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Huang A, Zhao Y, Cao C, Lyu M, Tang K. Integrating interventions supported by development assistance for health into local health system: evidence from a China-World Bank-UK rural health system strengthening project (1998-2007). BMJ Glob Health 2024; 9:e012853. [PMID: 38789275 PMCID: PMC11129031 DOI: 10.1136/bmjgh-2023-012853] [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: 05/15/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system. METHODS From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems. RESULTS Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions. CONCLUSION The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.
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Affiliation(s)
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Niang M, Alami H, Gagnon MP, Dupéré S. A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action. Glob Health Action 2023; 16:2230813. [PMID: 37459240 DOI: 10.1080/16549716.2023.2230813] [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: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. OBJECTIVE By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. METHOD We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. RESULTS The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. CONCLUSION From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health.
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Affiliation(s)
- Marietou Niang
- Department of Social Work and Psychosociology, Université du Québec à Rimouski, Lévis, QC, Canada
| | - Hassane Alami
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | | | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, Québec, QC, Canada
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Fryatt RJ, Blecher M. In with the good, out with the bad - Investment standards for external funding of health? HEALTH POLICY OPEN 2023; 5:100104. [PMID: 38059005 PMCID: PMC10696456 DOI: 10.1016/j.hpopen.2023.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/10/2023] [Accepted: 10/28/2023] [Indexed: 12/08/2023] Open
Abstract
In recent decades, external financing of health systems in low- and middle-income countries has helped achieve remarkable improvements across the world. However, these successes have not come without problems. There are a growing number of areas where external assistance can cause harm and even undermine the development of national health systems. Recent decades have seen a surge of knowledge on investing in health systems. We propose the setting up of investment standards for external assistance that aim to incentivize a more efficient evidence-based investment in a country's health system, led by decision-makers in country. Using a more standardized process would lead to a better use of precious external assistance resources. The long-term goal would be fully functioning health systems with all the necessary essential public health functions in all countries.
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Affiliation(s)
- Robert John Fryatt
- Position: Lead, International Health, Mott MacDonald, Address: 10 Fleet Place, London EC1M, UK
| | - Mark Blecher
- Chief Director, Health and Social Development, Address: National Treasury, Government of South Africa, Pretoria, South Africa
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Niang M, Gagnon MP, Dupéré S. Using systems thinking to understand the scale-up and sustainability of health innovation: a case study of seasonal malaria chemoprevention processes in Burkina Faso. BMC Public Health 2023; 23:1902. [PMID: 37784102 PMCID: PMC10544612 DOI: 10.1186/s12889-023-16729-x] [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: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Scale-up and sustainability are often studied separately, with few studies examining the interdependencies between these two processes and the implementation contexts of innovations towards malaria prevention and control. Researchers and implementers offer much more attention to the content of innovations, as they focus on the technological dimensions and the conditions for expansion. Researchers have often considered innovation a linear sequence in which scaling up and sustainability represented the last stages. Using systems thinking in this manuscript, we analyze complex scaling and sustainability processes through adopting and implementing seasonal malaria chemoprevention (SMC) in Burkina Faso from 2014 to 2018. METHODS We conducted a qualitative case study involving 141 retrospective secondary data (administrative, press, scientific, tools and registries, and verbatim) spanning from 2012 to 2018. We complemented these data with primary data collected between February and March 2018 in the form of 15 personal semi-structured interviews with SMC stakeholders and non-participant observations. Processual analysis permitted us to conceptualize scale-up and sustainability processes over time according to different vertical and horizontal levels of analysis and their interconnections. RESULTS Our results indicated six internal and external determinants of SMC that may negatively or positively influence its scale-up and sustainability. These determinants are effectiveness, monitoring and evaluation systems, resources (financial, material, and human), leadership and governance, adaptation to the local context, and other external elements. Our results revealed that donors and implementing actors prioritized financial resources over other determinants. In contrast, our study clearly showed that the sustainability of the innovation, as well as its scaling up, depends significantly on the consideration of the interconnectedness of the determinants. Each determinant can concurrently constitute an opportunity and a challenge for the success of the innovation. CONCLUSION Our findings highlight the usefulness of the systemic perspective to consider all contexts (international, national, subnational, and local) to achieve large-scale improvements in the quality, equity, and effectiveness of global health interventions. Thus, complex and systems thinking have made it possible to observe emergent and dynamic innovation behaviors and the dynamics particular to sustainability and scaling up processes.
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Affiliation(s)
- Marietou Niang
- Department of Psychosociology and Social Work, Université Québec À Rimouski (UQAR), Campus de Lévis, Québec, Canada.
| | | | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, Québec, QC, Canada
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Lemma S, Daniels-Howell C, Tufa AA, Sarker M, Akter K, Nakidde C, Seruwagi G, Dube A, Mwandira K, Taye DB, English M, Shawar YR, Mwaba K, Djellouli N, Colbourn T, Marchant T. Opportunities to sustain a multi-country quality of care network: Lessons on the actions of four countries Bangladesh, Ethiopia, Malawi, and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001672. [PMID: 37698985 PMCID: PMC10497147 DOI: 10.1371/journal.pgph.0001672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
The Quality of Care Network (QCN) is a global initiative that was established in 2017 under the leadership of WHO in 11 low-and- middle income countries to improve maternal, newborn, and child health. The vision was that the Quality of Care Network would be embedded within member countries and continued beyond the initial implementation period: that the Network would be sustained. This paper investigated the experience of actions taken to sustain QCN in four Network countries (Bangladesh, Ethiopia, Malawi, and Uganda) and reports on lessons learned. Multiple iterative rounds of data collection were conducted through qualitative interviews with global and national stakeholders, and non-participatory observation of health facilities and meetings. A total of 241 interviews, 42 facility and four meeting observations were carried out. We conducted a thematic analysis of all data using a framework approach that defined six critical actions that can be taken to promote sustainability. The analysis revealed that these critical actions were present with varying degrees in each of the four countries. Although vulnerabilities were observed, there was good evidence to support that actions were taken to institutionalize the innovation within the health system, to motivate micro-level actors, plan opportunities for reflection and adaptation from the outset, and to support strong government ownership. Two actions were largely absent and weakened confidence in future sustainability: managing financial uncertainties and fostering community ownership. Evidence from four countries suggested that the QCN model would not be sustained in its original format, largely because of financial vulnerability and insufficient time to embed the innovation at the sub-national level. But especially the efforts made to institutionalize the innovation in existing systems meant that some characteristics of QCN may be carried forward within broader government quality improvement initiatives.
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Affiliation(s)
- Seblewengel Lemma
- Department of Disease Control, London School of Hygiene & Tropical Medicine, based in Ethiopia, Addis Ababa, Ethiopia
| | | | - Asebe Amenu Tufa
- Health System Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mithun Sarker
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Albert Dube
- Parent and Child Health Initiative PACHI, Lilongwe, Malawi
| | | | | | | | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health and Paul H. Nitze School of Advanced International Studies, John Hopkins University, Baltimore, Maryland, United States of America
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, based in Ethiopia, Addis Ababa, Ethiopia
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Abrahams N, Khodabakhsh S, Toumpakari Z, Marais F, Lambert EV, Foster C. Using social networks to scale up and sustain community-based programmes to improve physical activity and diet in low-income and middle-income countries: a scoping review. Int J Behav Nutr Phys Act 2023; 20:8. [PMID: 36707866 PMCID: PMC9883854 DOI: 10.1186/s12966-023-01412-6] [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: 03/24/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Community-based programmes [CBPs], targeting increased physical activity and/or healthier eating, have been used in the prevention and management of non-communicable diseases. However, CBPs are only useful, insofar as they can be scaled up and sustained in some meaningful way. Social networks-defined as "social structures that exists between actors, individuals or organizations"-may serve as an important tool to identify underlying mechanisms that contribute to this process. This scoping review aimed to map and collate literature on the role of social network research in scaling-up and sustaining physical activity and/or diet CBPs in low-and middle-income countries [LMICs]. METHODS Arksey and O'Malley's framework and its enhancement were followed. Inclusion criteria were peer-reviewed articles exploring the role of social networks in scaled-up and/or sustained physical activity and/or diet CBPs in adult populations, published in English since 2000, and based in a LMIC. Databases searched were PubMed, Cochrane, Scopus, Web of Science, CINAHL, SocIndex, International Bibliography of the Social Sciences, and Google Scholar. Books, conference abstracts, and programmes focused on children were excluded. Two reviewers independently selected and extracted eligible studies. Included publications were thematically analysed using the Framework Approach. RESULTS Authors identified 12 articles for inclusion, covering 13 CBPs. Most were based in Latin America, with others in the Caribbean, the Pacific Islands, Iran, and India. All articles were published since 2009. Only three used social network analysis methods (with others using qualitative methods). Five main social network themes were identified: centralisation, cliques, leaders, quality over quantity, and shared goals. Contextual factors to be considered when scaling-up programmes in LMICs were also identified. CONCLUSIONS This review has shown that the evidence of the use of social network research in programme scale-up has not yet caught up to its theoretical possibilities. Programmes aiming to scale should consider conducting social network research with identified network themes in mind to help improve the evidence-base of what network mechanisms, in what contexts, might best support the strengthening of networks in physical activity and diet programmes. Importantly, the voice of individuals and communities in these networks should not be forgotten.
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Affiliation(s)
- Nina Abrahams
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK ,grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sahar Khodabakhsh
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
| | - Zoi Toumpakari
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
| | - Frederick Marais
- grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa ,grid.451392.80000 0000 8557 0256Healthy Lifestyle Services, Public Health, Somerset County Council, Taunton, UK ,grid.25881.360000 0000 9769 2525Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Estelle V. Lambert
- grid.7836.a0000 0004 1937 1151Health Through Physical Activity Lifestyle and Sport Research Centre, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charlie Foster
- grid.5337.20000 0004 1936 7603Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK
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Knittel B, Coile A, Zou A, Saxena S, Brenzel L, Orobaton N, Bartel D, Williams CA, Kambarami R, Tiwari DP, Husain I, Sikipa G, Achan J, Ajiwohwodoma JO, Banerjee B, Kasungami D. Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance. Gates Open Res 2023; 6:116. [PMID: 36415884 PMCID: PMC9646484 DOI: 10.12688/gatesopenres.13632.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
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Affiliation(s)
- Barbara Knittel
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Amanda Coile
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, CA, 94028, USA
| | - Sweta Saxena
- United States Agency for International Development, Washington, DC, 20523, USA
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Doris Bartel
- Independent Researcher, Washington, District of Columbia, USA
| | | | | | | | - Ishrat Husain
- United States Agency for International Development, Washington, DC, 20523, USA
| | | | | | | | | | - Dyness Kasungami
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
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Knittel B, Coile A, Zou A, Saxena S, Brenzel L, Orobaton N, Bartel D, Williams CA, Kambarami R, Tiwari DP, Husain I, Sikipa G, Achan J, Ajiwohwodoma JO, Banerjee B, Kasungami D. Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance. Gates Open Res 2022; 6:116. [PMID: 36415884 PMCID: PMC9646484 DOI: 10.12688/gatesopenres.13632.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Development assistance for health (DAH) is an important mechanism for funding and technical support to low-income countries. Despite increased DAH spending, intractable health challenges remain. Recent decades have seen numerous efforts to reform DAH models, yet pernicious challenges persist amidst structural complexities and a growing number of actors. Systems-based approaches are promising for understanding these types of complex adaptive systems. This paper presents a systems-based understanding of DAH, including barriers to achieving sustainable and effective country-driven models for technical assistance and capacity strengthening to achieve better outcomes Methods: We applied an innovative systems-based approach to explore and map how donor structures, processes, and norms pose challenges to improving development assistance models. The system mapping was carried out through an iterative co-creation process including a series of discussions and workshops with diverse stakeholders across 13 countries. Results: Nine systemic challenges emerged: 1) reliance on external implementing partners undermines national capacity; 2) prioritizing global initiatives undercuts local programming; 3) inadequate contextualization hampers program sustainability; 4) decision-maker blind spots inhibit capacity to address inequities; 5) power asymmetries undermine local decision making; 6) donor funding structures pose limitations downstream; 7) program fragmentation impedes long-term country planning; 8) reliance on incomplete data perpetuates inequities; and 9) overemphasis on donor-prioritized data perpetuates fragmentation. Conclusions: These interconnected challenges illustrate interdependencies and feedback loops manifesting throughout the system. A particular driving force across these system barriers is the influence of power asymmetries between actors. The articulation of these challenges can help stakeholders overcome biases about the efficacy of the system and their role in perpetuating the issues. These findings indicate that change is needed not only in how we design and implement global health programs, but in how system actors interact. This requires co-creating solutions that shift the structures, norms, and mindsets governing DAH models.
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Affiliation(s)
- Barbara Knittel
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Amanda Coile
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, CA, 94028, USA
| | - Sweta Saxena
- United States Agency for International Development, Washington, DC, 20523, USA
| | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA
| | - Doris Bartel
- Independent Researcher, Washington, District of Columbia, USA
| | | | | | | | - Ishrat Husain
- United States Agency for International Development, Washington, DC, 20523, USA
| | | | | | | | | | - Dyness Kasungami
- JSI Research & Training Institute, Inc., Arlington, VA, 22202, USA
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Jerwanska V, Kebbie I, Magnusson L. Coordination of health and rehabilitation services for person with disabilities in Sierra Leone – a stakeholders’ perspective. Disabil Rehabil 2022; 45:1796-1804. [DOI: 10.1080/09638288.2022.2074551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Victoria Jerwanska
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ismaila Kebbie
- National Rehabilitation Centre, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Lina Magnusson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Improving timeliness in the neglected tropical diseases preventive chemotherapy donation supply chain through information sharing: A retrospective empirical analysis. PLoS Negl Trop Dis 2021; 15:e0009523. [PMID: 34843476 PMCID: PMC8659369 DOI: 10.1371/journal.pntd.0009523] [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: 05/29/2021] [Revised: 12/09/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Billions of doses of medicines are donated for mass drug administrations in support of the World Health Organization's "Roadmap to Implementation," which aims to control, eliminate, and eradicate Neglected Tropical Diseases (NTDs). The supply chain to deliver these medicines is complex, with fragmented data systems and limited visibility on performance. This study empirically evaluates the impact of an online supply chain performance measurement system, "NTDeliver," providing understanding of the value of information sharing towards the success of global health programs. METHODS Retrospective secondary data were extracted from NTDeliver, which included 1,484 shipments for four critical medicines ordered by over 100 countries between February 28, 2006 and December 31, 2018. We applied statistical regression models to analyze the impact on key performance metrics, comparing data before and after the system was implemented. FINDINGS The results suggest information sharing has a positive association with improvement for two key performance indicators: purchase order timeliness (β = 0.941, p = 0.003) and-most importantly-delivery timeliness (β = 0.828, p = 0.027). There is a positive association with improvement for three variables when the data are publicly shared: shipment timeliness (β = 2.57, p = 0.001), arrival timeliness (β = 2.88, p = 0.003), and delivery timeliness (β = 2.82, p = 0.011). CONCLUSIONS Our findings suggest that information sharing between the NTD program partners via the NTDeliver system has a positive association with supply chain performance improvements, especially when data are shared publicly. Given the large volume of medicine and the significant number of people requiring these medicines, information sharing has the potential to provide improvements to global health programs affecting the health of tens to hundreds of millions of people.
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Wickremasinghe D, Alkali Hamza Y, Umar N, Willey B, Okolo M, Gana A, Shuaibu A, Anyanti J, Marchant T, Spicer N. 'A seamless transition': how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria. Health Policy Plan 2021; 36:1067-1076. [PMID: 34131728 PMCID: PMC8359746 DOI: 10.1093/heapol/czab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme's sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents' accounts, six key actions emerged as essential in promoting the VHW Scheme's sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial.
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Affiliation(s)
| | - Yashua Alkali Hamza
- Childcare and Wellness Clinics, 26 Anthony Enahoro Street, Utako, Abuja, Nigeria
| | - Nasir Umar
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Barbara Willey
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Magdalene Okolo
- Formerly with Society for Family Health, Justice Ifeyinwa Nzeako House, #8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Ahmed Gana
- Gombe State Government, Dukku Road, Gombe, Nigeria
| | - Abdulrahman Shuaibu
- Gombe State Primary Health Care Development Agency, Jeka Da Fari, near Government science secondary school, 760212 Gombe, Nigeria
| | - Jennifer Anyanti
- Society for Family Health, Justice Ifeyinwa Nzeako House, #8 Port Harcourt Crescent, Area 11, Garki, Abuja, Nigeria
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Neil Spicer
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Finnegan A, Biru B, Taylor A, Rajan S, Udayakumar K, Baumgartner JN. Improving global maternal and newborn survival via innovation: Stakeholder perspectives on the Saving Lives at Birth Grand Challenge. PLoS One 2021; 16:e0254589. [PMID: 34260640 PMCID: PMC8279342 DOI: 10.1371/journal.pone.0254589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
The Saving Lives at Birth (SL@B) funding partners joined in 2011 to source, support, and scale maternal and newborn health (MNH) innovations to improve maternal and newborn survival by focusing on the 24 hours around the time of birth. A multi-methods, retrospective portfolio evaluation was conducted to determine SL@B's impact. Forty semi-structured, key informant interviews (KIIs) were conducted with experts in global MNH based in low- and middle-income and in high-income countries to assess the SL@B program. KIIs were conducted with global MNH technical experts, innovators, government officials in low- and middle-income countries, donors, private investors, and implementing partners to include the full spectrum of voices involved in identifying and scaling innovations. Data were analyzed using thematic analysis. Stakeholders believe the SL@B program has been successful in changing the way maternal and newborn health programs are delivered with a focus on doing things differently through innovation. The open approach to sourcing innovation was seen as positive to the extent that it brought more interdisciplinary stakeholders to think about the problem of maternal and newborn survival. However, a demand-driven approach that aims to source innovations that address MNH priority needs and takes into account the needs of end users (e.g. individuals and governments) was suggested as a strategy for ensuring that more innovations go to scale.
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Affiliation(s)
- Amy Finnegan
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blen Biru
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Andrea Taylor
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Sowmya Rajan
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Joy Noel Baumgartner
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Chiliza J, Laing R, Feeley FG, Borba CPC. Program sustainability post PEPFAR direct service support in the Western Cape, South Africa. PLoS One 2021; 16:e0251230. [PMID: 34029323 PMCID: PMC8189145 DOI: 10.1371/journal.pone.0251230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/22/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Public health practitioners have little guidance around how to plan for the sustainability of donor sponsored programs after the donor withdraws. The literature is broad and provides no consensus on a definition of sustainability. This study used a mixed-methods methodology to assess program sustainability factors to inform donor-funded programs. METHODS This study examined 61 health facilities in the Western Cape, South Africa, supported by four PEPFAR-funded non-governmental organizations from 2007 to 2012. Retention in care (RIC) was used to determine health facility performance. Sustainability was measured by comparing RIC during PEPFAR direct service (20072012), to RIC in the post PEPFAR period (2013 to 2015). Forty-three semi-structured in-depth interviews were conducted with key informants. The qualitative data were used to examine how predictor variables were operationalized at a health facility and NGO level. RESULTS Our qualitative results suggest the following lessons for the sustainability of future programs: Sufficient and stable resources (i.e., financial, human resources, technical expertise, equipment, physical space)Investment in organizations that understand the local context and have strong relationships with local government.Strong leadership at a health facility levelJoint planning/coordination and formalized skill transferLocal positive perceived value of the programPartnerships. CONCLUSION Sustainability is complex, context dependent, and is reliant on various processes and outcomes. This study suggests additional health facility and community level staff should be employed in the health system to ensure RIC sustainability. Sustainability requires joint donor coordination with experienced local organizations with strong managers before during and after program implementation. If the program is as large as the South African HIV effort some dedicated additional resources in the long term would be required.
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Affiliation(s)
- Jessica Chiliza
- Department of Global Health, School of Public Health, Boston University,
Boston, Massachusetts, United States of America
| | - Richard Laing
- Department of Global Health, School of Public Health, Boston University,
Boston, Massachusetts, United States of America
- School of Public Health, University of Western Cape, Bellville, South
Africa
| | - Frank Goodrich Feeley
- Department of Global Health, School of Public Health, Boston University,
Boston, Massachusetts, United States of America
| | - Christina P. C. Borba
- Department of Psychiatry, Boston University School of Medicine, Boston
Medical Center, Boston, Massachusetts, United States of
America
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Bulthuis SE, Kok MC, Raven J, Dieleman MA. Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review. Health Policy Plan 2020; 35:219-234. [PMID: 31722382 PMCID: PMC7050685 DOI: 10.1093/heapol/czz140] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with a qualitative research component. The GRADE-CERQual approach was applied to assess the confidence in the evidence for each key review finding. A multi-level perspective on transition was applied to ensure a focus on vertical scale-up for sustainability. According to this theory, changes in the way of organizing (structure), doing (practice) and thinking (culture) need to take place to ensure the scale-up of an intervention. Among the most prominent factors influencing scale-up through changes in structure was the availability of financial, human and material resources. Inadequate supply chains were often barriers to scale-up. Advocacy activities positively influenced scale-up, and changes in the policy environment hindered or facilitated scale-up. The most outstanding factors influencing scale-up through changes in practice were the availability of a strategic plan for scale-up and the way in which training and supervision was conducted. Furthermore, collaborations such as community participation and partnerships facilitated scale-up, as well as the availability of research and monitoring and evaluation data. Factors influencing scale-up through a change in culture were less prominent in the literature. While some studies articulated the acceptability of the intervention in a given sociocultural environment, more emphasis was placed on the importance of stakeholders feeling a need for a specific intervention to facilitate its scale-up. All identified factors should be taken into account when scaling up public health interventions in LMICs. The different factors are strongly interlinked, and most of them are related to one crucial first step: the development of a scale-up strategy before scaling up.
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Affiliation(s)
- Susan E Bulthuis
- KIT Health, KIT Royal Tropical Institute, PO Box 95001, Amsterdam 1090 HA, The Netherlands
| | - Maryse C Kok
- KIT Health, KIT Royal Tropical Institute, PO Box 95001, Amsterdam 1090 HA, The Netherlands
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Marjolein A Dieleman
- KIT Health, KIT Royal Tropical Institute, PO Box 95001, Amsterdam 1090 HA, The Netherlands.,Athena Institute, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Bowser DM, Jha R, Bhawalkar M, Berman P. The Challenge of Additionality: The Impact of Central Grants for Primary Healthcare on State-Level Spending on Primary Healthcare in India. Int J Health Policy Manag 2019; 8:329-336. [PMID: 31256565 PMCID: PMC6600018 DOI: 10.15171/ijhpm.2019.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/02/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via "additionalities." The concept of "additionality," when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of "additionality" can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of primary healthcare expenditures. This paper explores this idea by examining the impact of central level primary healthcare expenditure, on individual state level contributions to primary healthcare expenditure within 16 Indian states between 2005 and 2013. METHODS In examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level primary healthcare expenditure distributions to these states, we measured its impact on each state's own contributions to primary healthcare spending. RESULTS Our results show that, at the state level, growth in per capita central level primary healthcare expenditure has increased by 110% from 2005-2013, while state's own contributions to primary healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a -0.132%, although not significant, change by states in their own expenditure. The effect for wealthier states is -0.151% and significant and for poorer states the effect is smaller at -0.096% and not significant. CONCLUSION This analysis suggests that increases in central level primary healthcare expenditure to states have an inverse relationship with primary healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India's decision to increase block grants to states in place of targeted program expenditures.
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Affiliation(s)
- Diana M Bowser
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Manjiri Bhawalkar
- Health Financing Team, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Peter Berman
- Department of Global Health and Population, International Health Systems Program, Harvard School of Public Health, Boston, MA, USA
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Ogbuoji O, Yamey G. Aid Effectiveness in the Sustainable Development Goals Era Comment on ""It's About the Idea Hitting the Bull's Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations". Int J Health Policy Manag 2019; 8:184-186. [PMID: 30980636 PMCID: PMC6462193 DOI: 10.15171/ijhpm.2018.130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/16/2018] [Indexed: 11/14/2022] Open
Abstract
Over just a six-year period from 2005-2011, five aid effectiveness initiatives were launched: the Paris Declaration on Aid Effectiveness (2005), the International Health Partnership plus (2007), the Accra Agenda for Action (2008), the Busan Partnership for Effective Cooperation (2011), and the Global Partnership for Effective Development Cooperation (GPEDC) (2011). More recently, in 2015, the Addis Ababa Action Agenda (AAAA) was signed at the third international conference on financing for development and the Universal Health Coverage (UHC) 2030 Global Compact was signed in 2017. Both documents espouse principles of aid effectiveness and would most likely guide financing decisions in the Sustainable Development Goals (SDG) era. This is therefore a good moment to assess whether the aid effectiveness agenda made a difference in development and its relevance in the SDG era.
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Affiliation(s)
- Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, USA
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, USA
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Beracochea E. Effective Aid for Hitting the Bull's Eye Comment on "It's About the Idea Hitting the Bull's Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations". Int J Health Policy Manag 2018; 7:1155-1157. [PMID: 30709093 PMCID: PMC6358664 DOI: 10.15171/ijhpm.2018.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/09/2018] [Indexed: 11/20/2022] Open
Abstract
This article studies how six key aid effectiveness principles for "Hitting the bull’s eye" can bring about the scale up of maternal and newborn health (MNH) interventions. These key principles are based on accepted international agreements such as the Paris Declaration on Aid Effectiveness. The results indicate that the six principles should be a guide for recipient countries to take ownership of the development process and work with donors to plan effective coordination structures. Countries that take ownership will be able to work with donors and implementers to not only test new interventions that address pressing challenges to deliver quality MNH care but also include the successful knowledge transfer and handover of these interventions, the effective integration of the new intervention as part of the country’s health system and a costed scale-up plan. The article could have been strengthened with clear and actionable recommendations for the three countries to improve their ownership of donor-funded assistance, but it showed that there is need to change how aid is delivered and that embracing and applying these principles will help countries take ownership of MNH programs and lead the dialog and effective scale up with those involved. The authors should be commended on taking the lead in the field of aid effectiveness, and encouraged to conduct quantitative and further qualitative measurements of the application of their findings in the three counties included in the study.
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Martinez-Alvarez M. Ownership in Name, But not Necessarily in Action Comment on "It's About the Idea Hitting the Bull's Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations". Int J Health Policy Manag 2018; 7:1053-1055. [PMID: 30624878 PMCID: PMC6326639 DOI: 10.15171/ijhpm.2018.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022] Open
Abstract
A recently-published paper by Wickremasinghe et al assesses the scalability of pilot projects in three countries
using the aid effectiveness agenda as an analytical framework. The authors report uneven progress and
recommend applying aid effectiveness principles to improve the scalability of projects. This commentary
focuses on one key principle of aid effectiveness – country ownership; it describes difficulties in defining and
achieving it, and provides practical steps donors and recipient governments can take to move forward towards
country ownership.
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