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Alasfar S, Alashavi H, Nasan KH, Haj Mousa AA, Polinori C, Luyckx V, Sekkarie M, Kaysi S, Murad L, Burnham GM. Providing Hemodialysis in Unstable Areas: An Assessment and Framework for Effective Care. Kidney Int Rep 2024; 9:580-588. [PMID: 38481490 PMCID: PMC10927480 DOI: 10.1016/j.ekir.2023.12.006] [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] [Received: 06/12/2023] [Revised: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 04/21/2024] Open
Abstract
Introduction Providing hemodialysis to patients with kidney failure (KF) in conflict-affected areas poses a significant challenge. Achieving and sustaining reasonable quality hemodialysis operations in such regions necessitates a comprehensive approach. Methods In the conflict area of Northwest (NW) Syria, a 3-phase project was initiated to address the quality of hemodialysis operations. The assessment phase involved the examination of infection prevention and control (IPC) protocols, staff training, medical protocols, individualized hemodialysis prescriptions, and laboratory testing capabilities. The second phase involved activities toward capacity building and implementing an action plan based on feasibility and sustainability. Results The assessment phase revealed that only 7 of 14 centers had IPC protocols, and 8 centers provided IPC training for their staff. Furthermore, only 7 centers had medical protocols, and 5 used individualized hemodialysis prescriptions. Difficulties in testing for potassium was reported in 7 centers and the inability to perform hepatitis B and C serologies was reported in 3 centers. Only 2 centers adhered to machine and water treatment system maintenance guidelines, and 4 conducted daily water quality checks. Recommendations were formulated, and an action plan was developed for implementation in the second phase. The plan encompassed enhancements in IPC practices, medical protocols, record-keeping, laboratory testing, and equipment maintenance. Conclusion This project underscores that hemodialysis services in conflict-affected areas do not meet the standards for quality care. It emphasizes the necessity of implementing a comprehensive framework that engages relevant stakeholders in defining and upholding quality care, a model that should be extended to other protracted conflict-affected regions.
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Affiliation(s)
- Sami Alasfar
- Department of Medicine, Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Hani Alashavi
- The World Health Organization office in Gaziantep, Gaziantep, Türkiye
| | - Khaled Hajj Nasan
- Department of Medicine, Dr. Muhammad Waseem Maaz Hospital, Azaz, Northwest Syria, Syria
| | | | - Camila Polinori
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Mohamed Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, Brugmann University Hospital, Brussels, Belgium
| | - Lina Murad
- Syrian National Kidney Foundation, Washington, District of Columbia, USA
- Metropolitan Access Center, Colmar Manor, Maryland, USA
| | - Gilbert M. Burnham
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
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2
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Alasfar S, Alashavi H, Nasan KH, Haj Mousa AA, Alkhatib I, Kazancioglu R, Sekkarie M, Kaysi S, Daher M, Murad L, Burnham GM. Improving and maintaining quality of hemodialysis in areas affected by war: a call to action! Kidney Int 2023; 103:817-820. [PMID: 37085252 DOI: 10.1016/j.kint.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/13/2023] [Accepted: 02/14/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Sami Alasfar
- Department of Medicine, Division of Nephrology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Hani Alashavi
- Gaziantep Health Cluster, The World Health Organization, Gaziantep, Turkey
| | | | | | | | - Rumeyza Kazancioglu
- Department of Medicine, Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mohamad Sekkarie
- Nephrology and Hypertension Associates, Bluefield, West Virginia, USA
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, Brugmann University Hospital, Brussels, Belgium
| | - Mahmoud Daher
- Gaziantep Health Cluster, The World Health Organization, Gaziantep, Turkey
| | - Lina Murad
- Syrian National Kidney Foundation, Washington, DC, USA
| | - Gilbert M Burnham
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
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3
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Landon TJ, Hill JC, Froehlich R, Shlemon P. Embracing the Future: Updating and Revising the Code of Professional Ethics for Rehabilitation Counselors. REHABILITATION COUNSELING BULLETIN 2023. [DOI: 10.1177/00343552221146166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Commission on Rehabilitation Counselor Certification (CRCC) certifies qualified candidates as certified rehabilitation counselors in the United States (CRCs) and as Canadian certified rehabilitation counselors (CCRCs) in Canada. Those professionals who are certified as CRCs/CCRCs are expected to adhere to the CRCC Code of Professional Ethics. The CRCC Code of Ethics is updated from time to time. With the completion of the recent revision process, a revised Code of Professional Ethics for CRCs/CCRCs is now being distributed and implemented by the CRCC. Given the changes and updates to the Code of Professional Ethics, this article and subsequent articles in this special issue help to outline the process and rationale that framed the recent revision process. Although some specific changes are highlighted through this special issue, practitioners are encouraged to familiarize themselves with the entire code.
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Affiliation(s)
| | | | | | - Pamela Shlemon
- Commission on Rehabilitation Counselor Certification, Schaumburg, IL, USA
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4
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Sikazwe I, Bolton-Moore C, Herce MB. Nongovernmental organizations supporting the HIV service delivery response in Africa - an engine for innovation. Curr Opin HIV AIDS 2023; 18:52-56. [PMID: 36503879 DOI: 10.1097/coh.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Nongovernmental organizations (NGOs) are pivotal to the HIV response, supporting access to HIV services since the start of the epidemic. Against the backdrop of the impact of NGOs, is the recognition of the unique role that local NGOs bring to the HIV response, drawing from their deep understanding of the context and knowledge of local health problems. RECENT FINDINGS The Centre for Infectious Disease Research in Zambia (CIDRZ) is one such NGO. Through various implementation science research and programs, CIDRZ has supported the Zambian government's HIV response. As Zambia moves closer to epidemic control, understanding reasons for patient disengagement from care and patient preferences for HIV care demonstrated by CIDRZ have contributed to global and national HIV treatment and care guidelines. SUMMARY This paper offers a case study for how NGOs like CIDRZ can serve as health system-wide catalyst to identify, integrate, and scale up evidence-based practices for HIV prevention, care, and treatment. It draws from the public health literature, CIDRZ extensive program and research experience and implementation science theory, to illustrate key strategies that can be deployed by local NGOs to spark innovation, quality improvement, and support governments to achieve and sustain HIV epidemic control.
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Affiliation(s)
- Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Michael B Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
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5
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Rudasingwa M, Jahn A, Uwitonze AM, Hennig L. Increasing health system synergies in low-income settings: Lessons learned from a qualitative case study of Rwanda. Glob Public Health 2022; 17:3303-3321. [PMID: 36194788 DOI: 10.1080/17441692.2022.2129726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Building synergies is seen as an effective strategy to address and decrease existing fragmentation in health systems of low-and middle-income countries (LMICs). To that end, different programmes, such as the Sector Wide Approach, have been adopted to increase health system synergies. Despite these efforts, fragmentation remains an enduring problem, hampering health system performance in LMICs. This study is part of the Lancet Commission on synergies between Universal Health Coverage, Health Security, and Health Promotion; we aimed to document synergising strategies adopted by Rwanda. Data for this paper came from a qualitative study including in-depth interviews of 15 key informants and a document review. A thematic analysis embracing deductive and inductive approaches was used to analyse the data. We found that Rwanda adopted three main strategies to increase health system synergies: (1) alignment of health programmes with national health policies and strategies, (2) increased coordination across national health institutions, and (3) effective monitoring and evaluation frameworks. Achieving synergies in a low-resource country is challenging but not impossible. To meet the target of global health agendas such as the Sustainable Development Goals and the prevention of future global pandemics, efforts to increase health system synergies in LMICs need to be strengthened.
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Affiliation(s)
- Martin Rudasingwa
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Anne-Marie Uwitonze
- College of Medicine and Health Sciences, University of Rwanda, Kigali City, Rwanda
| | - Lisa Hennig
- Heidelberg Institute of Global Health, Ruprecht-Karls-University, Heidelberg, Germany
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6
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Sanadgol A, Doshmangir L, Majdzadeh R, Gordeev VS. Strategies to strengthen non-governmental organizations' participation in the Iranian health system. Front Public Health 2022; 10:929614. [PMID: 36518578 PMCID: PMC9742430 DOI: 10.3389/fpubh.2022.929614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals. Method We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study. Result Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency. Conclusion The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest.
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Affiliation(s)
- Arman Sanadgol
- Student Research Committee, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Health Policy and Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Majdzadeh
- Interdisciplinary Research and Practice Division, School of Health and Social Care University of Essex, Colchester, United Kingdom
| | - Vladimir Sergeevich Gordeev
- Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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7
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Elkhodary HM, Sabbagh HJ, El Meligy OAES, Talaat IM, Abdellatif EB, Mostafa MH, Khader Y, Al-Batayneh OB, Alhabli S, Al-Khanati NM, Qureshi S, Qureshi N, Yousaf MA, Marafi YF, Al Harrasi SN, Al-Rai S, Gomaa N, Mattar H, Bakhaider HA, Samodien B, Lố H, El Tantawi M. Children’s access to dental care during the COVID-19 pandemic: a multi-country survey. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2114478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Heba Mohamed Elkhodary
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Heba Jafar Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar Abd El Sadek El Meligy
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Iman Mamdouh Talaat
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Enas B. Abdellatif
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Hassan Mostafa
- Department of Pedodontics and Oral Health, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Jordan
| | - Ola B. Al-Batayneh
- Preventive Dentistry Department, Faculty of Dentistry, Jordan University of Science and Technology, Jordan
| | - Sara Alhabli
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Shabnum Qureshi
- Department of Education, University of Kashmir, Srinagar, India
| | - Nafeesa Qureshi
- General Dental services NHS Tayside, NHS Tayside Scotland, DD2 2RZ, Dundee, United Kingdom
| | - Muhammad Abrar Yousaf
- Department of Biology, Faculty of Science and Technology, Virtual University of Pakistan, Lahore, Pakistan
| | | | | | - Sarah Al-Rai
- Department of Conservative and Preventive Dentistry, Faculty of Dentistry, Saba University, Yemen
| | - Noha Gomaa
- Oral Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Oral Medicine, Children’s Health Research Institute, London, ON, Canada
| | - Hala Mattar
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hanin A. Bakhaider
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bahia Samodien
- Western Cape Education Department, Cape Town, South Africa
| | - Hanane Lố
- Department of Pediatric Dentistry, Clinique Dentaire D’Agadir, Morocco
| | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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8
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Role of Public-Private Partnerships in Primary Healthcare Services Worldwide: A Scoping Review. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-129176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The public health system is currently facing a shortage of resources, and the demand for healthcare has increased, indicating the need to use the capacities of other sectors through public-private partnership (PPP) strategies to improve the quantity and quality of health services. Objectives: The purpose is to identify PPPs' role in providing primary healthcare worldwide. Methods: This study was conducted in 2020. The Arksey O’Malley framework was used, along with a systematic literature search on five databases, including Web of Science (ISI), Scopus, Pubmed, ProQuest, and Google Scholar. Data were gathered from 2000 to 2020. Results: The findings presented in this study are reported based on 16 selected studies. The findings point to the positive impacts of cooperation between the public and private sectors in health care systems on matters of provision, coverage, and performance of services, as well as improvements in responsiveness to providers towards enhancing health referral systems. The provision of participatory services in countries varied according to their level of development, and further interactions between the government and the private sector resulted in better coverage and reduced inequality in service delivery. Conclusions: Public-private partnership is an effective way to achieve sustainable development goals. Public-private partnerships can be strengthened by integrating public and private sector facilities and aligning the interests and motivations of service providers with public health goals. Also, awareness of the plans and capacity of public and private sectors, along with conscious and mutual interaction, can strengthen health on a larger scale. Scientific approaches and correct participation can also relieve the part of governmental responsibilities to focus on more primary measures so that it can carry out its core tasks, including stewardship, policy-making, and supervision, with greater focus and power to facilitate the achievement of goals.
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9
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Leroi I, Karanja W, Adrion ER, Alladi S, Custodio N, Goswami SP, Guerchet M, Gubner J, Ibanez A, Ilinica S, Jafri H, Lawlor B, Mohamed AA, Ogunniyi A, Robertson I, Robinson L, Spector A, Varghese M, Weidner W, Caramelli P. Equity and balance in applied dementia research: A charter of conduct and checklist for global collaborations. Int J Geriatr Psychiatry 2022; 37. [PMID: 35703570 DOI: 10.1002/gps.5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Wambui Karanja
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily R Adrion
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,School of Social and Political Science at the University of Edinburgh, Edinburgh, Scotland
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
| | - S P Goswami
- All India Institute of Speech & Hearing, Mysuru, India
| | - Maëlenn Guerchet
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Jennie Gubner
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Agustin Ibanez
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Santiago, Chile.,Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Buenos Aires, Argentina
| | - Stefania Ilinica
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Hussain Jafri
- Fatima Jinnah Medical University Lahore, Lahore, Pakistan
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Aya Ashour Mohamed
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Adesola Ogunniyi
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Ian Robertson
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Louise Robinson
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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10
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Bwirire D, Crutzen R, Ntabe Namegabe E, Letschert R, de Vries N. Health inequalities in post-conflict settings: A systematic review. PLoS One 2022; 17:e0265038. [PMID: 35286351 PMCID: PMC8920275 DOI: 10.1371/journal.pone.0265038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
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Affiliation(s)
- Dieudonne Bwirire
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Edmond Ntabe Namegabe
- Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo
| | | | - Nanne de Vries
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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11
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Kram NAZ, Yesufu V, Lott B, Palmer KNB, Balogun M, Ehiri J. 'Making the most of our situation': a qualitative study reporting health providers' perspectives on the challenges of implementing the prevention of mother-to-child transmission of HIV services in Lagos, Nigeria. BMJ Open 2021; 11:e046263. [PMID: 34716154 PMCID: PMC8559101 DOI: 10.1136/bmjopen-2020-046263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the challenges of, and opportunities for, effective delivery of prevention of mother-to-child transmission (PMTCT) services from the perspectives of primary healthcare providers in Lagos, Nigeria. DESIGN This qualitative study consisted of nine focus groups with 59 health providers, analysed thematically. SETTING Thirty-eight primary health facilities in central and western districts of Lagos, Nigeria. PARTICIPANTS Participants included nurses, nursing assistants, community health workers, laboratory workers, pharmacists, pharmacy technicians, monitoring and evaluation staff and medical records personnel. RESULTS Health providers' challenges included frustration with the healthcare system where unmet training needs, lack of basic amenities for effective and safe treatment practices, low wages and inefficient workflow were discussed. Providers discussed patient-level challenges, which included the practice of giving fake contact information for fear of HIV-related stigmatisation, and refusal to accept HIV-positive results and to enrol in care. Providers' suggestions for addressing PMTCT service delivery challenges included the provision of adequate supplies and training of healthcare workers. To mitigate stigmatisation, participants suggested home-based care, working with traditional birth attendants and religious institutions and designating a HIV health educator for each neighbourhood. CONCLUSIONS Findings illustrate the complex nature of PMTCT service delivery and illuminate issues at the patient and health system levels. These results may be used to inform strategies for addressing identified barriers and to improve the provision of PMTCT services, thus ensuring better outcomes for women and families.
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Affiliation(s)
- Nidal A-Z Kram
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Victoria Yesufu
- Department of Community Health and Primary Care, University of Lagos, Mushin, Lagos, Nigeria
| | - Breanne Lott
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Kelly N B Palmer
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, University of Lagos, Mushin, Lagos, Nigeria
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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12
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O'Donovan J, Saul Namanda A, Hamala R. Exploring supervision for volunteer community health workers in Mukono District, Uganda: An exploratory mixed-methods study. Glob Public Health 2021; 17:1958-1972. [PMID: 34459360 DOI: 10.1080/17441692.2021.1969671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Community Health Worker (CHW) supervision is an under-researched area. This mixed-methods study engaged key stakeholders involved in CHW supervision in Mukono District, Uganda including CHWs (n = 14), District Health Office officials (n = 5), NGO programme managers (n = 3) and facility-based health staff (n = 3). Our study aimed to explore how supervision is currently conceptualised and delivered in this setting, the desired qualities of a potential supervisor, as well as the challenges regarding supervision and potential solutions to address these. To understand these concepts, we conducted structured surveys and individual interviews. Survey data were analysed in SPSS using descriptive statistics. Interview transcripts were thematically analysed in NVivo using conventional content analysis. This study revealed current CHW supervision in this context is fragmented. Supervision is perceived both as a means of motivating CHWs and facilitating ongoing training, as well as a way of holding CHWs accountable for their work. Stakeholders identified technical knowledge and expertise, strong interpersonal skills and cultural awareness as desirable qualities for a supervisor. Challenges surrounding supervision included a shortage of funding, a lack of guidelines on supervision, and infrequent supervision. To address these challenges, stakeholders proposed the need for increased funding, creating clearer job descriptions for supervisors, and in-person supervisory meetings.
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Affiliation(s)
- James O'Donovan
- Learning and New Technologies Research Group, Department of Education, University of Oxford, Oxford, UK.,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | | | - Rebecca Hamala
- Division of Research and Health Equity, Omni Med, Mukono, Uganda
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Tadesse AW, Gurmu KK, Kebede ST, Habtemariam MK. Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia. Global Health 2021; 17:53. [PMID: 33902625 PMCID: PMC8074348 DOI: 10.1186/s12992-021-00702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country's health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. METHODS We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the "hardware" (using the World Health Organization's building blocks) and the "software" (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. RESULTS Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. CONCLUSIONS Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country's health indicators and may promote sustained functionality of the health system.
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Affiliation(s)
- Amare Worku Tadesse
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Reproductive Health, Nutrition and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Kassu Ketema Gurmu
- Department of Global Health and Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Selamawit Tesfaye Kebede
- Department of Global Health and Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Abdalla S, Weng Y, Mehta KM, Mahapatra T, Srikantiah S, Shah H, Ward VC, Pepper KT, Bentley J, Carmichael SL, Creanga A, Wilhelm J, Tarigopula UK, Nanda P, Bhattacharya D, Atmavilas Y, Darmstadt GL. Trends in reproductive, maternal, newborn and child health and nutrition indicators during five years of piloting and scaling-up of Ananya interventions in Bihar, India. J Glob Health 2020; 10:021003. [PMID: 33427818 PMCID: PMC7757843 DOI: 10.7189/jogh.10.021003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Ananya program in Bihar implemented household and community-level interventions to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) in two phases: a first phase of intensive ancillary support to governmental implementation and innovation testing by non-government organisation (NGO) partners in eight focus districts (2012-2014), followed by a second phase of state-wide government-led implementation with techno-managerial assistance from NGOs (2014 onwards). This paper examines trends in RMNCHN indicators in the program's implementation districts from 2012-2017. METHODS Eight consecutive rounds of cross-sectional Community-based Household Surveys conducted by CARE India in 2012-2017 provided comparable data on a large number of indicators of frontline worker (FLW) performance, mothers' behaviours, and facility-based care and outreach service delivery across the continuum of maternal and child care. Logistic regression, considering the complex survey design and sample weights generated by that design, was used to estimate trends using survey rounds 2-5 for the first phase in the eight focus districts and rounds 6-9 for the second phase in all 38 districts statewide, as well as the overall change from round 2-9 in focus districts. To aid in contextualising the results, indicators were also compared amongst the formerly focus and the non-focus districts at the beginning of the second phase. RESULTS In the first phase, the levels of 34 out of 52 indicators increased significantly in the focus districts, including almost all indicators of FLW performance in antenatal and postnatal care, along with mother's birth preparedness, some breastfeeding practices, and immunisations. Between the two phases, 33 of 52 indicators declined significantly. In the second phase, the formerly focus districts experienced a rise in the levels of 14 of 50 indicators and a decline in the levels of 14 other indicators. There was a rise in the levels of 22 out of 50 indicators in the non-focus districts in the second phase, with a decline in the levels of 13 other indicators. CONCLUSIONS Improvements in indicators were conditional on implementation support to program activities at a level of intensity that was higher than what could be achieved at scale so far. Successes during the pilot phase of intensive support suggests that RMNCHN can be improved statewide in Bihar with sufficient investments in systems performance improvements. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andreea Creanga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jess Wilhelm
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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Abdalla S, Weng Y, Mehta1, KM, Mahapatra T, Srikantiah S, Shah H, Ward VC, Pepper KT, Bentley J, Carmichael SL, Creanga A, Wilhelm J, Tarigopula UK, Nanda P, Bhattacharya D, Atmavilas Y, Darmstadt GL. Trends in reproductive, maternal, newborn and child health and nutrition indicators during five years of piloting and scaling-up of Ananya interventions in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Munro J. ‘Saving our people’: health workers, medical citizenship, and vernacular sovereignties in West Papua. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2020. [DOI: 10.1111/1467-9655.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jenny Munro
- School of Social ScienceUniversity of Queensland Brisbane, Qld 4072 Australia
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Hartmann C, Hartmann JMK, Lopez A, Flores P. Health non-governmental organizations (NGOs) amidst civil unrest: Lessons learned from Nicaragua. Glob Public Health 2020; 15:1810-1819. [PMID: 32633696 DOI: 10.1080/17441692.2020.1789193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The community-based disaster risk management (CBDRM) framework recognises the crucial role that small- and medium-sized NGOs play during adverse events, particularly in marginalised communities. Despite the global frequency of civil unrest, its effect on NGOs' programmatic, administrative, and operational capabilities is poorly understood. To this end, we completed in-depth semi-structured interviews with eight key informants representing seven health NGOs in Nicaragua several months after widespread and persistent civil unrest erupted in April 2018. Data analysis revealed that all NGOs experienced notable disruptions in community education and health promotion, healthcare provision, fundraising, and strategic planning. Further, NGOs experienced several key challenges in responding to crises, including mobility within and between communities, diminishing financial resources, and safety concerns for staff and volunteers. Several NGOs anticipated long-term adverse impacts. In light of these challenges, we propose that health NGOs create a plan of action to mitigate adverse impacts of civil unrest and promote population health. Specifically, a plan of action should address institutional planning, communication strategies, and partnerships and coalitions. We also propose important ways in which future research could build on this preliminary study.
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Affiliation(s)
- Chris Hartmann
- Public Health Department, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Alexis Lopez
- Public Health Department, SUNY Old Westbury, Old Westbury, NY, USA
| | - Paola Flores
- Public Health Department, SUNY Old Westbury, Old Westbury, NY, USA
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Sousa C, Akesson B, Badawi D. 'Most importantly, I hope God keeps illness away from us': The context and challenges surrounding access to health care for Syrian refugees in Lebanon. Glob Public Health 2020; 15:1617-1626. [PMID: 32529947 DOI: 10.1080/17441692.2020.1775865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The influx of 1.5 million Syrians into Lebanon has created an increased demand for health services, which is largely unmet, due to cost, a highly fragmented and privatised system, and crises around legal documentation and refugee status. The aim of this study was to use a constant comparison analysis of qualitative data to explore how Syrian refugees living in Lebanon describe their experiences accessing healthcare (N = 351 individuals within 46 families). Pervasive fear, lack of confidence in the medical system, and high costs all hinder access to healthcare for Syrians in Lebanon. Findings demonstrate the need for attention to the costs and accessibility of care, and for stronger coordination of care within a centrally led comprehensive emergency plan. While we attend to understanding and alleviating the barriers surrounding refugee healthcare, we must also address the underlying cause of health crisis: the brutal realities caused by armed conflict.
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Affiliation(s)
- Cindy Sousa
- Bryn Mawr College, Graduate School of Social Work and Social Research, Bryn Mawr, PA, USA
| | - Bree Akesson
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Dena Badawi
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
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Holst J. Global Health - emergence, hegemonic trends and biomedical reductionism. Global Health 2020; 16:42. [PMID: 32375801 PMCID: PMC7201392 DOI: 10.1186/s12992-020-00573-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
Background Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term “Global Health” still lacks a uniform use today. Objectives The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term “Global Health” goes beyond the territorial meaning of “global”, connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health. Conclusions Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.
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Affiliation(s)
- Jens Holst
- Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Strasse 123, D-36037, Fulda, Germany.
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Marten MG, Sullivan N. Hospital side hustles: Funding conundrums and perverse incentives in Tanzania's publicly-funded health sector. Soc Sci Med 2019; 244:112662. [PMID: 31726268 DOI: 10.1016/j.socscimed.2019.112662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022]
Abstract
Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used "side hustle" strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low income countries, undermining those health systems' ability to achieve the goal of universal health care.
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Affiliation(s)
- Meredith G Marten
- Department of Anthropology, University of West Florida, 11000 University Pkwy, Pensacola FL 32514, USA
| | - Noelle Sullivan
- Program in Global Health Studies, Northwestern University, 1800 Sherman, Suite 1-200, Evanston, IL 60208, USA.
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Tankwanchi AS, Hagopian A, Vermund SH. International migration of health labour: monitoring the two-way flow of physicians in South Africa. BMJ Glob Health 2019; 4:e001566. [PMID: 31565405 PMCID: PMC6747914 DOI: 10.1136/bmjgh-2019-001566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/04/2019] [Accepted: 08/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although health labour migration is a global phenomenon, studies have neglected the flow of health workers into low-income and middle-income countries (LMICs). In compliance with the data-monitoring recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (Code), we estimated post-Code physician net migration (NM) in South Africa (SA), and SA's net loss of physicians to Organisation for Economic Co-operation and Development (OECD) countries from 2010 to 2014. METHODS We sourced data from the National Reporting Instrument reports, the OECD and the General Medical Council. Using the numbers of foreign nationals and international medical graduates (IMGs) registered in SA, and SA medical graduates registered in OECD countries (South African-trained international medical graduates (SA-IMGs)) as respective proxies for immigration and emigration, we estimated 'NM' as the difference between immigrant physicians and emigrant physicians and 'net loss' as the difference between OECD-trained IMGs and OECD-based SA-IMGs. RESULTS In 2010, SA hosted 8443 immigrant physicians, while OECD countries hosted 14 933 SA-IMGs, yielding a NM of -6490 physicians and a NM rate of -18% in SA. By 2014, SA-based immigrant physicians had increased by 4%, while SA-IMGs had decreased by -15%, halving the NM rate to -9%. SA-to-OECD estimated net loss of physicians dropped from -12 739 physicians in 2010 to -10 563 in 2014. IMGs represented 46% of 2010-2014 new registrations in SA, with the UK, Nigeria and the Democratic Republic of the Congo serving as leading sources. Registrants from conflict-scarred Libya increased >100-fold. More than 3400 SA-IMGs exited OECD-based workforces. CONCLUSION NM is a better measure of the brain drain than simply the emigration fraction. Strengthened health personnel data management and reporting through implementation of the Code-related system of National Health Workforce Accounts will further increase our understanding of health worker mobility in LMICs, with policymakers empowered to make more informed policies to address shortage.
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Affiliation(s)
- Akhenaten Siankam Tankwanchi
- DST/NRF SARChI Programme on the Health Workforce for Equity and Quality, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Amy Hagopian
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Sten H Vermund
- Office of the Dean, Yale School of Public Health, New Haven, Connecticut, USA
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Kabir MF, Schulman D, Abdullah AS. Promoting Relational Agent for Health Behavior Change in Low and Middle - Income Countries (LMICs): Issues and Approaches. J Med Syst 2019; 43:227. [PMID: 31190131 DOI: 10.1007/s10916-019-1360-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
The use of contemporary technologies in healthcare systems to improve quality of care and to promote behavioral healthcare outcomes are prevalent in high-income countries. However, low and middle-income countries (LMICs) are not receiving the same advantages of technology, which may be due to inadequate technological infrastructure and financial resources, lack of interest among policy makers and healthcare service providers, lack of skills and capacity among healthcare professionals in using technology based interventions, and resistance of the public to the use of technologies for healthcare or health promotion activities. Technology-based interventions offer considerable promise to develop entirely new models of healthcare both within and outside of formal systems of care and offer the opportunity to have a large public health impact. Such technology-based interventions could be used to address targeted global health problems in LMICs, including the chronic non-communicable diseases (NCDs) - a growing health system burden in LMICs. Major preventable behavioral risk factors of chronic NCDs are increasing in LMICs, and innovative interventions are essential to address these risk factors. Computer-based or mobile-based virtual coaches or Relational Agents (RAs) are increasingly being explored for counseling patients to change their health behavior in high-income countries; however, the use of RAs in LMICs has not been studied. In this paper, we summarize the growing application of RA technology in behavior change interventions in high-income countries and describe the potential of its use in LMICs. Finally, we review the potential barriers and challenges in promoting RAs in LMICs.
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Affiliation(s)
- Md Faisal Kabir
- Department of Computer Science, North Dakota State University, Fargo, ND, 58108, USA
| | - Daniel Schulman
- Philips Research North America, 2 Canal Park, 3rd Floor, Cambridge, MA, 02141, USA
| | - Abu S Abdullah
- Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA. .,Duke Global Health Institute, Duke University, Durham, NC, 27710, USA. .,Global Health Program, Duke Kunshan University, Kunshan, 215347, Jiangsu Province, China.
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Khalid H, Fox AM. Political and Governance Challenges to Achieving Global HIV Goals with Injecting Drug Users: The Case of Pakistan. Int J Health Policy Manag 2019; 8:261-271. [PMID: 31204442 PMCID: PMC6571491 DOI: 10.15171/ijhpm.2018.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently set the ambitious "90-90-90 target" of having 90% of people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve viral suppression by 2020. This ambitious new goal is occurring in a context of global "scale-down" following nearly a decade of heightened investment in HIV prevention and treatment efforts. Arguably international goals spur action, however, setting unrealistic goals that do not take weak health systems and variations in the nature of the epidemic across countries into consideration may set them up for failure in unproductive ways that lead to a decline in confidence in global governance institutions. This study explores how policy actors tasked with implementing HIV programs navigate the competing demands placed upon them by development targets and national politics, particularly in the current context of waning international investments towards HIV.
Methods: To examine these questions, we interviewed 29 key informants comprising health experts in donor organizations and government employees in HIV programs in Pakistan, a country where HIV programs must compete with other issues for attention. Themes were identified inductively through an iterative process and findings were triangulated with various data sources and existing literature.
Results: We found both political and governance challenges to achieving the target, particularly in the context of the global HIV scale-down. Political challenges included, low and heterogeneous political commitment for HIV and a conservative legal environment that contributed towards a ban on opiate substitution therapy, creating low treatment coverage. Governance challenges includedstrained state and non-governmental organization (NGO) relations creating a hostile service delivery environment, weak bureaucratic and civil society capacity contributing to poor regulation of the health infrastructure, and resource mismanagement on both the part of the government and NGOs.
Conclusion: Our findings suggest that in a context of waning international attention to HIV, policy actors on the ground face a number of practical hurdles to achieving the ambitious targets set out by international agencies. Greater attention to the political and governance challenges of implementing HIV programs in low- and middle-income countries (LMICs) could help technical assistance agencies to develop more realistic implementation plans.
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Affiliation(s)
- Hina Khalid
- Department of Economics, School of Humanities and Social Sciences, Information Technology University, Lahore, Pakistan
| | - Ashley M Fox
- Rockefeller College of Public Affairs and Policy, University at Albany, Albany, NY, USA
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Landes M, Pfaff C, Zerihun M, Wondimagegn D, Sodhi S, Rouleau K, Kidd MR. Calling non-governmental organisations to strengthen primary health care: Lessons following Alma-Ata. Afr J Prim Health Care Fam Med 2019; 11:e1-e2. [PMID: 31038348 PMCID: PMC6556919 DOI: 10.4102/phcfm.v11i1.1945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background The Alma-Ata Declaration’s commitment to primary health care (PHC) reaches its 40th anniversary in 2018. Over the last 40 years, the number of non-governmental organisations (NGOs) working in low-income countries (LICs) has rapidly multiplied, and over time, NGOs have both positively and negatively impacted equity, effectiveness, appropriateness and efficiency of PHC systems in LICs. Aim The authors aim to demonstrate that at the 40th anniversary of the Alma-Ata Declaration’s commitment to PHC, NGOs are particularly poised to strengthen PHC in LICs. Methods In this letter, the authors reflect on how NGOs have both positively and negatively impacted equity, effectiveness, appropriateness and efficiency of PHC systems based on their experience working with NGOs in LICs. Results NGOs are poised to strengthen PHC in LICs in four distinct ways: assisting with local human resources development, strengthening local information systems, enabling community-based health services and testing innovative service delivery projects. Conclusions The authors call for NGOs to commit their expertise and resources to long-term strengthening of PHC in LICs and to critically examine the factors that prevent or assist them in this goal. As the principles of Alma-Ata are renewed, NGOs should be responsibly engaged in strengthening the declaration’s goal of ‘health for all’.
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Affiliation(s)
- Megan Landes
- Dignitas International, Zomba, Malawi; and, Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
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Linkage to care of HIV positive clients in a community based HIV counselling and testing programme: A success story of non-governmental organisations in a South African district. PLoS One 2019; 14:e0210826. [PMID: 30668598 PMCID: PMC6342293 DOI: 10.1371/journal.pone.0210826] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Although current data projects South Africa potentially meeting the UN target to test 90% of all people living with HIV by 2020, linking them to HIV care remains a big challenge. In an effort to increase linkage to care (LTC) of HIV positive clients an innovative collaborative intervention between two non-governmental organisations was developed and implemented between 2016 and 2017. This paper investigated the outcome of this collaborative intervention. Methods We used a mixed methods approach to assess the outcome of the innovative relationship. This was done by analysing routine programmatic quantitative data on LTC between 2015 and 2017 and qualitatively interviewing five programme managers, four programme implementers and five HIV positive clients on their perceived success/failure factors. Qualitative data were analysed using thematic content analysis while LTC rates were descriptively analysed. Two consultative meetings presented draft findings to programme managers (n = 7) and implementers (n = 10) for feedback, results verification and confirmation. Results In 2015 cumulative LTC rate was 27% and it rose to 85% two years post-intervention in 2017. Six themes emerged as success factors at the health system and structural levels and these include: provision of client escort services, health facility human resource capacity strengthening, inter and intra-organisational teamwork, onsite LTC, facilitated and expedited jumping of queues and shifting administrative tasks to non-clinical staff to protect nurses’ time on ART initiation. These measures in turn ensured increased, affordable and swift ART initiation of clients while strengthening client support. Conclusions We concluded that multi-faceted interventions that target both health system challenges including staff shortages, efficiencies, and extended facility opening times, and structural inadequacies, including client time and resource limitations due to poverty or nature of jobs, can help to increase LTC.
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Barr A, Garrett L, Marten R, Kadandale S. Health sector fragmentation: three examples from Sierra Leone. Global Health 2019; 15:8. [PMID: 30670026 PMCID: PMC6341573 DOI: 10.1186/s12992-018-0447-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/14/2018] [Indexed: 11/27/2022] Open
Abstract
Background Fragmentation across governance structures, funding, and external actor engagement in Sierra Leone continues to challenge the efficiency and coherence of health sector activities and impedes sustained health system strengthening. Three examples are discussed to highlight the extent, causes, and impacts of health sector fragmentation in Sierra Leone: the community health worker programme, national medical supply chain, and service level agreements. Results In these examples we discuss factors contributing to fragmentation, the impact on efficiency of systems and sustainability of interventions, and persistent barriers to achieving sustainable improvements in health system performance. Prolonged external dependence and a proliferation of partner and donor involvement tending towards vertical programming and funding have contributed to this fragmentation. Conclusion Alignment of policy and planning initiatives, investment in proactive (to reduce need for reactive) policy and plan development, strengthened partnerships, and strengthened governance and accountability mechanisms offer opportunities for greater health sector integration.
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Affiliation(s)
- Arwen Barr
- Simon Fraser University, 8888 University Drive, Burnaby, Canada
| | - Lauryn Garrett
- Simon Fraser University, 8888 University Drive, Burnaby, Canada.
| | - Robert Marten
- London School of Hygiene and Tropical Medicine, London, England
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Citrin D, Mehanni S, Acharya B, Wong L, Nirola I, Sherchan R, Gauchan B, Karki KB, Singh DR, Shamasunder S, Le P, Schwarz D, Schwarz R, Dangal B, Dhungana SK, Maru S, Mahar R, Thapa P, Raut A, Adhikari M, Basnett I, Kaluanee SP, Deukmedjian G, Halliday S, Maru D. Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal. Glob Health Action 2018; 10:1367161. [PMID: 28914185 PMCID: PMC5645653 DOI: 10.1080/16549716.2017.1367161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.
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Affiliation(s)
- David Citrin
- a Possible , Kathmandu , Nepal.,b Department of Anthropology , University of Washington , Seattle , WA , USA.,c Department of Global Health , University of Washington , Seattle , WA , USA.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Stephen Mehanni
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,g Gallup Indian Medical Center , Gallup , NM , USA
| | - Bibhav Acharya
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,i Shared Minds , Boston , MA , USA
| | - Lena Wong
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,j Tuba City Regional Health Care , Tuba City , AZ , USA
| | - Isha Nirola
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Rekha Sherchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Bikash Gauchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Khem Bahadur Karki
- k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal
| | - Dipendra Raman Singh
- l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal
| | - Sriram Shamasunder
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Phuoc Le
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Dan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA
| | - Ryan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | | | - Sheela Maru
- a Possible , Kathmandu , Nepal.,q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.,r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.,s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA
| | | | | | | | - Mukesh Adhikari
- t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal
| | | | - Shankar Prasad Kaluanee
- a Possible , Kathmandu , Nepal.,u School of Leadership and Development , Eastern University , St. Davids , PA , USA
| | - Grace Deukmedjian
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,v Tséhootsooí Medical Center , Fort Defiance , AZ , USA
| | - Scott Halliday
- a Possible , Kathmandu , Nepal.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Duncan Maru
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA.,w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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A bioethical framework for health systems activity: a conceptual exploration applying ‘systems thinking’. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2014.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shroff ZC, Ghaffar A, Soucat A. Moving Beyond Diagonal and T-Shaped: Getting the Incentives Right for the Pie Not for the Slice. Health Syst Reform 2017; 3:261-267. [PMID: 30359176 DOI: 10.1080/23288604.2017.1366964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Zubin Cyrus Shroff
- a Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Abdul Ghaffar
- a Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Agnès Soucat
- b Department of Health Systems Governance and Financing, World Health Organization , Geneva , Switzerland
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Abstract
OBJECTIVE We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people. DESIGN A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model (n = 13) and those implementing care-as-usual (n = 669). METHODS Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July 2013 and June 2014 - representing 129 938 patients in care across 682 health facilities - using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained. RESULTS The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi (P < 0.001; 95% confidence interval: 0.079-0.104). The economic cost of receiving care in Neno district (n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. CONCLUSION Neno District's comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.
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Mays DC, O’Neil EJ, Mworozi EA, Lough BJ, Tabb ZJ, Whitlock AE, Mutimba EM, Talib ZM. Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts. Int J Equity Health 2017; 16:129. [PMID: 28728553 PMCID: PMC5520299 DOI: 10.1186/s12939-017-0619-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/03/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Uganda's national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda. METHODS A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged. RESULTS VHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting. CONCLUSIONS Supporting and retaining Uganda's VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.
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Affiliation(s)
- Daniel C. Mays
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
| | | | - Edison A. Mworozi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Benjamin J. Lough
- University of Illinois at Urbana-Champaign, School of Social Work, 1010 W. Nevada Street, Urbana, IL 61801 USA
| | - Zachary J. Tabb
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903 USA
| | - Ashlyn E. Whitlock
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
| | | | - Zohray M. Talib
- George Washington University School of Medicine & Health Sciences, 2300 Eye St. NW, Washington D.C., 20037 USA
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Adeola HA, Soyele OO, Adefuye AO, Jimoh SA, Butali A. Omics-based molecular techniques in oral pathology centred cancer: prospect and challenges in Africa. Cancer Cell Int 2017; 17:61. [PMID: 28592923 PMCID: PMC5460491 DOI: 10.1186/s12935-017-0432-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The completion of the human genome project and the accomplished milestones in the human proteome project; as well as the progress made so far in computational bioinformatics and "big data" processing have contributed immensely to individualized/personalized medicine in the developed world. MAIN BODY At the dawn of precision medicine, various omics-based therapies and bioengineering can now be applied accurately for the diagnosis, prognosis, treatment, and risk stratification of cancer in a manner that was hitherto not thought possible. The widespread introduction of genomics and other omics-based approaches into the postgraduate training curriculum of diverse medical and dental specialties, including pathology has improved the proficiency of practitioners in the use of novel molecular signatures in patient management. In addition, intricate details about disease disparity among different human populations are beginning to emerge. This would facilitate the use of tailor-made novel theranostic methods based on emerging molecular evidences. CONCLUSION In this review, we examined the challenges and prospects of using currently available omics-based technologies vis-à-vis oral pathology as well as prompt cancer diagnosis and treatment in a resource limited setting.
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Affiliation(s)
- Henry A. Adeola
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of the Western Cape and Tygerberg Hospital, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Olujide O. Soyele
- Department of Oral Maxillo-facial Surgery and Oral Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anthonio O. Adefuye
- Division of Health Sciences Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Sikiru A. Jimoh
- Department of Anatomical Sciences, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape South Africa
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA USA
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Lohman N, Hagopian A, Luboga SA, Stover B, Lim T, Makumbi F, Kiwanuka N, Lubega F, Ndizihiwe A, Mukooyo E, Barnhart S, Pfeiffer J. District Health Officer Perceptions of PEPFAR's Influence on the Health System in Uganda, 2005-2011. Int J Health Policy Manag 2017; 6:83-95. [PMID: 28812783 PMCID: PMC5287933 DOI: 10.15171/ijhpm.2016.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/18/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including the President's Emergency Plan for AIDS Relief (PEPFAR), have successfully contributed to reducing HIV/AIDS related morbidity and mortality. However, there is still debate about whether these disease-specific programs have improved or harmed health systems overall, especially with respect to non-HIV health needs. METHODS As part of a larger evaluation of PEPFAR's effects on the health system between 2005-2011, we collected qualitative and quantitative data through semi-structured interviews with District Health Officers (DHOs) from all 112 districts in Uganda. We asked DHOs to share their perceptions about the ways in which HIV programs (largely PEPFAR in the Ugandan context) had helped and harmed the health system. We then identified key themes among their responses using qualitative content analysis. RESULTS Ugandan DHOs said PEPFAR had generally helped the health system by improving training, integrating HIV and non-HIV care, and directly providing resources. To a lesser extent, DHOs said PEPFAR caused the health system to focus too narrowly on HIV/AIDS, increased workload for already overburdened staff, and encouraged doctors to leave public sector jobs for higher-paid positions with HIV/AIDS programs. CONCLUSION Health system leaders in Uganda at the district level were appreciative of resources aimed at HIV they could often apply for broader purposes. As HIV infection becomes a chronic disease requiring strong health systems to manage sustained patient care over time, Uganda's weak health systems will require broad infrastructure improvements inconsistent with narrow vertical health programming.
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Affiliation(s)
- Nathaniel Lohman
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | | | - Bert Stover
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Travis Lim
- Division of Global HIV and Tuberculosis, Atlanta, GA, USA
| | | | - Noah Kiwanuka
- Faculty of Health Sciences, Makerere University, Kampala, Uganda
| | - Flavia Lubega
- Faculty of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Eddie Mukooyo
- Resource Center for the Uganda Ministry of Health, Uganda Ministry of Health, Nakasero, Uganda
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Gushulak BD, Weekers J, MacPherson DW. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework. EMERGING HEALTH THREATS JOURNAL 2017. [DOI: 10.3402/ehtj.v2i0.7091] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- BD Gushulak
- Research Section, Migration Health Consultants, Ontario, Canada
| | - J Weekers
- Migration Health Department, International Organization for Migration, Geneva, Switzerland and
| | - DW MacPherson
- Faculty of Health Sciences, McMaster University, Ontario, Canada
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Acharya B, Maru D, Schwarz R, Citrin D, Tenpa J, Hirachan S, Basnet M, Thapa P, Swar S, Halliday S, Kohrt B, Luitel NP, Hung E, Gauchan B, Pokharel R, Ekstrand M. Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal. Global Health 2017; 13:2. [PMID: 28086925 PMCID: PMC5237195 DOI: 10.1186/s12992-016-0226-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. PARTNERSHIPS NETWORK We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. CONCLUSIONS We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.
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Affiliation(s)
- Bibhav Acharya
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal. .,Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA. .,Shared Minds, Boston, MA, USA.
| | - Duncan Maru
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ryan Schwarz
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David Citrin
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Jasmine Tenpa
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Soniya Hirachan
- Shared Minds, Boston, MA, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Madhur Basnet
- Shared Minds, Boston, MA, USA.,Faculty of Medicine, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Poshan Thapa
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Sikhar Swar
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Psychiatric Department, Kathmandu Medical College, Kathmandu, Nepal
| | - Scott Halliday
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Brandon Kohrt
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,Global Health Institute, Duke University, Durham, NC, USA.,Department of Cultural Anthropology, Duke University, Durham, NC, USA
| | - Nagendra P Luitel
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Erick Hung
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Langley Porter, San Francisco, CA, 94143, USA
| | - Bikash Gauchan
- Bayalpata Hospital, Possible, Sanfebagar-10, Achham, Nepal
| | - Rajeev Pokharel
- Policy Planning & International Cooperation Division, Ministry of Health, Kathmandu, Nepal
| | - Maria Ekstrand
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Olakunde BO, Ndukwe CD. Improved Domestic Funding Enhances the Sustainability of HIV/AIDS Response in Nigeria. Ann Glob Health 2017; 81:684-8. [PMID: 27036726 DOI: 10.1016/j.aogh.2015.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fan VY, Tsai FJJ, Shroff ZC, Nakahara B, Vargha N, Weathers S. Dedicated health systems strengthening of the Global Fund to Fight AIDS, Tuberculosis, and Malaria: an analysis of grants. Int Health 2016; 9:50-57. [PMID: 27986840 DOI: 10.1093/inthealth/ihw055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/06/2016] [Accepted: 11/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to understand the determinants of the Global Fund to Fight AIDS, Tuberculosis, and Malaria's dedicated channel for health systems strengthening (HSS) funding across countries and to analyze their health system priorities expressed in budgets and performance indicators. METHODS We obtained publicly available data for disease-specific and HSS grants from the Global Fund over 2004-2013 prior to the new funding model. Regression analysis was employed to assess the determinants of dedicated HSS funding across 111 countries. Documents for 27 dedicated HSS grants including budgets and performance indicators were collected, and activities were analyzed by health system functions. RESULTS HSS funding per capita is significantly associated with TB and HIV funding per capita, but not per capita income and health worker density. Of 27 dedicated HSS grants, 11 had line-item budgets publicly available, in which health workforce and medical products form the majority (89% or US$132 million of US$148 million) of funds. Yet these areas accounted for 41.7% (215) of total 516 performance indicators. CONCLUSIONS Health worker densities were not correlated with HSS funding, despite the emphasis on health workforce in budgets and performance indicators. Priorities in health systems in line-item budgets differ from the numbers of indicators used.
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Affiliation(s)
- Victoria Y Fan
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Biomed D204, Honolulu, HI 96822, USA .,Center for Global Development, 2055 L Street NW, Fifth Floor, Washington, DC 20036, USA
| | - Feng-Jen J Tsai
- Master program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wuxing Street, Taipei City, 110 Taiwan
| | - Zubin C Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Branden Nakahara
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Biomed D204, Honolulu, HI 96822, USA
| | - Nabil Vargha
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Biomed D204, Honolulu, HI 96822, USA
| | - Scott Weathers
- Center for Global Development, 2055 L Street NW, Fifth Floor, Washington, DC 20036, USA
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Bvumbwe T. Enhancing nursing education via academic–clinical partnership: An integrative review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Smith RJ. Healthcare under siege: Geopolitics of medical service provision in the Gaza Strip. Soc Sci Med 2016; 146:332-40. [PMID: 26603311 DOI: 10.1016/j.socscimed.2015.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
Siege, a process of political domination aimed at isolating an entire population, represents a unique threat to healthcare provision. This study is a qualitative examination of the impacts of siege on the practices and systems that underlie health in Gaza. Data are from participant observation conducted over a period of six years (2009-2014), along over 20 interviews with doctors and health administrators in the Non-Governmental Organisation (NGO), Governmental, and United Nations sectors. Analyses were informed by two connected theories. First, the theory of surplus population was used, an idea that builds on Marx's conception of primitive accumulation and Harvey's accumulation by dispossession. Second, Roy's theory of de-development was used, particularly as it is connected to neoliberal trends in healthcare systems organizing and financing. Findings indicate that siege impinges on effective healthcare provision through two central, intertwined processes: withholding materials and resources and undermining healthcare at a systems level. These strains pose considerable threats to healthcare, particularly within the Ministry of Health but also within and among other entities in Gaza that deliver care. The strategies of de-development described by participants reflect the ways the population that is codified as a surplus population. Gazan society is continually divested of any of the underpinnings necessary for a well-functioning sovereign health care infrastructure. Instead of a self-governing, independent system, this analysis of health care structures in Gaza reveals a system that is continually at risk of being comprised entirely of captive consumers who are entirely dependent on Israel, international bodies, and the aid industry for goods and services. This study points to the importance of foregrounding the geopolitical context for analysis of medical service delivery within conflict settings. Findings also highlight the importance of advocating for sovereignty and self-determination as related to health systems.
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Risso-Gill I, McKee M, Coker R, Piot P, Legido-Quigley H. Health system strengthening in Myanmar during political reforms: perspectives from international agencies. Health Policy Plan 2016; 29:466-74. [PMID: 23749651 DOI: 10.1093/heapol/czt037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes. International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.
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Whyle EB, Olivier J. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review. Health Policy Plan 2016; 31:1515-1529. [PMID: 27296061 DOI: 10.1093/heapol/czw075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/12/2022] Open
Abstract
In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated.
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Affiliation(s)
- Eleanor Beth Whyle
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Srivastava A, Bhattacharyya S, Gautham M, Schellenberg J, Avan BI. Linkages between public and non-government sectors in healthcare: A case study from Uttar Pradesh, India. Glob Public Health 2016; 11:1216-1230. [PMID: 26947898 DOI: 10.1080/17441692.2016.1144777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Effective utilisation of collaborative non-governmental organisation (NGO)-public health system linkages in pluralistic health systems of developing countries can substantially improve equity and quality of services. This study explores level and types of linkages between public health sector and NGOs in Uttar Pradesh (UP), an underprivileged state of India, using a social science model for the first time. It also identifies gaps and challenges for effective linkage. Two NGOs were selected as case studies. Data collection included semi-structured in-depth interviews with senior staff and review of records and reporting formats. Formal linkages of NGOs with the public health system related to registration, participation in district level meetings, workforce linkages and sharing information on government-supported programmes. Challenges included limited data sharing, participation in planning and limited monitoring of regulatory compliances. Linkage between public health system and NGOs in UP was moderate, marked by frequent interaction and some reciprocity in information and resource flows, but weak participation in policy and planning. The type of linkage could be described as 'complementarity', entailing information and resource sharing but not joint action. Stronger linkage is required for sustained and systematic collaboration, with joint planning, implementation and evaluation.
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Affiliation(s)
- Aradhana Srivastava
- a Department of Research , Public Health Foundation of India , Gurgaon , India
| | | | - Meenakshi Gautham
- b Faculty of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
| | - Joanna Schellenberg
- b Faculty of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
| | - Bilal I Avan
- b Faculty of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
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Marten MG. From emergency to sustainability: shifting objectives in the US Government's HIV response in Tanzania. Glob Public Health 2015; 12:988-1003. [PMID: 26609563 DOI: 10.1080/17441692.2015.1094707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The US President's Emergency Plan for AIDS Relief (PEPFAR) was originally designed as an emergency initiative, operating with considerable funds, immediate roll-out, fast scale-up, and top-down technocratic administration. In a more recent iteration, PEPFAR shifted its focus from an emergency response to more closely account for healthcare sustainability. This transition came on the heels of the 2008 financial crisis, which threatened to stall the 'marvellous momentum' of the 2000's boom in donor aid for global health overall. Now many programmes are having to do more with less as funding flattens or decreases. This paper examines how this transition took shape in Tanzania in 2011-2012, and the successes and challenges associated with it, using participant observation and interview data from 20 months of fieldwork in rural and urban healthcare settings. In particular, I discuss (1) efforts to increase sustainability and country ownership of HIV programmes in Tanzania, focusing on the shift from PEPFAR-funded American non-governmental organisations to Tanzanian partner organisations; (2) principal challenges stakeholders encountered during the transition, including fragmented systems of healthcare delivery and a weakened healthcare workforce; and (3) strategies informants identified to better integrate services in order to build a stronger, more equitable, and sustainable health system in Tanzania.
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Affiliation(s)
- Meredith G Marten
- a Department of Anthropology , University of West Florida , Pensacola , FL , USA
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Ng’ang’a N, Byrne MW. Professional practice models for nurses in low-income countries: an integrative review. BMC Nurs 2015; 14:44. [PMID: 26300694 PMCID: PMC4546202 DOI: 10.1186/s12912-015-0095-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/31/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries. METHODS An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH). RESULTS Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs. CONCLUSIONS Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.
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Affiliation(s)
- Njoki Ng’ang’a
- />Center for Children & Families, School of Nursing, Columbia University, New York, NY USA
- />International Organization for Women and Development, Rockville Centre, NY USA
| | - Mary Woods Byrne
- />Center for Children & Families, School of Nursing, Columbia University, New York, NY USA
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Okma KGH, Kay A, Hockenberry S, Liu J, Watkins S. The changing role of health-oriented international organizations and nongovernmental organizations. Int J Health Plann Manage 2015; 31:488-510. [PMID: 26238264 DOI: 10.1002/hpm.2298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Apart from governments, there are many other actors active in the health policy arena, including a wide array of international organizations (IOs), public-private partnerships and non-governmental organizations (NGOs) that state as their main mission to improve the health of (low-income) populations of low-income countries. Despite the steady rise in numbers and prominence of NGOs, however, there is lack of empirical knowledge about their functioning in the international policy arena, and most studies focus on the larger organizations. This has also caused a somewhat narrow focus of theoretical studies. Some scholars applied the 'principal-agent' theory to study the origins of IOs, for example, other focus on changing power relations. Most of those studies implicitly assume that IOs, public-private partnerships and large NGOs act as unified and rational actors, ignoring internal fragmentation and external pressure to change directions. We assert that the classic analytical instruments for understanding the shaping and outcome of public policy: ideas, interests and institutions apply well to the study of IOs. As we will show, changing ideas about the proper role of state and non-state actors, changing positions and activities of major stakeholders in the (international) health policy arena, and shifts in political institutions that channel the voice of diverging interests resulted in (and reflected) the changing positions of the health-oriented organizations-and also affect their future outlook. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kieke G H Okma
- Catholic University Leuven, Belgium.,McGill University, Montreal
| | - Adrian Kay
- Crawford School of Public Policy, ANU, Canberra
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Ippolito G, Di Caro A, Capobianchi MR. The Chronology of the International Response to Ebola in Western Africa: Lights and Shadows in a Frame of Conflicting Position and Figures. Infect Dis Rep 2015; 7:5957. [PMID: 26294954 PMCID: PMC4508539 DOI: 10.4081/idr.2015.5957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 11/23/2022] Open
Abstract
The ongoing Ebola virus outbreak in western Africa illustrates the threat coming from emerging infectious diseases and is perceived by the public as a preeminent public health problem[...]
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Affiliation(s)
- Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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B-Lajoie MR, Hulme J, Johnson K. Payday, ponchos, and promotions: a qualitative analysis of perspectives from non-governmental organization programme managers on community health worker motivation and incentives. HUMAN RESOURCES FOR HEALTH 2014; 12:66. [PMID: 25475643 PMCID: PMC4267436 DOI: 10.1186/1478-4491-12-66] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/17/2014] [Indexed: 05/26/2023]
Abstract
BACKGROUND Community health workers (CHWs) have been central to broadening the access and coverage of preventative and curative health services worldwide. Much has been debated about how to best remunerate and incentivize this workforce, varying from volunteers to full time workers. Policy bodies, including the WHO and USAID, now advocate for regular stipends. METHODS This qualitative study examines the perspective of health programme managers from 16 international non-governmental organizations (NGOs) who directly oversee programmes in resource-limited settings. It aimed to explore institutional guidelines and approaches to designing CHW incentives, and inquire about how NGO managers are adapting their approaches to working with CHWs in this shifting political and funding climate. Second, it meant to understand the position of stakeholders who design and manage non-governmental organization-run CHW programmes on what they consider priorities to boost CHW motivation. Individuals were recruited using typical case sampling through chain referral at the semi-annual CORE Group meeting in the spring of 2012. Semi-structured interviews were guided by a peer reviewed tool. Two reviewers analyzed the transcripts for thematic saturation. RESULTS Six key factors influenced programme manager decision-making: National-level government policy, donor practice, implicit organizational approaches, programmatic, cultural, and community contexts, experiences and values of managers, and the nature of the work asked of CHWs. Programme managers strongly relied on national government to provide clear guidance on CHW incentives schemes. Perspectives on remuneration varied greatly, from fears that it is unsustainable, to the view that it is a basic human right, and a mechanism to achieve greater gender equity. Programme managers were interested in exploring career paths and innovative financing schemes for CHWs, such as endowment funds or material sales, to heighten local ownership and sustainability of programmes. Participants also supported the creation of both national-level and global interfaces for sharing practical experience and best practices with other CHW programmes. CONCLUSION Prescriptive recommendations for monetary remuneration, aside from those coming from national governments, will likely continue to meet resistance by NGOs, as contexts are nuanced. There is growing consensus that incentives should reflect the nature of the work asked of CHWs, and the potential for motivation through sustainable financial schemes other than regular salaries. Programme managers advocate for greater transparency and information sharing among organizations.
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Affiliation(s)
- Marie-Renée B-Lajoie
- />Department of Family Medicine, McGill University, Montréal, QC Canada
- />Emergency Department, Jewish General Hospital, Montréal, QC Canada
| | - Jennifer Hulme
- />Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Kirsten Johnson
- />Department of Family Medicine, McGill University, Montréal, QC Canada
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Abramowitz S, Marten M, Panter-Brick C. Medical humanitarianism: anthropologists speak out on policy and practice. Med Anthropol Q 2014; 29:1-23. [PMID: 25345372 DOI: 10.1111/maq.12139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.
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Pfeiffer J, Robinson J, Hagopian A, Johnson W, Fort M, Gimbel-Sherr K, Rowden R, Friedman E, Davis P, Adedokun L, Gloyd S. The end of AIDS and the NGO Code of Conduct. Lancet 2014; 384:639-40. [PMID: 25152262 DOI: 10.1016/s0140-6736(14)61259-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- James Pfeiffer
- Health Alliance International, Seattle, WA 98115, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Julia Robinson
- Health Alliance International, Seattle, WA 98115, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Amy Hagopian
- Health Alliance International, Seattle, WA 98115, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Wendy Johnson
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Meredith Fort
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Colorado-Denver, CO, USA
| | - Kenneth Gimbel-Sherr
- Health Alliance International, Seattle, WA 98115, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rick Rowden
- Economic Studies and Planning, Jawaharlal Nehru University, New Delhi, India
| | | | - Paul Davis
- Health GAP (Global Access Project), Washington, DC, USA
| | | | - Steve Gloyd
- Health Alliance International, Seattle, WA 98115, USA; Department of Global Health, University of Washington, Seattle, WA, USA
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