to address the rising burden of non-communicable diseases (NCDs) in resource-poor settings. There is little information about the health system challenges and opportunities in organizing NCD services. This study examined the health system challenges and opportunities in organizing NCD services for four major NCDs (cervical cancer, diabetes mellitus, cardiovascular diseases, and chronic respiratory illnesses) at the primary healthcare (PHC) level in Bangladesh. Methods Using a qualitative method, data were collected from May to October 2021 by conducting 15 in-depth interviews with local healthcare providers, 14 key informant interviews with facility-based providers and managers, and 16 focus group discussions with community members. Based on a health system dynamics framework, data were analyzed thematically. Information gathered through the methods and sources was triangulated to validate the data. Results Organization of NCD services at the PHC level was influenced by a wide range of health system factors, including the lack of using standard treatment guidelines and protocols, under-regulated informal and profit-based private healthcare sectors, poor health information system and record-keeping, and poor coordination across healthcare providers and platforms. Furthermore, the lack of functional referral services; inadequate medicine, diagnostic facilities, and logistics supply; and a large number of untrained human resources emerged as key weaknesses that affected the organization of NCD services. The availability of NCD-related policy documents, the vast network of healthcare infrastructure and frontline staff, and increased demand for NCD services were identified as the major opportunities. Conclusion Despite the substantial potential, the health system challenge impeded the organization of NCD services delivery at the PHC level. This weakness needs be to addressed to organize quality NCD services to better respond to the rising burden of NCDs at the PHC level.
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Anderson R, Williams A, Jess N, Read JM, Limmer M. The impact of professional midwives and mentoring on the quality and availability of maternity care in government sub-district hospitals in Bangladesh: a mixed-methods observational study. BMC Pregnancy Childbirth 2022; 22:827. [PMID: 36348362 PMCID: PMC9644636 DOI: 10.1186/s12884-022-05096-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background This study compared government sub-district hospitals in Bangladesh without globally standard midwives, with those with recently introduced midwives, both with and without facility mentoring, to see if the introduction of midwives was associated with improved quality and availability of maternity care. In addition, it analysed the experiences of the newly deployed midwives and the maternity staff and managers that they joined. Methods This was a mixed-methods observational study. The six busiest hospitals from three pre-existing groups of government sub-district hospitals were studied; those with no midwives, those with midwives, and those with midwives and mentoring. For the quantitative component, observations of facility readiness (n = 18), and eight quality maternity care practices (n = 641) were carried out using three separate tools. Willing maternity staff (n = 237) also completed a survey on their knowledge, perceptions, and use of the maternity care interventions. Descriptive statistics and logistic regression were used to identify differences between the hospital types. The qualitative component comprised six focus groups and 18 interviews involving midwives, other maternity staff, and managers from the three hospital types. Data were analysed using an inductive cyclical process of immersion and iteration to draw out themes. The quantitative and qualitative methods complemented each other and were used synergistically to identify the study’s insights. Results Quantitative analysis found that, of the eight quality practices, hospitals with midwives but no mentors were significantly more likely than hospitals without midwives to use three: upright labour (94% vs. 63%; OR = 22.57, p = 0.001), delayed cord clamping (88% vs. 11%; OR = 140.67, p < 0.001), skin-to-skin (94% vs. 13%; OR = 91.21, p < 0.001). Hospitals with mentors were significantly more likely to use five: ANC card (84% vs. 52%; OR = 3.29, p = 0.002), partograph (97% vs. 14%; OR = 309.42, p = 0.002), upright positioning for labour (95% vs. 63%; OR = 1850, p < 0.001), delayed cord clamping (98% vs. 11%; OR = 3400, p = 0.003), and skin-to-skin contact following birth (93% vs. 13%; OR = 70.89, p < 0.001) Qualitative analysis identified overall acceptance of midwives and the transition to improved quality care; this was stronger with facility mentoring. The most resistance to quality care was expressed in facilities without midwives. In facilities with midwives and mentoring, midwives felt proud, and maternity staff conveyed the greatest acceptance of midwives. Conclusion Facilities with professional midwives had better availability and quality of maternity care across multiple components of the health system. Care quality further improved with facility mentors who created enabling environments, and facilitated supportive relationships between existing maternity staff and managers and the newly deployed midwives. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05096-x.
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Klünder V, Schwenke P, Hertig E, Jochem C, Kaspar-Ott I, Schwienhorst-Stich EM, Stauch L, Coenen M. A cross-sectional study on the knowledge of and interest in Planetary Health in health-related study programmes in Germany. Front Public Health 2022; 10:937854. [PMID: 36388321 PMCID: PMC9660317 DOI: 10.3389/fpubh.2022.937854] [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: 05/11/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
Planetary Health connects human health with the natural and anthropogenic systems on which it depends. Planetary Health education has been growing in a wide range of health-related disciplines, yet not been widely implemented in health-related university curricula. This cross-sectional study focused on students' knowledge of and interest in Planetary Health education in order to assess the relevance of Planetary Health and Planetary Health topics for university students and their fields of study. We surveyed 1,303 students enrolled in health-related programmes in Bavaria, Germany. Data was collected on students' previous knowledge of and interest in Planetary Health, as well as the relevance of different Planetary Health topics and students' willingness to select a Planetary Health elective within their study programmes. Descriptive statistics were calculated. The majority of participants (73.8%) had not yet heard of Planetary Health but were interested in learning more about this field (90.7%). Most participants considered Planetary Health as relevant to their field (81.6%) and would likely choose a Planetary Health elective (81.9%). Participants were most interested in topics about general associations between climate and health as well as its connections with mental health and (micro) plastics. There is an urgent need and high student interest to implement a Planetary Health module in health-related study programmes in order to move this topic more into focus for the next generation of students.
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Affiliation(s)
- Vera Klünder
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Paula Schwenke
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Elke Hertig
- Faculty of Medicine, Regional Climate Change and Health, University of Augsburg, Augsburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Irena Kaspar-Ott
- Faculty of Medicine, Regional Climate Change and Health, University of Augsburg, Augsburg, Germany
| | - Eva-Maria Schwienhorst-Stich
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany,Teaching Clinic of the Faculty of Medicine and Institute of Medical Teaching and Medical Education Research, University of Würzburg, Würzburg, Germany
| | - Lisa Stauch
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry, and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany,*Correspondence: Michaela Coenen
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Cox M, Sharma D, Phillips G, Mitchell R, Herron LM, Brolan CE, O'Reilly G, Körver S, Kendino M, Poloniati P, Kafoa B. Lessons from the frontline: Documenting the pandemic emergency care experience from the Pacific region - Infrastructure and equipment. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 25:100516. [PMID: 35818575 PMCID: PMC9259041 DOI: 10.1016/j.lanwpc.2022.100516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background The COVID-19 pandemic highlighted challenges for all health systems worldwide. This research aimed to explore the impact of COVID-19 across the Pacific especially with regards to emergency care (EC) and clinicians' preparations and responses. Methods A collaboration of Australia and Pacific researchers conducted prospective qualitative research over 18 months of the pandemic. In this three phase study data were gathered from Emergency Clinicians and stakeholders through online support forums, in-depth interviews and focus groups. A phenomenological methodological approach was employed to explore the lived experience of participants. This paper discusses the findings of the study regarding the EC building block of 'Infrastructure and Equipment.' Findings Pre-existing infrastructure and equipment were not sufficient to help control the pandemic. Adequate space and correct equipment were essential needs for Pacific Island emergency clinicians, with donations, procurement and local ingenuity required for suitable, sustainable supplies and facilities. Adequate personal protective equipment (PPE) conferred a sense of security and increased Health Care Workers willingness to attend to patients. Interpretation Investing in adequate infrastructure and appropriate equipment is crucial for an effective response to the COVID-19 pandemic. The sustainability of such investments in the Pacific context is paramount for ongoing EC and preparation for future surge responses and disasters. Funding Phases 1 and 2A of this study were part of an Epidemic Ethics/World Health Organization (WHO) initiative, supported by Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding for this research was received from the Australasian College for Emergency Medicine Foundation via an International Development Fund Grant.
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Affiliation(s)
- Megan Cox
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Sutherland Hospital, Sydney, NSW, Australia
- NSW Ambulance, Sydney, Australia
| | | | - Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Rob Mitchell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Health, Melbourne, Australia
| | - Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Claire E. Brolan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Policy Futures, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Australia
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Health, Melbourne, Australia
| | - Sarah Körver
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Berlin Kafoa
- Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
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24
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Masiga MA, Wandibba S. Navigating the healthcare system in Nairobi City County: perspectives and experiences in the utilization of oral healthcare by caregivers of children with HIV/AIDS. BMC Health Serv Res 2022; 22:964. [PMID: 35906605 PMCID: PMC9336068 DOI: 10.1186/s12913-022-08260-3] [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: 01/21/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background The healthcare system in any republic can cause inequalities in health outcomes if they do not take into account the needs of deprived populations. Children with HIV/AIDS are known to have a high vulnerability to oral diseases; yet, they continue to face limitations in the utilization of oral healthcare. While other determinants of healthcare utilization may co-exist, possible gaps in the oral healthcare system can collectively affect a vulnerable group disproportionately in the utilization of oral healthcare. Objective To explore qualitatively, the perspectives, experiences and attributions of a cohort of caregivers of children with HIV/AIDS and their Health Care Providers (HCPs), on the utilization of oral healthcare within the structure of the oral healthcare system in Nairobi City County (NCC). Design A cross-sectional explorative mixed methods study design of two hundred and twenty one (221) female caregivers of children with HIV/AIDS and their HCPs using a survey, Focus Group Discussions (FGDs) and In-depth Interviews (IDIs). The study setting was the HIV-Care Facilities (HIV-CCFs) at three large hospitals in NCC. Results Caregivers mainly utilized independent ‘nearby’ private dental clinics for oral healthcare services, attributing their selection to cheaper user-fees, proximal service location, and recommendations from social networks. Wait time, opening and closing hours, health workers’ attitudes and inferred opportunity costs were perceived as important quality issues in the utilization of oral healthcare. Conclusion The oral healthcare system in NCC does not support the utilization of oral healthcare within the context of providing comprehensive healthcare for children with HIV/AIDS. Absence of ‘in-house’ oral health services at the HIV- CCFs is viewed as a defining structural barrier.
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Affiliation(s)
- Mary Atieno Masiga
- Department of Dental Sciences, Faculty of Health Sciences, University of Nairobi, P.O Box 48792-00100, Nairobi, Kenya.
| | - Simiyu Wandibba
- Institute of Anthropology, Gender & African Studies, University of Nairobi, Uhuru Gardens, P.O. Box 474-00517, Nairobi, Kenya
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25
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Amedari MI, Ogunbodede EO, Uti OG, Aborisade AO, Amedari IK. Strengthening the oral health system in Nigeria: A health systems building block approach. Niger Postgrad Med J 2022; 29:173-182. [PMID: 35900452 DOI: 10.4103/npmj.npmj_127_22] [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: 06/15/2023]
Abstract
AIM The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. METHODOLOGY This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. RESULTS More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. CONCLUSION Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.
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Affiliation(s)
- Mcking Izeiza Amedari
- Department of Preventive and Community Dentistry, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Eyitope O Ogunbodede
- Department of Preventive and Community Dentistry, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Omolara G Uti
- Department of Preventive and Community Dentistry, Faculty of Dental Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adetayo O Aborisade
- Department of Oral Diagnostic Sciences, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ifeoma Katerine Amedari
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone. PLoS Negl Trop Dis 2022; 16:e0010423. [PMID: 35587495 PMCID: PMC9159599 DOI: 10.1371/journal.pntd.0010423] [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: 08/13/2021] [Revised: 06/01/2022] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014–2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone. Methodology/Principal findings This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system’s ability to respond to outbreak-prone disease. Conclusions/Significance Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system—and therefore patient outcomes more generally. Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014–2016 Ebola epidemic. Data from other LF-endemic countries suggest the drop in case numbers reflects reduced health seeking behaviour or issues within the surveillance, response and health systems. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19, meaning that findings from a case study of LF have wider applicability. There are no recent empirical studies of the functionality of Sierra Leone’s disease surveillance and response system. Qualitative analysis of policy documents and primary data collected from within the health system identified multiple challenges including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system’s ability to respond to outbreak-prone disease.
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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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28
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Malakoane B, Heunis JC, Chikobvu P, Kigozi NG, Kruger WH. Improving public health sector service delivery in the Free State, South Africa: development of a provincial intervention model. BMC Health Serv Res 2022; 22:486. [PMID: 35413918 PMCID: PMC9004016 DOI: 10.1186/s12913-022-07777-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components. Methods This study describes the development of the ‘Health Systems Governance & Accountability’ (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton’s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization’s (2007) conceptual framework for health system strengthening and reform comprised of six health system ‘building blocks.’ The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.’s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation. Results The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH’s Strategic Transformation Plan 2015–2030. The HSGA intervention model was used as a tool to implement and integrate the Plan’s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them. Conclusion The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.
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Affiliation(s)
- Benjamin Malakoane
- Department of Community Health, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - James Christoffel Heunis
- Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
| | - Perpetual Chikobvu
- Department of Community Health, Free State Department of Health, University of the Free State, PO Box 277, Bloemfontein, 9300, South Africa
| | - Nanteza Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - Willem Hendrik Kruger
- Department of Community Health, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
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Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open 2022; 12:e060387. [PMID: 35140165 PMCID: PMC8830230 DOI: 10.1136/bmjopen-2021-060387] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.
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Affiliation(s)
- Ashraful Kabir
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, Ground Floor, AMREP Building, The Alfred, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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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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Fort MP, Mundo W, Paniagua-Avila A, Cardona S, Figueroa JC, Hernández-Galdamez D, Mansilla K, Peralta-García A, Roche D, Palacios EA, Glasgow RE, Gulayin P, Irazola V, He J, Ramirez-Zea M. Hypertension in Guatemala's Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework. BMC Health Serv Res 2021; 21:908. [PMID: 34479559 PMCID: PMC8414027 DOI: 10.1186/s12913-021-06889-0] [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: 11/29/2020] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06889-0.
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Affiliation(s)
- Meredith P Fort
- Department of Health Systems, Management and Policy, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA. .,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA. .,INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
| | - William Mundo
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Alejandra Paniagua-Avila
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Sayra Cardona
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Juan Carlos Figueroa
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Diego Hernández-Galdamez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Kristyne Mansilla
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Ana Peralta-García
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Dina Roche
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | - Russell E Glasgow
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Pablo Gulayin
- South American Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Jiang He
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Tulane University Translation Science Institute, New Orleans, LA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
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An Overview of Healthcare Systems in Comoros: The Effects of Two Decades of Political Instability. Ann Glob Health 2021; 87:84. [PMID: 34458108 PMCID: PMC8378088 DOI: 10.5334/aogh.3100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: There is ongoing scientific evidence pointing out the adverse effects of conflict on population health and development. Union of Comoros has experienced nearly two decades of political instability and military rule. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability. Methods: This study involved a series of semi-structured interviews with key informants complemented by a comprehensive literature search of electronic databases and grey literature. A literature search was performed using all identified keywords associated with health indicators in Comoros to identify potential eligible publications in both English and French from 1975 to July 2020. Results: The analysis demonstrated that political instability and lack of proper leadership from the Government undermine the establishment of health policies which contributed dramatically to the decline in health performance. Additionally, the resurgence and emergence of old and new diseases such as cholera, chikungunya, malaria, HIV/AIDS as indicators of inadequate health services were most likely during political turmoil. Data also showed an out-migration of the health workforce and an increased overseas medical treatment demand, which indicate less attractive working conditions and weak health systems in the country. Meanwhile, an increasing performance of health status indicators was observed after the comprehensive peace process of the 2000-Fomboni Declaration. Conclusions: The chronic political instability in Comoros has contributed to the health crisis facing the Union of Comoros. It has hampered the implementation of proper institutions, which might guarantee the socio-economic development and prosperity of the population. Further studies were needed to evaluate the health burden associated with the two decades of political instability and military rule.
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Balqis-Ali NZ, Fun WH, Ismail M, Ng RJ, Jaaffar FSA, Low LL. Addressing Gaps for Health Systems Strengthening: A Public Perspective on Health Systems' Response towards COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179047. [PMID: 34501637 PMCID: PMC8431426 DOI: 10.3390/ijerph18179047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/13/2021] [Accepted: 08/21/2021] [Indexed: 01/12/2023]
Abstract
Strengthening the health systems through gaps identification is necessary to ensure sustainable improvements especially in facing a debilitating outbreak such as COVID-19. This study aims to explore public perspective on health systems’ response towards COVID-19, and to identify gaps for health systems strengthening by leveraging on WHO health systems’ building blocks. A qualitative study was conducted using open-ended questions survey among public followed by in-depth interviews with key informants. Opinions on Malaysia’s health systems response towards COVID-19 were gathered. Data were exported to NVIVO version 12 and analysed using content analysis approach. The study identified various issues on health systems’ response towards COVID-19, which were then mapped into health systems’ building blocks. The study showed the gaps were embedded among complex interactions between the health systems building blocks. The leadership and governance building block had cross-cutting effects, and all building blocks influenced service deliveries. Understanding the complexities in fostering whole-systems strengthening through a holistic measure in facing an outbreak was paramount. Applying systems thinking in addressing gaps could help addressing the complexity at a macro level, including consideration of how an action implicates other building blocks and approaching the governance effort in a more adaptive manner to develop resilient systems.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (W.H.F.); (L.L.L.)
- Correspondence: ; Tel.: +60-3-3362-7500 (ext. 8519)
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (W.H.F.); (L.L.L.)
| | - Munirah Ismail
- Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (M.I.); (R.J.N.); (F.S.A.J.)
| | - Rui Jie Ng
- Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (M.I.); (R.J.N.); (F.S.A.J.)
| | - Faeiz Syezri Adzmin Jaaffar
- Institute for Health Management, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (M.I.); (R.J.N.); (F.S.A.J.)
| | - Lee Lan Low
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia; (W.H.F.); (L.L.L.)
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Bhattacharjee S, Yaghmaei N, Phuong CTL, Neupane D. Factors influencing the readiness to tackle the burden of ischaemic heart disease in India: a systematic review protocol. BMJ Open 2021; 11:e047464. [PMID: 34413100 PMCID: PMC8378362 DOI: 10.1136/bmjopen-2020-047464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Ischaemic heart disease (IHD) is one of the leading causes of death and disease burden in India affecting all age groups. To reduce the deaths and tackle the burden of existing IHD, the government approach has been mostly through the National Health Policy (2017) and National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke. This paper offers a protocol for the systematic review of studies exploring the factors influencing service readiness of the public health system of India to tackle the burden of IHD. METHODS AND ANALYSIS Electronic databases of Embase (Ovid), AMED (Ovid), HMIC (Ovid), BNI (ProQuest), CINAHL (EBSCO), EMCARE (Ovid), PsycINFO (ProQuest), MEDLINE/PubMed and Web of Science (Clarivate Analytics) will be searched till 2020 for primary studies. Grey literature will be accessed through OpenGrey, TRIP Medical, WHO database, MoHFW website, Open Government Data (OGD) Platform of India and Google Scholar (between 2010 and 2020). Primary studies meeting the eligibility criteria and grey literature published in English between 2010 and 2020 will be included. Data will be analysed through a conceptual framework, and the primary outcome will constitute both quantitative and qualitative data. The quality of included studies will be assessed based on study design. Data will be managed on the COVIDENCE platform. All authors will be involved in data extraction, quality appraisal, data synthesis and formulation of the final draft. ETHICS AND DISSEMINATION This study, being a systematic review, does not involve any clinical trial, primary data collection or empirical study involving humans or animals. Therefore, no ethical permissions were sought by reviewers. PROSPERO REGISTRATION NUMBER CRD42020219490.
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Affiliation(s)
| | - Nima Yaghmaei
- Research & Development Wing, HumERA Consulting, Toronto, Ontario, Canada
| | - Cao Tran Le Phuong
- Department of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Dinesh Neupane
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Neel AH, Closser S, Villanueva C, Majumdar P, Gupta SD, Krugman D, Akinyemi OO, Deressa W, Kalbarczyk A, Alonge O. 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation. BMJ Glob Health 2021; 6:bmjgh-2021-006002. [PMID: 34344665 PMCID: PMC8336205 DOI: 10.1136/bmjgh-2021-006002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction The debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time. Methods We constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication. Results Pursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise. Conclusion It benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate.
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Affiliation(s)
- Abigail H Neel
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Svea Closser
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine Villanueva
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Piyusha Majumdar
- SDG School of Public Health, Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - S D Gupta
- SDG School of Public Health, Indian Institute of Health Management Research, Jaipur, Rajasthan, India
| | - Daniel Krugman
- Anthropology, Middlebury College, Middlebury, Vermont, USA
| | | | - Wakgari Deressa
- Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anna Kalbarczyk
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olakunle Alonge
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zakumumpa H, Rujumba J, Amde W, Damian RS, Maniple E, Ssengooba F. Transitioning health workers from PEPFAR contracts to the Uganda government payroll. Health Policy Plan 2021; 36:1397-1407. [PMID: 34240177 PMCID: PMC8505860 DOI: 10.1093/heapol/czab077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/28/2021] [Accepted: 06/25/2021] [Indexed: 11/14/2022] Open
Abstract
Although increasing public spending on health worker (HW) recruitments could reduce workforce shortages in sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning HWs from President's Emergency Plan for AIDS Relief (PEPFAR) to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this expanded workforce. We conducted a multiple case study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates ('high absorbers') and two with the lowest absorption rates ('low absorbers'). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR-implementing organizations (n = 16), district health teams (n = 15) and facility managers (n = 22). Twelve focus groups were conducted with 87 HWs absorbed on GoU payrolls. We utilized the Consolidated Framework for Implementation Research to guide thematic analysis. At the sub-national level, facilitators of transition in 'high absorber' districts were identified as the presence of transition 'champions', prioritizing HWs in district wage bill commitments, host facilities providing 'bridge financing' to transition workforce during salary delays and receiving donor technical support in district wage bill analysis-attributes that were absent in 'low absorber' districts. At the national level, multi-sectoral engagements (incorporating the influential Ministry of Finance), developing a joint transition road map, aligning with GoU salary scales and recruitment processes emerged as facilitators of the transition process. Our case studies offer implementation research lessons on effective donor transition and insights into pragmatic strategies for increasing public spending on expanding the health workforce in a low-income setting.
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Affiliation(s)
- Henry Zakumumpa
- School of Public Health, University of the Western Cape, Private Bag x17, Bellville, 7535 Republic of South Africa
| | - Joseph Rujumba
- Makerere University, School of Medicine, P O Box 7062, Kampala, Uganda
| | - Woldekidan Amde
- School of Public Health, University of the Western Cape, Private Bag x17, Bellville, 7535 Republic of South Africa
| | | | - Everd Maniple
- School of Medicine, Kabale University, P O Box 317, Kabale, Uganda
| | - Freddie Ssengooba
- Makerere University, School of Public Health, P O Box 7072, Kampala, Uganda
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Alami H, Lehoux P, Fleet R, Fortin JP, Liu J, Attieh R, Cadeddu SBM, Abdoulaye Samri M, Savoldelli M, Ag Ahmed MA. How Can Health Systems Better Prepare for the Next Pandemic? Lessons Learned From the Management of COVID-19 in Quebec (Canada). Front Public Health 2021; 9:671833. [PMID: 34222176 PMCID: PMC8249772 DOI: 10.3389/fpubh.2021.671833] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communication mechanisms were put in place; (5) what form of governance emerged; and (6) whether trust was established and maintained throughout the crisis. Our findings and observations stress that resilience and ability to adequately respond to a systemic and global crisis depend upon preexisting system-level characteristics and capacities at both the provincial and federal governance levels. By providing recommendations for policy and practice from a learning health system perspective, this paper contributes to the groundwork required for interdisciplinary research and genuine policy discussions to help health systems better prepare for future pandemics.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Pascale Lehoux
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
- Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC, Canada
| | - Richard Fleet
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
- Research Chair in Emergency Medicine Université Laval-CHAU Hôtel-Dieu de Lévis, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Laval University, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Joanne Liu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Randa Attieh
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Stéphanie Bernadette Mafalda Cadeddu
- Research Centre of the University of Montreal Hospital Centre, University of Montreal, Montreal, QC, Canada
- Faculty of Law, University of Montreal, Montreal, QC, Canada
| | | | | | - Mohamed Ali Ag Ahmed
- Research Chair on Chronic Diseases in Primary Care, Sherbrooke University, Chicoutimi, QC, Canada
- The Institute of Tropical Medicine, Antwerp, Belgium
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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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Seelam B, Liu H, Borah RR, Sheeladevi S, Keay L. A realist evaluation of the implementation of a large-scale school eye health programme in India: a qualitative study. Ophthalmic Physiol Opt 2021; 41:565-581. [PMID: 33860968 DOI: 10.1111/opo.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India. METHODS We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. theory gleaning, 2. eliciting programme theory, 3. revisiting programme theory. The Initial Programme Theories (IPTs) were developed and revised through review of the literature, programme documents and field notes. We reviewed informal and formal discussions from the participatory advisory workshops and conducted semi-structured interviews with key stakeholders for the development and refinement of the IPTs. We based our analysis on the programme designers' perspective; used contexts, mechanisms and outcomes configuration for the analysis and presentation of the findings and reported the revised IPTs for the REACH programme. RESULTS We identified four major programme aspects of the REACH programme for evaluation: programme governing unit, human resource, innovation and technology and funding. Based on the intended outcomes of the programme, themes and contexts were sorted and IPTs were defined. We revised the IPTs based on the analysis of the interviews (n = 19). The contexts and mechanisms that were reported to have potential influence on the attainment of favourable programme outcomes were identified. The revisions to the IPTs included: co-designing a collaborative model and involving local government officials to reinforce trust, community partnerships; local well-trained staff to encourage participation; use of the web-based data capturing system with built-in quality control measures and continued technical support; pre-determined costs and targets for the outputs promoted transparency and adherence with costs. CONCLUSION This process provided a comprehensive understanding of the opportunities and possibilities for a large-scale school eye health programme in diverse local contexts in India. This illustrated the importance of embracing principles of system thinking and considering contextual factors for School Eye Health programmes in low and middle-income countries.
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Affiliation(s)
- Bharani Seelam
- The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, New Delhi, India
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Lisa Keay
- The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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Arrossi S, Paolino M, Laudi R, Thouyaret L. Changing the paradigm of cervical cancer prevention through introduction of HPV-testing: evaluation of the implementation process of the Jujuy Demonstration Project in Argentina. Ecancermedicalscience 2021; 15:1199. [PMID: 33889208 PMCID: PMC8043686 DOI: 10.3332/ecancer.2021.1199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The Jujuy Demonstration Project (JDP) was a project carried out over the course of 4 years (2011–2014) to develop, implement and evaluate the programmatic components of a Human Papilloma Virus (HPV)-based screening programme in Argentina. The aim of this paper is to present a qualitative evaluation of the context and implementation process of the JDP. Methods We used an adaptation of the Health System Framework (HSF), which includes interconnected contextual factors that are considered key drivers for successful health interventions. We reviewed secondary documents, which included scientific reports, norms and regulations, information sheets, power point presentations and manuals and recommendations published by the National Programme for Cervical Cancer Prevention. We also carried out semi-structured interviews with key informants to explore their views about technology acceptability. Results Key components of the JDP implementation process were: a high level of political support and consensus among stakeholders, the demonstrated effectiveness of the technology and its acceptability by health authorities and providers, the funding of tests and diagnosis/treatment services, the implementation of an information system for monitoring and evaluation and the reorganisation of the network of screening, diagnosis and treatment services. Conclusion This analysis examines the policy context in which the JDP was implemented and the system components that were key for the demonstrated effectiveness of the strategy. Such analyses provide useful insights into core components of HPV testing implementation that are needed to guarantee its potential effectiveness to reduce cervical cancer incidence and mortality.
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Affiliation(s)
- Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Rosa Laudi
- Hospital Ramos Mejía, Urquiza 609, Buenos Aires 1221, Argentina
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Buenos Aires 1067, Argentina
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Bensberg M, Joyce A, Wilson E. Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1618. [PMID: 33567719 PMCID: PMC7914461 DOI: 10.3390/ijerph18041618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/27/2022]
Abstract
Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria's (HTV) macro infrastructure for the delivery of large-scale prevention interventions. METHODS This paper reports on findings of 31 semi-structured interviews about participants' understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results. RESULTS Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods. CONCLUSIONS HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.
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Affiliation(s)
- Monica Bensberg
- Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, P.O. Box 218, Mail H25, Hawthorn, VIC 3122, Australia; (A.J.); (E.W.)
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Williams SM, Renjua J, Moshabela M, Wringe A. Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa. Glob Public Health 2021; 16:167-185. [PMID: 33284727 PMCID: PMC7612946 DOI: 10.1080/17441692.2020.1851385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
We explored women's experiences of Option B+ in sub-Saharan African health facility settings through a meta-ethnography of 32 qualitative studies published between 2010 and 2019. First and second-order constructs were identified from the data and authors' interpretations respectively. Using a health systems lens, third-order constructs explored how the health systems shaped women's experiences of Option B+ and their subsequent engagement in care. Women's experiences of Option B+ services were influenced by their interactions with health workers, which were often reported to be inadequate and rushed, reflecting insufficient staffing or training to address pregnant women's needs. Women's experiences were also undermined by various manifestations of stigma which persisted in the absence of resources for social or mental health support, and were exacerbated by space constraints in health facilities that infringed on patient confidentiality. Sub-optimal service accessibility, drug stock-outs and inadequate tracing systems also shaped women's experiences of care. Strengthening health systems by improving health worker capacity to provide respectful and high-quality clinical and support services, improving supply chains and improving the privacy of consultation spaces would improve women's experiences of Option B+ services, thereby contributing to improved care retention. These lessons should be considered as universal test and treat programmes expand.
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Affiliation(s)
- Shannon M. Williams
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenny Renjua
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Durban, South Africa
| | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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43
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Amponsah-Dacosta E, Kagina BM, Olivier J. Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review. Health Policy Plan 2021; 35:701-717. [PMID: 32538437 PMCID: PMC7294244 DOI: 10.1093/heapol/czaa017] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/03/2022] Open
Abstract
Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.,Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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Vaz LME, Franco L, Guenther T, Simmons K, Herrera S, Wall SN. Operationalising health systems thinking: a pathway to high effective coverage. Health Res Policy Syst 2020; 18:132. [PMID: 33143734 PMCID: PMC7641804 DOI: 10.1186/s12961-020-00615-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.
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Affiliation(s)
- Lara M E Vaz
- Population Reference Bureau, 1875 Connecticut Avenue, NW Suite 520, Washington, DC, 20009, United States of America.
| | - Lynne Franco
- EnCompass LLC, 1451 Rockville Pike Suite 600, Rockville, MD, 20852, USA
| | - Tanya Guenther
- Formerly with Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Kelsey Simmons
- Ford Foundation, 320 E 43rd St, New York, NY, 10017, USA
| | - Samantha Herrera
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Stephen N Wall
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
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Aghaji A, Burchett H, Hameed S, Webster J, Gilbert C. The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study. JMIR Res Protoc 2020; 9:e17263. [PMID: 33107837 PMCID: PMC7655465 DOI: 10.2196/17263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. Objective Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. Methods This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. Results Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. Conclusions This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. International Registered Report Identifier (IRRID) DERR1-10.2196/17263
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Affiliation(s)
- Ada Aghaji
- Department of Ophthalmology, College of Medicine, Enugu, Nigeria.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Burchett
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shaffa Hameed
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Shahabi S, Teymourlouy AA, Shabaninejad H, Kamali M, Lankarani KB, Mojgani P. Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study. Global Health 2020; 16:86. [PMID: 32967707 PMCID: PMC7510125 DOI: 10.1186/s12992-020-00618-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Although the main aims of sanctions are the political and economic pressures on governments, literature has demonstrated the harsh effects of sanctions on the general public, especially on the patients, poor and disabled people. Since the international sanctions regime negatively affected almost all dimensions of Iran’s health sector, this qualitative study was conducted to investigate the situation of the physical rehabilitation sector after these sanctions. Methods This qualitative study was conducted from January 2019 to June 2019 in Iran using Skype, telephone, and face-to-face in-depth semi-structured interviews. Purposive and snowball sampling approaches were used to identify the participants. Also, framework analysis approach was applied to analyze the collected data. Results In total, 38 individuals including health policy-maker, faculty member, rehabilitation expert, Physiotherapist, Occupational therapist, and Orthotist/Prosthetist, were involved in the study. Based on our findings, a number of challenges facing the Iranian physical rehabilitation sector during the international sanctions period included: 1) socioeconomic challenges (inadequate funding, rising inflation rate, high unemployment rate, catastrophic expenditures, and inappropriate employment status of practitioners); 2) education challenges (decreased international collaboration and shortage of training devices and materials); 3) international challenges (rising issues in accessing services for patients from neighborhood countries); and 4) service delivery challenges (shortage of raw materials for producing the orthoses and prostheses, hardening of the importing the needed equipment, inappropriate infrastructures, and impossibility to use external assistance). Conclusion After international sanctions, the Iranian physical rehabilitation sector has faced considerable multifaceted challenges. Therefore, the international community must be aware of the situation and be concerned about the irreparable consequences.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kamali
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
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Marshall J, Scott B, Delva J, Ade C, Hernandez S, Patel J, Moreno-Cheek M, Rojas D, Tanner JP, Kirby RS. An Evaluation of Florida's Zika Response Using the WHO Health Systems Framework: Can We Apply These Lessons to COVID-19? Matern Child Health J 2020; 24:1212-1223. [PMID: 32583172 PMCID: PMC7314660 DOI: 10.1007/s10995-020-02969-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES From 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https://www.floridahealth.gov/diseases-and-conditions/mosquito-bornediseases/surveillance.html , 2019a). Florida's response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida's response focused on care for pregnant women and families with infants exposed to Zika virus. METHODS Fifteen focus groups and interviews were conducted with 33 public health and healthcare workers who managed outbreak response, case investigations, and patient care in south Florida. Data were thematically analyzed, and the results were framed by the World Health Organization's (WHO) Healthcare Systems Framework of six building blocks: health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance (World Health Organization, https://www.who.int/healthsystems/strategy/everybodys_business.pdf , 2007, https://www.who.int/healthinfo/systems/monitoring/en/ , 2010). RESULTS Results highlighted coordination of resources, essential services and treatment, data collection, communication among public health and healthcare systems, and dissemination of information. Community education, testing accuracy and turnaround time, financing, and continuity of health services were areas of need, and there was room for improvement in all indicator areas. CONCLUSIONS The WHO Framework encapsulated important infrastructure and process factors relevant to the Florida Zika response as well as future epidemics. In this context, similarities, differences, and implications for the Coronavirus COVID-19 pandemic response are discussed.
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Affiliation(s)
- Jennifer Marshall
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Blake Scott
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jennifer Delva
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Cedrick Ade
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Santiago Hernandez
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jaladhikumar Patel
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Mantero Moreno-Cheek
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Dogeli Rojas
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jean-Paul Tanner
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Russell S Kirby
- University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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Phillips G, Creaton A, Airdhill-Enosa P, Toito'ona P, Kafoa B, O'Reilly G, Cameron P. Emergency care status, priorities and standards for the Pacific region: A multiphase survey and consensus process across 17 different Pacific Island Countries and Territories. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 1:100002. [PMID: 34173588 PMCID: PMC7382998 DOI: 10.1016/j.lanwpc.2020.100002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022]
Abstract
Background Effective emergency care (EC) reduces mortality, aids disaster and outbreak response, and is necessary for universal health coverage. Surge events frequently challenge Pacific Island Countries and Territories (PICTs), where robust routine EC is required for resilient health systems. We aimed to describe the current status, determine priority actions and set minimum standards for EC systems development across the Pacific region. Methods We used a prospective, multiphase, expert consensus process to collect data from PICT EC stakeholders using focus groups, electronic surveys and panel review between August 2018 and April 2019. Data were analysed using descriptive statistics, consensus agreement and graphic interpretation. We structured the research according to the World Health Organisation EC Systems and building block framework adapted for the Pacific context. Findings Over 200 participants from 17 PICTs engaged in at least one component of the multiphase process. Gaps in functional capacity exist in most PICTs for both facility-based and pre-hospital care. EC is a low priority across the Pacific and integrated poorly with disaster plans. Participants emphasised human resource support and government recognition of EC as priority actions, and generated 24 facility-based and 22 pre-hospital Pacific EC standards across all building blocks. Interpretation PICT stakeholders now have baseline indicators and a comprehensive roadmap for EC development within a globally recognised health systems framework. This study generates practical, context-appropriate tools to trigger further research, conduct evidence-based advocacy, drive future improvements and measure progress towards achieving universal health access for Pacific peoples. Funding Secretariat of the Pacific Community (partial)
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Affiliation(s)
- Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency Physician, Emergency Department, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Anne Creaton
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency Physician, West Gippsland Healthcare Group, VIC, Australia
| | - Pai Airdhill-Enosa
- Director, Emergency Department, Tupua Tamasese Meaole Hospital, Apia, Samoa
| | - Patrick Toito'ona
- Deputy Director, Emergency Department, National Referral Hospital, Honiara, Solomon Islands
| | - Berlin Kafoa
- Director, Clinical Services Program, Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
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Nandi S, Schneider H. Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India. Health Res Policy Syst 2020; 18:50. [PMID: 32450870 PMCID: PMC7249418 DOI: 10.1186/s12961-020-00555-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low- and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access. METHODS This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author's PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health. RESULTS The analysis finds that evidence of equitable enrolment in Chhattisgarh's PFHI scheme may mask many other inequities. Firstly, equitable enrolment does not automatically lead to the acceptability of the scheme for the poor or to equity in utilisation. Utilisation, especially in the private sector, is skewed towards the areas that have the least health and social need. Secondly, related to this, resource allocation patterns under PFHI deepen the 'infrastructure inequality trap', with resources being effectively transferred from tribal and vulnerable to 'better-off' areas and from the public to the private sector. Thirdly, PFHI fails in its fundamental objective of effective financial protection. Technological innovations, such as the biometric smart card and billing systems, have not provided the necessary safeguards nor led to greater accountability. CONCLUSION The study shows that development of PFHI schemes, within the context of wider neoliberal policies promoting private sector provisioning, has negative consequences for health equity and access. More research is needed on key knowledge gaps related to the impact of PFHI schemes on health systems. An over-reliance on and rapid expansion of PFHI schemes in India is unlikely to achieve UHC.
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Affiliation(s)
- Sulakshana Nandi
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Public Health Resource Network, 29, New Panchsheel Nagar, Raipur, Chhattisgarh 492001 India
| | - Helen Schneider
- School of Public Health, UWC/MRC Health Services to Systems Unit, University of the Western Cape, Bellville, South Africa
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Maser B, Force LM, Friedrich P, Antillon F, Arora RS, Herrera CA, Rodriguez-Galindo C, Atun R, Denburg A. Paediatric Oncology System Integration Tool (POSIT) for the joint analysis of the performance of childhood cancer programs and health systems. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2019.100208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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