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Arce Cardozo RK, Fonseca-Rodríguez O, Mamani Ortiz Y, San Sebastian M, Jonsson F. Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? an interrupted time series analysis. Glob Health Action 2024; 17:2371184. [PMID: 38949664 PMCID: PMC11218584 DOI: 10.1080/16549716.2024.2371184] [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: 04/25/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited. OBJECTIVE To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia. METHODS Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods. RESULTS The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies. CONCLUSION This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.
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Affiliation(s)
- Rodrigo K. Arce Cardozo
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
- Biomedical and Social Research Institute, “Aurelio Melean” Medical School, San Simon University, Cochabamba, Bolivia
| | | | - Yercin Mamani Ortiz
- Biomedical and Social Research Institute, “Aurelio Melean” Medical School, San Simon University, Cochabamba, Bolivia
| | | | - Frida Jonsson
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
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Chamla D, Iwu-Jaja C, Jaca A, Ndlambe AM, Buwa M, Idemili-Aronu N, Okeibunor J, Wiysonge CS, Gueye AS. The critical elements of the health system that could make for resilience in the World Health Organization African Region: a scoping review. PeerJ 2024; 12:e17869. [PMID: 39247547 PMCID: PMC11380474 DOI: 10.7717/peerj.17869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 07/15/2024] [Indexed: 09/10/2024] Open
Abstract
Background Unpredictable events, such as the outbreak of infectious diseases and humanitarian crises, are putting a strain on health care systems. As a result, African countries will need to prepare themselves with appropriate strategies to withstand such occurrences. Therefore, the purpose of this scoping review was to map available evidence about what type and what components of health systems are needed to help countries cope with health emergencies and to foster health system resilience in the WHO African Region. Methods A systematic search was performed independently in Scopus and PubMed electronic databases as well as grey literature. Studies were selected based on set eligibility criteria based on the Joanna Brigg's Institute (JBI) methodology for scoping reviews. The key findings were focused on health system resilience and were mapped based on the WHO's core health system components. Our data were tabulated, and a narrative synthesis was conducted. Results A total of 28 studies were included in this scoping review, mostly conducted in the WHO African Region and region of the Americas. Studies focused on a variety of strategies, such as the continuous delivery of essential services, the strengthening of the health workforce, including community health care workers, community engagement, the provision of protective mechanisms for the health workforce, and flexible leadership and governance measures. Conclusion Our findings suggest that strategies to improve health system resilience must include all areas of the healthcare delivery process, including primary care. A resilient health system should be ready for a crisis and have adaptable policies in place to offer adequate response at all levels, as well as post-recovery planning. Such health systems should also seek for continuous improvement. More research is needed to assess the efficacy of initiatives for improving health system resilience, particularly in vulnerable African health systems.
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Affiliation(s)
- Dick Chamla
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Chinwe Iwu-Jaja
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Asiphe Mavi Ndlambe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Muyunda Buwa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | - Joseph Okeibunor
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Charles Shey Wiysonge
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Abdou Salam Gueye
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
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Munakampe MN, Ngoma-Hazemba A, Sampa M, Jacobs CN. Understanding inequalities in the coverage of adolescent sexual and reproductive health services: a qualitative case study of the selected regions of Zambia. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1399289. [PMID: 39166176 PMCID: PMC11333446 DOI: 10.3389/frph.2024.1399289] [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: 03/11/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. Materials and methods In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. Results We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. Conclusion While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.
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Affiliation(s)
- Margarate Nzala Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Yakini Health Research Institute, Lusaka, Zambia
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
| | - Alice Ngoma-Hazemba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mutale Sampa
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Choolwe N. Jacobs
- Women in Global Health, Zambia Chapter, Lusaka, Zambia
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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Ibrahim AM. Exploring society-to-cells resilience among community members: A multidisciplinary study in outpatient clinics with diverse participant demographics. J Adv Nurs 2024. [PMID: 38924555 DOI: 10.1111/jan.16296] [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: 01/13/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
AIM This study explores and understands community members' resilience in outpatient clinics, considering various dimensions and types of resilience. DESIGN A cross-sectional study. METHODS This study was conducted in Saudi outpatient clinics from September to December 2023 and included 384 individuals chosen through systematic random sampling. Various tools were used, such as Social Cohesion and Trust Scale, Community Resilience Assessment Tool, Community Assessment of Psychic Experiences, Environmental Resilience Assessment, Economic Resilience Index, Connor-Davidson Resilience Scale, Brief Resilience Scale, Resilience Scale for Adults and Healthcare Resilience Index. RESULTS Participants displayed a robust overall resilience level, as indicated by Total Connor-Davidson Resilience Scale score of 63.0 ± 9.0. Additionally, they demonstrated commendable levels of resilience in Total Brief Resilience Scale (56.04 ± 8.6), Resilience Scale for Adults (82.5 ± 7.2) and Healthcare Resilience Index (45.8 ± 5.5). These findings offer significant insights into psychological and emotional well-being of the study population, highlighting their adaptive capacities and coping mechanisms across various life domains. CONCLUSION This study provides valuable insights into the multidimensional nature of resilience in outpatient settings. The cross-sectional design sets the groundwork for future longitudinal investigations, highlighting the need for a holistic approach to understanding and promoting resilience. IMPACT This study holds immediate implications for participants and their communities. It underscores the adaptive capacities and coping mechanisms prevalent in the outpatient population by revealing commendable resilience levels. This insight enhances individuals' psychological and emotional well-being, contributing positively to the overall resilience and communal strength. Additionally, this study sheds light on how resilience among community members in Saudi Arabia relates to international advanced nursing communities, providing insight into their work. PATIENT OR PUBLIC CONTRIBUTION Patients who have received outpatient services in the past 6 months were purposively chosen to ensure a diverse representation across age, gender and socio-economic backgrounds in this study.
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Affiliation(s)
- Ateya Megahed Ibrahim
- Assistant Professor, College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Assistant Professor, Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
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Gueye AS, Okeibunor J, Ngofa R, Conteh I, Onyeneho N, Mbainodji N, Braka F, Chamla D, Koua EL, Moeti M. Willingness of WHO staff to work in health emergencies in the African Region: opportunity for phased deployment of staff and ensure continuity of health services. Pan Afr Med J 2024; 47:68. [PMID: 38681108 PMCID: PMC11055190 DOI: 10.11604/pamj.2024.47.68.40362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/30/2023] [Indexed: 05/01/2024] Open
Abstract
A human resource base that ensures appropriate deployment of staff to emergencies, addressing different shock events in emergencies, without disrupting continuity of service is germane to a successful response. Consequently, the WHO Health Emergencies programme in the African Region, in collaboration with Africa Centre for Disease Control (ACDC) launched the African Volunteer Health Corps (AVoHC) and Strengthening and Utilization of Response Group for Emergencies (SURGE), an initiative aimed at ensuring a pool of timely responders. We explored the willingness of WHO staff to work in emergencies. A call for expression of interest to be part of the Elite Emergency Experts (Triple E) was published on 5th July 2022 via email and was open for 5 weeks. The responses were analyzed using simple descriptive statistics and presented with graphic illustrations. A total of 1253 WHO staff, from all the six WHO regions, cutting across all cadre, applied to the call. The applicants had various trainings and experiences in emergency and have responded to mostly disease outbreaks. Two-third of the applicants were males. This paper did not explore reasons for the willingness to work in emergencies. However, contrary to fears expressed in literature that health workers would not want to work in emergencies with potential for infections, the applicants have worked mostly in infectious emergencies. Literature identified some themes on factors that could impact on willingness of health workers to work in emergencies. These include concerns for the safety of the responders and impact of partners, child and elderly care, as well as other family obligations, which emergency planners must consider in planning emergency response.
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Affiliation(s)
| | - Joseph Okeibunor
- WHO African Region, Brazzaville, Congo
- University of Nigeria, Nsukka, Nigeria
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Hernandez-Pineda E, Amaya CA, González-Uribe C, Herrera A, Velasco N. Covid-19 vaccination: a mixed methods analysis of health system resilience in Latin America. Int J Equity Health 2024; 23:27. [PMID: 38347545 PMCID: PMC10863163 DOI: 10.1186/s12939-023-02073-4] [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: 07/28/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This paper discusses the stages of health system resilience (HSR) and the factors underlying differences in HSR during the covid-19 pandemic, especially the vaccination challenge. We studied the relationship between vaccination strategies and macro-context backgrounds in 21 Latin American countries. Our objective was to capture the impact of those aspects in the SR and identify potential improvements for future crises and for vaccination programs in general. METHODS The study uses mixed-methods research to provide insights into how the countries' backgrounds and vaccination strategies impact the HSR. Particularly, we used explanatory sequential mixed methods, which entails a quantitative-qualitative two-phase sequence. The quantitative phase was conducted using cluster and variance analysis, in which the HSR was measured using as a proxy the covid-19 vaccination outcomes in three cut-offs of reaching 25%, 50%, and 75% of population coverage. This approach allows us to discriminate covid-19 vaccination progress by stages and contrast it to the qualitative stage, in which we performed a country-case analysis of the background conditions and the changes in vaccination strategies that occurred during the corresponding dates. RESULTS The paper provides a rich comparative case analysis of countries, classifying them by early, prompt, and delayed performers. The results show that differences in vaccination performance are due to flexibility in adapting strategies, cooperation, and the ability to design multilevel solutions that consider the needs of various actors in the health ecosystem. These differences vary depending on the vaccination stage, which suggests the importance of acknowledging learning, diffusion, and feedback processes at the regional level. CONCLUSIONS We identified the importance of societal well-being as an ideal country antecedent for high and sustained levels of performance in covid-19 vaccination. Whereas in other countries where the set-up and beginning phases were rough, the value of the operational decisions and the learning on the move regarding their own and their peers' trajectories were crucial and were reflected in performance improvement. A contribution of this study is that the above-mentioned analysis was done using vaccination coverage cut-off points that allow a performance view that takes into consideration the stages of the vaccination progress and the learning process that goes with it. As well as framing this into the HSR shock cycles that allow to differentiate the stages of resilience on which countries must act.
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Affiliation(s)
| | - Ciro-Alberto Amaya
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Catalina González-Uribe
- School of Medicine, Universidad de Los Andes, Carrera 1 No 18 A - 10 42 Bloque Q Piso 8, Bogotá, 111711, Colombia
| | - Andrea Herrera
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Nubia Velasco
- School of Management, Universidad de Los Andes, Calle 21 # 1-20, Bogotá, 111711, Colombia
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Fall IS, Wango RK, Yahaya AA, Stephen M, Mpairwe A, Nanyunja M, Herring BL, Latt A, Mghamba J, Ndoungue VF, Yota D, Massidi C, Diallo AB, Ohene SA, Njuguna C, Oke A, Kizerbo GA, Chamla D, Yoti Z, Talisuna A. Implementing Joint External Evaluations of the International Health Regulations (2005) capacities in all countries in the WHO African region: process challenges, lessons learnt and perspectives for the future. BMJ Glob Health 2023; 8:e013326. [PMID: 37802545 PMCID: PMC10565161 DOI: 10.1136/bmjgh-2023-013326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Following the West Africa Ebola virus disease outbreak (2013-2016), the Joint External Evaluation (JEE) is one of the three voluntary components recommended by the WHO for evaluating the International Health Regulations (2005) capacities in countries. Here, we share experience implementing JEEs in all 47 countries in the WHO African region. In February 2016, the United Republic of Tanzania (Mainland) was the first country globally to conduct a JEE. By April 2022, JEEs had been conducted in all 47 countries plus in the island of Zanzibar. A total of 360 subject matter experts (SMEs) from 88 organisations were deployed 607 times. Despite availability of guidelines, the process had to be contextualised while avoiding jeopardising the quality and integrity of the findings. Key challenges were: inadequate understanding of the process by in-country counterparts; competing country priorities; limited time for validating subnational capacities; insufficient availability of SMEs for biosafety and biosecurity, antimicrobial resistance, points of entry, chemical events and radio-nuclear emergencies; and inadequate financing to fill gaps identified. Key points learnt were: importance of country leadership and ownership; conducting orientation workshops before the self-assessment; availability of an external JEE expert to support the self-assessment; the skills, attitudes and leadership competencies of the team lead; identifying national experts as SMEs for future JEEs to promote capacity building and experience sharing; the centrality of involving One Health stakeholders from the beginning to the end of the process; and the need for dedicated staff for planning, coordination, implementation and timely report writing. Moving forward, it is essential to draw from this learning to plan future JEEs. Finally, predictable financing is needed immediately to fill gaps identified.
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Affiliation(s)
- Ibrahima-Soce Fall
- Neglected Tropical Diseases (NTDs), WHO Headquarters, Geneva, Switzerland
| | - Roland Kimbi Wango
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Ali Ahmed Yahaya
- AMR Unit, Office of the Assistant Regipnal Director, WHO regional Office for Africa, Brazzaville, Congo
| | - Mary Stephen
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Allan Mpairwe
- Emergency Preparedness and Response Hub, WHO, Regional Office for Africa, Nairobi, Kenya
| | - Miriam Nanyunja
- Emergency Preparedness and Response Hub, WHO, Regional Office for Africa, Nairobi, Kenya
| | - Belinda Louise Herring
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Anderson Latt
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | | | - Viviane Fossouo Ndoungue
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Daniel Yota
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Christian Massidi
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Amadou Bailo Diallo
- Emergency Preparedness and Response Hub, WHO Regional Office for Africa, Dakar, Senegal
| | - Sally-Ann Ohene
- Emergency Preparedness and Response Programme, WHO, Ghana Country Office, Accra, Ghana
| | - Charles Njuguna
- Health Emergecy Programme, WHO, Sierra Leone Country Office, Free Town, Sierra Leone
| | - Antonio Oke
- WHE Programme, WHO, Sudan Country Office, Juba, South Sudan
| | - Georges Alfred Kizerbo
- Liaison Office to the African Unions and the United Nations Economic Commission for Africa, WHO Regional Office for Africa, Addis Ababa, Ethiopia
| | - Dick Chamla
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Zabulon Yoti
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- Liaison Office to the African Unions and the United Nations Economic Commission for Africa, WHO Regional Office for Africa, Addis Ababa, Ethiopia
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Ellis LA, Saba M, Long JC, Lyng HB, Haraldseid-Driftland C, Churruca K, Wiig S, Austin E, Clay-Williams R, Carrigan A, Braithwaite J. The rise of resilient healthcare research during COVID-19: scoping review of empirical research. BMC Health Serv Res 2023; 23:833. [PMID: 37550640 PMCID: PMC10405417 DOI: 10.1186/s12913-023-09839-0] [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: 02/22/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients). METHODS Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis. RESULTS Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care. CONCLUSIONS This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Maree Saba
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Hilda Bø Lyng
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Cecilie Haraldseid-Driftland
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siri Wiig
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Elizabeth Austin
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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McDarby G, Seifeldin R, Zhang Y, Mustafa S, Petrova M, Schmets G, Porignon D, Dalil S, Saikat S. A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19. Front Public Health 2023; 11:1105537. [PMID: 37250074 PMCID: PMC10213627 DOI: 10.3389/fpubh.2023.1105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict' Health systems resilience has become a ubiquitous concept as countries respond to and recover from crises such as the COVID-19 pandemic, war and conflict, natural disasters, and economic stressors inter alia. However, the operational scope and definition of health systems resilience to inform health systems recovery and the building back better agenda have not been elaborated in the literature and discourse to date. When widely used terms and their operational definitions appear nebulous or are not consistently used, it can perpetuate misalignment between stakeholders and investments. This can hinder progress in integrated approaches such as strengthening primary health care (PHC) and the essential public health functions (EPHFs) in health and allied sectors as well as hinder progress toward key global objectives such as recovering and sustaining progress toward universal health coverage (UHC), health security, healthier populations, and the Sustainable Development Goals (SDGs). This paper represents a conceptual synthesis based on 45 documents drawn from peer-reviewed papers and gray literature sources and supplemented by unpublished data drawn from the extensive operational experience of the co-authors in the application of health systems resilience at country level. The results present a synthesis of global understanding of the concept of resilience in the context of health systems. We report on different aspects of health systems resilience and conclude by proposing a clear operational definition of health systems resilience that can be readily applied by different stakeholders to inform current global recovery and beyond.
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Affiliation(s)
- Geraldine McDarby
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Sohel Saikat
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
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Karamagi HC, Sy S, Kipruto H, Kembabazi B, Kidane SN, Moyo TN, Titi-Ofei R, Atweam D, Debpuur C, Ofosu A, Kasolo FC. Making districts functional for universal health coverage attainment: lessons from Ghana. Front Public Health 2023; 11:1159362. [PMID: 37228733 PMCID: PMC10204803 DOI: 10.3389/fpubh.2023.1159362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Ensuring the sub national level in the health system can function effectively is central to attainment of health results in countries. However, the current health agenda has not prioritized how districts can deploy their existing resources effectively, to maximize the efficiency equity and effectiveness in their use. Ghana initiated a self-assessment process to understand the functionality of districts to deliver on health results. The assessment was conducted by health managers in 33 districts during August-October 2022 using tools pre-developed by the World Health Organization. Functionality was explored around service provision, oversight, and management capacities, each with defined dimensions and attributes. The objective of the study was to highlight specific functionality improvements needed by districts in terms of investments and access to service delivery in achieving Universal Health Care. The results showed a lack of correlation between functionality and performance as is currently defined in Ghana; a higher functionality of oversight capacity compared to service provision or management capacities; and specifically low functionality for dimensions relating to capacity to make available quality services, responsiveness to beneficiaries and the systems and three structures for health management. The findings highlight the need to shift from quantitative outcome indicator-based performance approaches to measures of total health and wellbeing of beneficiaries. Specific functionality improvements are needed to improve the engagement and answerability to the beneficiaries, investments in access to services, and in building management architecture.
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Affiliation(s)
| | - Sokona Sy
- World Health Organization—Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | | | - Bertha Kembabazi
- World Health Organization—Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | | | | | - Regina Titi-Ofei
- The Global Fund to Fight AIDS, TB and Malaria, Switzerland, Geneva
| | | | | | | | - Francis Chisaka Kasolo
- World Health Organization—Regional Office for Africa, Brazzaville, Democratic Republic of Congo
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Fawole OI, Bello S, Adebowale AS, Bamgboye EA, Salawu MM, Afolabi RF, Dairo MD, Namale A, Kiwanuka S, Monje F, Namuhani N, Kabwama S, Kizito S, Ndejjo R, Seck I, Diallo I, Makhtar M, Leye M, Ndiaye Y, Fall M, Bassoum O, Mapatano MA, Bosonkie M, Egbende L, Lazenby S, Wang W, Liu A, Bartlein R, Sambisa W, Wanyenze R. COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons. BMC Public Health 2023; 23:835. [PMID: 37158897 PMCID: PMC10165588 DOI: 10.1186/s12889-023-15708-6] [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: 11/23/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.
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Affiliation(s)
| | - Segun Bello
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ayo Stephen Adebowale
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Eniola Adetola Bamgboye
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Mobolaji Modinat Salawu
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Rotimi Felix Afolabi
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Magbagbeola David Dairo
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Alice Namale
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne Kiwanuka
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Monje
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Noel Namuhani
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Steven Kabwama
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Susan Kizito
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Ibrahima Seck
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Issakha Diallo
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Mamadou Makhtar
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Mbacke Leye
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Youssou Ndiaye
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Manel Fall
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Oumar Bassoum
- Department of Preventive Medicine and Public Health, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Mala Ali Mapatano
- Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Marc Bosonkie
- Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Landry Egbende
- Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Siobhan Lazenby
- Gates Ventures LLC, Exemplars in Global Health, Seattle, WA, USA
| | - William Wang
- Gates Ventures LLC, Exemplars in Global Health, Seattle, WA, USA
| | - Anne Liu
- Gates Ventures LLC, Exemplars in Global Health, Seattle, WA, USA
| | - Rebecca Bartlein
- Gates Ventures LLC, Exemplars in Global Health, Seattle, WA, USA
| | | | - Rhoda Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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12
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Olu OO, Karamagi HC, Okeibunor JC. Editorial: Harnessing digital health innovations to improve healthcare delivery in Africa: Progress, challenges and future directions. Front Digit Health 2023; 5:1037113. [PMID: 37077405 PMCID: PMC10109448 DOI: 10.3389/fdgth.2023.1037113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Olushayo Oluseun Olu
- Office of the Representative, World Health Organization Country Office, Juba, South Sudan
| | - Humphrey Cyprian Karamagi
- Assistant Regional Director Cluster, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Joseph Chukwudi Okeibunor
- Assistant Regional Director Cluster, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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13
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Ensor S, Mechie I, Ryan R, Mussa A, Bame B, Tamuthiba L, Moshashane N, Morroni C. Measuring the impact of COVID-19 social distancing measures on sexual health behaviours and access to HIV and sexual and reproductive health services for people living with HIV in Botswana. Front Glob Womens Health 2023; 4:981478. [PMID: 36970120 PMCID: PMC10030995 DOI: 10.3389/fgwh.2023.981478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction Uninterrupted access to HIV and sexual and reproductive health (SRH) services is essential, particularly in high HIV prevalence settings, to prevent unintended pregnancy and vertical HIV transmission. Understanding the challenges that COVID-19 and associated social distancing measures (SDMs) posed on health service access is imperative for future planning. Methods This cross-sectional study was conducted in Botswana between January-February 2021. A web-based questionnaire was disseminated on social media as part of the International Sexual Health and REproductive Health (I-SHARE) Survey. Respondents answered questions on SRH, before and during COVID-19 SDMs. Subgroup analysis and comparison of descriptive data was performed for people living with HIV (PLWH). Results Of 409 participants, 65 were PLWH (80% female, 20% male). During SDMs, PLWH found it more difficult to access condoms and treatment for HIV and STIs; attend HIV appointments; and maintain adherence to antiretroviral therapy. Compared to HIV-negative women, a higher proportion of women living with HIV used condoms as their primary method of contraception (54% vs. 48%), and had lower use of long-acting reversible contraception (8% vs. 14%) and dual contraception (8% vs. 16%). Discussion Mirroring global trends, COVID-19 disrupted HIV and SRH service access in Botswana. However, in high HIV-prevalence settings, disruption may more severely impact population health with disproportionate effects on women. Integration of HIV and SRH services could build health system capacity and resilience, reduce missed opportunities for delivering SRH services to PLWH and limit the consequences of future restrictions that may cause health system disruption.
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Affiliation(s)
- Samuel Ensor
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Imogen Mechie
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rebecca Ryan
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bame Bame
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lefhela Tamuthiba
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Moshashane
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health and Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
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Paschoalotto MAC, Lazzari EA, Rocha R, Massuda A, Castro MC. Health systems resilience: is it time to revisit resilience after COVID-19? Soc Sci Med 2023; 320:115716. [PMID: 36702027 PMCID: PMC9851720 DOI: 10.1016/j.socscimed.2023.115716] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.
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Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil.
| | - Eduardo Alves Lazzari
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Rudi Rocha
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Adriano Massuda
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, Harvard University, USA
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15
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Ongoma V, Epule TE, Brouziyne Y, Tanarhte M, Chehbouni A. COVID-19 response in Africa: impacts and lessons for environmental management and climate change adaptation. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2023; 26:1-23. [PMID: 36714211 PMCID: PMC9873540 DOI: 10.1007/s10668-023-02956-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic adds pressure on Africa; the most vulnerable continent to climate change impacts, threatening the realization of most Sustainable Development Goals (SDGs). The continent is witnessing an increase in intensity and frequency of extreme weather events, and environmental change. The COVID-19 was managed relatively well across in the continent, providing lessons and impetus for environmental management and addressing climate change. This work examines the possible impact of the COVID-19 pandemic on the environment and climate change, analyses its management and draws lessons from it for climate change response in Africa. The data, findings and lessons are drawn from peer reviewed articles and credible grey literature on COVID-19 in Africa. The COVID-19 pandemic spread quickly, causing loss of lives and stagnation of the global economy, overshadowing the current climate crisis. The pandemic was managed through swift response by the top political leadership, research and innovations across Africa providing possible solutions to COVID-19 challenges, and redirection of funds to manage the pandemic. The well-coordinated COVID-19 containment strategy under the African Centers for Disease Control and Prevention increased sharing of resources including data was a success in limiting the spread of the virus. These strategies, among others, proved effective in limiting the spread and impact of COVID-19. The findings provide lessons that stakeholders and policy-makers can leverage in the management of the environment and address climate change. These approaches require solid commitment and practical-oriented leadership. Supplementary Information The online version contains supplementary material available at 10.1007/s10668-023-02956-0.
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Affiliation(s)
- Victor Ongoma
- International Water Research Institute, Mohammed VI Polytechnic University, Lot 660, Hay Moulay Rachid, 43150 Ben Guerir, Morocco
| | - Terence Epule Epule
- International Water Research Institute, Mohammed VI Polytechnic University, Lot 660, Hay Moulay Rachid, 43150 Ben Guerir, Morocco
| | - Youssef Brouziyne
- International Water Management Institute, Level 3, 7 Abd El-Hady Saleh St., Off Nile Street, Giza, Egypt
| | - Meryem Tanarhte
- Faculty of Sciences and Techniques of Mohammedia, Laboratory of Process Engineering and Environment, Hassan II University of Casablanca, 20650 Mohammedia, Morocco
| | - Abdelghani Chehbouni
- International Water Research Institute, Mohammed VI Polytechnic University, Lot 660, Hay Moulay Rachid, 43150 Ben Guerir, Morocco
- Center for Remote Sensing and Applications, Mohammed VI Polytechnic University, Lot 660, Hay Moulay Rachid, 43150 Ben Guerir, Morocco
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16
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Saulnier DD, Duchenko A, Ottilie-Kovelman S, Tediosi F, Blanchet K. Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic. Int J Health Policy Manag 2022; 12:6659. [PMID: 37579465 PMCID: PMC10125099 DOI: 10.34172/ijhpm.2022.6659] [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: 07/28/2021] [Accepted: 11/12/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Health challenges like coronavirus disease 2019 (COVID-19) are becoming increasingly complex, transnational, and unpredictable. Studying health system responses to the COVID-19 pandemic is an opportunity to enhance our understanding of health system resilience and establish a clearer link between theoretical concepts and practical ideas on how to build resilience. METHODS This narrative literature review aims to address four questions using a health system resilience framework: (i) What do we understand about the dimensions of resilience? (ii) What aspects of the resilience dimensions remain uncertain? (iii) What aspects of the resilience dimensions are missing from the COVID-19 discussions? and (iv) What has COVID-19 taught us about resilience that is missing from the framework? A scientific literature database search was conducted in December 2020 and in April 2022 to identify publications that discussed health system resilience in relation to COVID-19, excluding articles on psychological and other types of resilience. A total of 63 publications were included. RESULTS There is good understanding around information sharing, flexibility and good leadership, learning, maintaining essential services, and the need for legitimate, interdependent systems. Decision-making, localized trust, influences on interdependence, and transformation remain uncertain. Vertical interdependence, monitoring risks beyond the health system, and consequences of changes on the system were not discussed. Teamwork, actor legitimacy, values, inclusivity, trans-sectoral resilience, and the role of the private sector are identified as lessons from COVID-19 that should be further explored for health system resilience. CONCLUSION Knowledge of health system resilience has continued to cohere following the pandemic. The eventual consequences of system changes and the resilience of subsystems are underexplored. Through governance, the concept of health system resilience can be linked to wider issues raised by the pandemic, like inclusivity. Our findings show the utility of resilience theory for strengthening health systems for crises and the benefit of continuing to refine existing resilience theory.
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Affiliation(s)
- Dell D. Saulnier
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Duchenko
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Khalil M, Ravaghi H, Samhouri D, Abo J, Ali A, Sakr H, Camacho A. What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation. Front Public Health 2022; 10:1009400. [PMID: 36311596 PMCID: PMC9614418 DOI: 10.3389/fpubh.2022.1009400] [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: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level. Aim This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature. Methods Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction. Findings and discussion In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings. Conclusion Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.
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Affiliation(s)
- Merette Khalil
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil
| | - Hamid Ravaghi
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dalia Samhouri
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Abo
- Asian Disaster Preparedness Center, Bangkok, Thailand
| | - Ahmed Ali
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hala Sakr
- Department of Healthier Populations, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Alex Camacho
- Health Emergencies Programme, World Health Organization, Regional Office for the Americas, Washington, DC, United States
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18
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Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
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Bwire G, Ario AR, Eyu P, Ocom F, Wamala JF, Kusi KA, Ndeketa L, Jambo KC, Wanyenze RK, Talisuna AO. The COVID-19 pandemic in the African continent. BMC Med 2022; 20:167. [PMID: 35501853 PMCID: PMC9059455 DOI: 10.1186/s12916-022-02367-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/13/2023] Open
Abstract
In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and public health experts to give an overview of COVID-19 in Africa and share their thoughts and opinions on why Africa behaved the way it did. Furthermore, the experts highlight what needs to be done to support Africa to consolidate the status quo and overcome the negative effects of COVID-19 so as to accelerate attainment of the SDGs.
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Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology Surveillance and Public Health Emergencies, Ministry of Health, P.O Box 7272, Kampala, Uganda
- School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Patricia Eyu
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Kwadwo A. Kusi
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Latif Ndeketa
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rhoda K. Wanyenze
- School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ambrose O. Talisuna
- Epidemic Preparedness and Response Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
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