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Dsouza SM, Katyal A, Kalaskar S, Kabeer M, Rewaria L, Satyanarayana S, Nallamalla KR, Chokshi M. A scoping review of health systems resilience assessment frameworks. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003658. [PMID: 39312539 PMCID: PMC11419368 DOI: 10.1371/journal.pgph.0003658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/11/2024] [Indexed: 09/25/2024]
Abstract
Health system resilience is a prerequisite for effectively managing cataclysmic events adversely affecting health outcomes. The COVID-19 pandemic reasserted the importance of having resilient health systems and called for a relook at the existing framework that measures health system resilience. Mixed methods were used in this study. The review started with the measurement of health systems resilience and its context. Ebola epidemic triggered the importance, hence our search focused on published literature from 2014 to 2021. Based on the review, a semi-structured tool was developed for key in-depth interviews of seven experts from different countries. The frameworks focused on climate change, disaster management, health systems, city-specific resilience, and e-resilience were reviewed. In-depth interviews highlighted that resilient health systems need to engage the private sector, priority areas like leadership and governance, health resources, and a unified agenda for global collaboration. From experts' point of view, the inherent nature of health systems to respond to shock was clearly defined as the resilient health system. Health systems resilience definition needs to be defined, based on which assessment indicators will be identified. Indicators need to evolve continuously and be able to measure resilience at sub-national, national, regional, and global levels.
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Affiliation(s)
| | - Anuradha Katyal
- Sambodhi Research & Communications Pvt. Ltd., Noida, Uttar Pradesh, India
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Seyghalani Talab F, Ahadinezhad B, Khosravizadeh O, Amerzadeh M. A model of the organizational resilience of hospitals in emergencies and disasters. BMC Emerg Med 2024; 24:105. [PMID: 38914937 PMCID: PMC11197230 DOI: 10.1186/s12873-024-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In the health system, hospitals are intricate establishments that offer vital medical services. Their resilience plays a crucial role in mitigating the societal repercussions of disasters. A hospital must possess the capacity to withstand risks, preserve its fundamental structure and operations, and enhance its preparedness by augmenting various capabilities and promptly recovering from the impacts of potential risks. It enables the hospital to attain a heightened level of readiness. Therefore, this study aimed to develop a resilience model tailored for hospitals to navigate crises and disasters effectively. METHODS This mixed-method study was conducted in 2023 in three phases: (1) Identification of the factors influencing the organizational resilience of the hospital, (2) Evaluation of the influential factors by an expert panel. (3) Following the standardization process, we administered 371 questionnaires to individuals, such as university staff managers and supervisors, nursing managers, and research unit managers. The sample size was determined by multiplying the components by 10, resulting in 360 (10 * 36). Therefore, we selected a sample size of 371 participants. Structural Equation Modeling (SEM) was employed to examine the causal relationships between variables. These steps were performed using SPSS 25.0 and AMOS 22 software. Finally, we identified and presented the final model. We utilized AMOS 22 and applied the SEM to assess the correlation between the variables, with a significance level of 0.05. RESULTS Findings indicate that the appropriate modeling identified five dimensions comprising 36 components. These dimensions include vulnerability, preparedness, support management, responsiveness and adaptability, and recovery after the disaster. The model demonstrates a good fit, as indicated by the X2/d indices with a value of 2.202, a goodness of fit index (GFI) of 0.832, a root mean square error of estimation (RMSEA) of 0.057, an adjusted comparative fit index (CFI) of 0.931, and a smoothed fit index (NFI) of 0.901. CONCLUSION Enhancing hospital resilience is crucial for effective preparedness and response to accidents and disasters. Developing a localized tool for measuring resilience can help identify vulnerabilities, ensure service continuity, and inform rehabilitation programs. The proposed model is a suitable framework for assessing hospital resilience. Key factors include human resource scarcity, hospital specialization, and trauma center capacity. Hospitals should prioritize efficient resource allocation, information technology infrastructure, in-service training, waste management, and a proactive organizational framework to build resilience. By adopting this approach, hospitals can better respond to crises and disasters, ultimately reducing casualties and improving overall preparedness.
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Affiliation(s)
- Fatemeh Seyghalani Talab
- Student Research Committee, Department of Healthcare Management, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Traore BM, Traore A, Kebe AT, Dabou K, Kassogue D. [Managing routine health information system data during a security crisis in the health district of Timbuktu, Mali in 2023]. Pan Afr Med J 2024; 47:180. [PMID: 39036020 PMCID: PMC11260052 DOI: 10.11604/pamj.2024.47.180.42772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/01/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction an effective health information system (HIS) ensures the production, analysis, dissemination and use of reliable and up-to-date information on the determinants of health. However, it can encounter obstacles that hinder its functioning, such as armed conflicts, which limit access and quality of healthcare services. The purpose of our study was to help improve data management for routine health information system in the health district of Timbuktu during a security crisis. Methods we conducted a descriptive cross-sectional study, among health information management professionals in the Timbuktu Health District from 15 April to 08 September 2023. Data obtained from a survey questionnaire were analyzed using Epi Info version 7.2.2. and processed using Microsoft Word and Excel 2016. Results a total of 6 health facilities were surveyed. Data collection, analysis and feedback were very poor. Data quality was 100% complete, 92.40% prompt and 68.11% accurate. The major constraints were: low involvement of health workers in the SIS (22.22%), insufficient training on the SISR (29.63%), supervision (47.06%), internet inaccessibility (66.67%), feeling of insecurity (37.04%) and fear (61.76%) in health facilities. Conclusion our results show low-level processes, poor network coverage, shortage of qualified health information management professionals and increasing insecurity. A broader mixed-methods research would provide a better understanding.
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Affiliation(s)
- Bocar Mahamane Traore
- Département du Système Local d'Information Sanitaire, Centre de Santé de Reference, Tombouctou, Mali
| | | | - Amadou Tila Kebe
- Département Santé, Direction Régionale de la Santé, Tombouctou, Mali
| | - Kizito Dabou
- Département Santé, Direction Régionale de la Santé, Tombouctou, Mali
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Haghighat M, Mousavi SM, jahadi naeini M. Identifying and ranking of the main organizational resilience indicators in the hospital during the COVID-19 pandemic: A study using fuzzy Delphi technique (FDT) and fuzzy analytical hierarchy process (FAHP). Heliyon 2024; 10:e27241. [PMID: 38449624 PMCID: PMC10915563 DOI: 10.1016/j.heliyon.2024.e27241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
Resilience in a hospital is referred to as the capability to withstand and respond to disasters while maintaining critical functions. The current study aims to identify and prioritize the defining indicators of organizational resilience in dealing with the critical conditions of the COVID-19 pandemic. First, a literature review and semi-structured interviews with experts were performed for the identification of the primary indicators affecting the hospital's organizational resilience in critical conditions caused by the COVID-19 disease. Next, the fuzzy Delphi technique (FDT) was used to determine the effective and final indicators with a 70% agreement level. Finally, the indicators were weighted and prioritized using the FAHP method. The results shows that three indicators of leadership and management (NW = 0.092), preparedness (NW = 0.080), and learning from previous experiences (NW = 0.078) had the greatest impact on the organizational resilience of the hospital, respectively. Three indicators of logistics support, fallibility culture, creativity, and innovation with the final weights of 0.56, 0.054, and 0.053 gained the least importance, respectively. It can be concluded that a higher level of leadership and management, preparedness, and learning from previous experiences in the conditions of the COVID-19 pandemic can help control this crisis.
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Affiliation(s)
| | - Seyed Mahdi Mousavi
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa jahadi naeini
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Truppa C, Yaacoub S, Valente M, Celentano G, Ragazzoni L, Saulnier D. Health systems resilience in fragile and conflict-affected settings: a systematic scoping review. Confl Health 2024; 18:2. [PMID: 38172918 PMCID: PMC10763433 DOI: 10.1186/s13031-023-00560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Health systems resilience (HSR) research is a rapidly expanding field, in which key concepts are discussed and theoretical frameworks are emerging with vibrant debate. Fragile and conflict-affected settings (FCAS) are contexts exposed to compounding stressors, for which resilience is an important characteristic. However, only limited evidence has been generated in such settings. We conducted a scoping review to: (a) identify the conceptual frameworks of HSR used in the analysis of shocks and stressors in FCAS; (b) describe the representation of different actors involved in health care governance and service provision in these settings; and (c) identify health systems operations as they relate to absorption, adaptation, and transformation in FCAS. METHODS We used standard, extensive search methods. The search captured studies published between 2006 and January 2022. We included all peer reviewed and grey literature that adopted a HSR lens in the analysis of health responses to crises. Thematic analysis using both inductive and deductive approaches was conducted, adopting frameworks related to resilience characteristics identified by Kruk et al., and the resilience capacities described by Blanchet et al. RESULTS: Thirty-seven studies met our inclusion criteria. The governance-centred, capacity-oriented framework for HSR emerged as the most frequently used lens of analysis to describe the health responses to conflict and chronic violence specifically. Most studies focused on public health systems' resilience analysis, while the private health sector is only examined in complementarity with the former. Communities are minimally represented, despite their widely acknowledged role in supporting HSR. The documentation of operations enacting HSR in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven different domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. CONCLUSIONS Our review findings suggest that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens.
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Affiliation(s)
- Claudia Truppa
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy.
- International Committee of the Red Cross, Geneva, Switzerland.
| | - Sally Yaacoub
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Giulia Celentano
- ETH Zürich, Institut Für Bau- Und Infrastrukturmanagement, Chair of Sustainable Construction, Zurich, Schweiz
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Dell Saulnier
- Division of Social Medicine and Global Health/Department of Clinical Sciences, Lund University, Malmö, Sweden
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Poroes C, Seematter-Bagnoud L, Wyss K, Peytremann-Bridevaux I. Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6666. [PMID: 37681806 PMCID: PMC10487449 DOI: 10.3390/ijerph20176666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.
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Affiliation(s)
- Camille Poroes
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Natural Science, University of Basel, 4001 Basel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
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Wang W, Li H, Huang M. A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations. Front Oncol 2023; 13:1178092. [PMID: 37519811 PMCID: PMC10382130 DOI: 10.3389/fonc.2023.1178092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 08/01/2023] Open
Abstract
This review article highlights the critical role of nurses in disaster management, with a specific focus on addressing blood tumors in disaster-affected populations. Disasters have a significant impact on healthcare systems and populations, and nurses play a crucial role in disaster preparedness, response, and recovery. The article provides case studies and successful examples of nursing interventions in disaster settings and tumor management, emphasizing the challenges and opportunities in providing cancer care in disaster settings. Recommendations for future research and practice in disaster nursing and blood tumor care are also presented. This information is essential for healthcare professionals and policymakers involved in disaster management, as well as researchers and clinicians working in the field of cancer care.
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McDarby G, Seifeldin R, Zhang Y, Mustafa S, Petrova M, Schmets G, Porignon D, Dalil S, Saikat S. A synthesis of concepts of resilience to inform operationalization of health systems resilience in recovery from disruptive public health events including COVID-19. Front Public Health 2023; 11:1105537. [PMID: 37250074 PMCID: PMC10213627 DOI: 10.3389/fpubh.2023.1105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict' Health systems resilience has become a ubiquitous concept as countries respond to and recover from crises such as the COVID-19 pandemic, war and conflict, natural disasters, and economic stressors inter alia. However, the operational scope and definition of health systems resilience to inform health systems recovery and the building back better agenda have not been elaborated in the literature and discourse to date. When widely used terms and their operational definitions appear nebulous or are not consistently used, it can perpetuate misalignment between stakeholders and investments. This can hinder progress in integrated approaches such as strengthening primary health care (PHC) and the essential public health functions (EPHFs) in health and allied sectors as well as hinder progress toward key global objectives such as recovering and sustaining progress toward universal health coverage (UHC), health security, healthier populations, and the Sustainable Development Goals (SDGs). This paper represents a conceptual synthesis based on 45 documents drawn from peer-reviewed papers and gray literature sources and supplemented by unpublished data drawn from the extensive operational experience of the co-authors in the application of health systems resilience at country level. The results present a synthesis of global understanding of the concept of resilience in the context of health systems. We report on different aspects of health systems resilience and conclude by proposing a clear operational definition of health systems resilience that can be readily applied by different stakeholders to inform current global recovery and beyond.
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Affiliation(s)
- Geraldine McDarby
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | - Sohel Saikat
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
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Paschoalotto MAC, Lazzari EA, Rocha R, Massuda A, Castro MC. Health systems resilience: is it time to revisit resilience after COVID-19? Soc Sci Med 2023; 320:115716. [PMID: 36702027 PMCID: PMC9851720 DOI: 10.1016/j.socscimed.2023.115716] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.
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Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil.
| | - Eduardo Alves Lazzari
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Rudi Rocha
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Adriano Massuda
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, Harvard University, USA
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Ravaghi H, Khalil M, Al-Badri J, Naidoo AV, Ardalan A, Khankeh H. Role of hospitals in recovery from COVID-19: Reflections from hospital managers and frontliners in the Eastern Mediterranean Region on strengthening hospital resilience. Front Public Health 2023; 10:1073809. [PMID: 36743170 PMCID: PMC9889830 DOI: 10.3389/fpubh.2022.1073809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background COVID-19 highlighted the critical role that hospitals play throughout the prolonged response and continuous recovery stages of the pandemic. Yet, there is limited evidence related to hospitals in the recovery stage, particularly capturing the perspectives of hospital managers and frontliners in resource-restrained and humanitarian settings. Objective This paper aims to capture the perspectives of hospital managers and frontliners across the Eastern Mediterranean Region on (1) the role of hospitals in recovering from COVID-19, (2) Hospitals' expectations from public health institutions to enable recovery from COVID-19, (3) the Evaluation of hospital resilience before and through COVID-19, and (4) lessons to strengthen hospital resilience throughout the COVID-19 recovery. Methods A multi-methods approach, triangulating a scoping review with qualitative findings from 64 semi-structured key-informant interviews and survey responses (n = 252), was used to gain a deeper context-specific understanding. Purposeful sampling with maximum diversity supported by snowballing was used and continued until reaching data saturation. Thematic analysis was conducted using MAXQDA and simple descriptive analysis using Microsoft Excel. Findings In recovering from COVID-19, hospital managers noted hospitals' role in health education, risk reduction, and services continuity and expected human resource management, financial and material resource mobilization, better leadership and coordination, and technical support through the provision of updated clinical evidence-based information from their public health institutions. Qualitative findings also indicated that hospital managers attributed considerable changes in hospitals' resilience capacities to the pandemic and suggested that strengthening hospitals' resilience required resilient staff, sustainable finance, and adaptive leadership and management. Conclusion Hospitals are the backbone of health systems and a main point of contact for communities during emergencies; strengthening their resilience throughout the various stages of recovery is critical. Hospitals cannot be resilient in silos but rather require an integrated-whole-of-society-approach, inclusive of communities and other health systems actors.
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Affiliation(s)
- Hamid Ravaghi
- Department of Universal Health Coverage and Health Systems, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Merette Khalil
- Department of Universal Health Coverage and Health Systems, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil ✉
| | - Jehan Al-Badri
- Health Emergencies Program, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Ali Ardalan
- Department of Universal Health Coverage and Health Systems, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
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Physician-Suggested Innovative Methods for Health System Resilience amidst Workforce Emigration and Sociopolitical Unrest in Nigeria: A Survey-Based Study. Ann Glob Health 2023; 89:13. [PMID: 36819969 PMCID: PMC9936909 DOI: 10.5334/aogh.4025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Physician emigration (the brain drain) and sociopolitical unrest significantly contribute to the instability of many low- and middle-income countries' healthcare systems. However, limited literature captures the locally driven and context specific suggestions to promote and sustain these health systems' resilience. Thus, the purpose of this study is to 1) understand the effects of physician emigration and sociopolitical unrest on Nigeria's healthcare system, and to 2) synthesize solutions suggested by Nigeria-trained physicians in the form of a resilience framework. Methods An anonymous online survey was conducted among Nigeria-trained physicians. Respondents were recruited using convenience and snowball sampling methods via a WhatsApp group for Nigeria-trained doctors. Quantitative data were analyzed using Stata 17 and qualitative themes were coded by two independent researchers. Results The final sample included 49 Nigeria-trained physicians-35 physicians practicing in Nigeria and 14 emigrated physicians. All of the physicians currently practicing in Nigeria have considered emigrating, with 79% of them having concrete plans to emigrate in the next five years. Among emigrated physicians, factors such as remuneration (92%) and socioeconomic state of the country (92%) contributed to their decision to emigrate. Suggestions to enhance health system resilience fell into six broad themes: 1) policy and politics, 2) funding and resources, 3) organization and structure, 4) training and education, 5) research and primary health, and 6) health for peace initiatives. Conclusions The healthcare system is currently unstable and vulnerable due to physician emigration and sociopolitical unrest. To develop and implement solutions to mitigate these issues, capturing the locally trained physicians' perspectives are critical. While each country's healthcare system is unique, countries with similar strains can adapt this model for resilience building. Future studies should focus on adapting the model in different countries with policy-level action points.
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Bricka TM, He Y, Schroeder AN. Difficult Times, Difficult Decisions: Examining the Impact of Perceived Crisis Response Strategies During COVID-19. JOURNAL OF BUSINESS AND PSYCHOLOGY 2022; 38:1-21. [PMID: 36531152 PMCID: PMC9734964 DOI: 10.1007/s10869-022-09851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 06/17/2023]
Abstract
Crises, such as the COVID-19 pandemic, require rapid action to be taken by leaders, despite minimal understanding of the impact of implemented crisis management policies and procedures in organizations. This study's purpose was to establish a greater understanding of which perceived crisis response strategies were the most beneficial or detrimental to relevant perceptions and outcomes during the recent COVID-19 crisis. Using a time-lagged study design and a sample of 454 healthcare employees, latent profile analysis was used to identify strategy profiles used by organizations based on several policy/procedure categories (i.e., human-resource supportive, human-resource disadvantaging, behavioral/interactional human safety and protection-focused, and environmental and structural safety supports-focused policies and procedures). Results indicated that four perceived crisis response strategies were employed: (1) human resource-disadvantaging, (2) maximizing, (3) safety and human resource-supportive, and (4) inactive. Perceived crisis response strategy was linked to several employee well-being (e.g., work stress) and behavioral (e.g., safety behavior) outcomes via proximal perceptions (i.e., perceived organizational support, ethical leadership, and safety climate). Proximal perceptions were the most positive for employees within organizations that enacted safety and human resource-supportive policies and procedures or that utilized a maximizing approach by implementing a wide array of crisis response policies and procedures. This paper contributes to the literature by providing crucial information needed to reduce organizational decision-making time in the event of future crises.
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Affiliation(s)
- Traci M. Bricka
- Department of Psychology, The University of Texas at Arlington, 313 Life Science, Box 19528, Arlington, TX 76019 USA
| | - Yimin He
- Department of Psychology, The University of Nebraska Omaha, ASH 347 F, 222 University Dr. E, Omaha, NE 68182 USA
| | - Amber N. Schroeder
- Department of Psychology, The University of Texas at Arlington, 313 Life Science, Box 19528, Arlington, TX 76019 USA
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Khalil M, Ravaghi H, Samhouri D, Abo J, Ali A, Sakr H, Camacho A. What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation. Front Public Health 2022; 10:1009400. [PMID: 36311596 PMCID: PMC9614418 DOI: 10.3389/fpubh.2022.1009400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level. Aim This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature. Methods Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction. Findings and discussion In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings. Conclusion Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.
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Affiliation(s)
- Merette Khalil
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil
| | - Hamid Ravaghi
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dalia Samhouri
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Abo
- Asian Disaster Preparedness Center, Bangkok, Thailand
| | - Ahmed Ali
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hala Sakr
- Department of Healthier Populations, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Alex Camacho
- Health Emergencies Programme, World Health Organization, Regional Office for the Americas, Washington, DC, United States
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Bentahir M, Barry MD, Koulemou K, Gala JL. Providing On-Site Laboratory and Biosafety Just-In-Time Training Inside a Box-Based Laboratory during the West Africa Ebola Outbreak: Supporting Better Preparedness for Future Health Emergencies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811566. [PMID: 36141839 PMCID: PMC9517019 DOI: 10.3390/ijerph191811566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/13/2023]
Abstract
The Biological Light Fieldable Laboratory for Emergencies (B-LiFE) is a box-based modular laboratory with the capacity to quickly deploy on-site in cases of uncontrolled spread of infectious disease. During the 2014-2015 West Africa Ebola outbreak, this tent laboratory provided diagnostic support to the N'Zerekore Ebola Treatment Center (ETC), Guinea, for three months. One of the objectives of B-LiFE deployment was to contribute, as much as possible, to national capacity building by training local scientists. Two Guinean biologists were selected according to their basic biological knowledge and laboratory skills among 50 candidate trainees, and were integrated into the team through "just-in-time training" (JiTT), which helped the biologists acquire knowledge and laboratory skills beyond their expertise. The JiTT program was conducted according to standard laboratory procedures, in line with international biosafety guidelines adapted to field conditions. Supervised acquisition of field-laboratory practices mainly focused on biochemical testing and Ebola viral load quantification using routine PCR-based detection, including the Biofire FilmArray® system (BFA), a novel, as yet non-validated, automated assay for diagnostic testing of Ebola virus disease at the time of B-LiFE deployment. During the JiTT, the two biologists were closely involved in all laboratory activities, including BFA validation and biosafety procedures. Meanwhile, this successful JiTT enhanced the B-LiFE in-field operational capacity and contributed to national capacity building. A post-training evaluation and contacts were organised to assess the evolution and technical skills gained by the two researchers during the B-LiFE mission. At the end of the B-LiFE mission, both biologists were enrolled in follow-on programmes to curb the epidemic spreading in Africa. These results demonstrate that during infectious disease outbreaks or major crises, the JiTT approach can rapidly expand access to critical diagnostic testing and train local staff to do so.
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Affiliation(s)
- Mostafa Bentahir
- Centre for Applied Molecular Technologies (CTMA), Institute of Clinical and Experimental Research, Université Catholique de Louvain, Avenue Hippocrate 54-55, B1.54.01, B-1200 Brussels, Belgium
| | - Mamadou Diouldé Barry
- Laboratoire des Fièvres Hémorragiques Virales de Guinée, N’Zérékoré P.O. Box 50, Guinea
| | - Kekoura Koulemou
- Laboratory of the Prefectural Hospital of Gueckedou, Gueckedou P.O. Box 82, Guinea
| | - Jean-Luc Gala
- Centre for Applied Molecular Technologies (CTMA), Institute of Clinical and Experimental Research, Université Catholique de Louvain, Avenue Hippocrate 54-55, B1.54.01, B-1200 Brussels, Belgium
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15
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Tomita A, Ncama BP, Moodley Y, Davids R, Burns JK, Mabhaudhi T, Modi AT, Slotow R. Community disaster exposure and first onset of depression: A panel analysis of nationally representative South African data, 2008-2017. PLOS CLIMATE 2022; 1:0000024. [PMID: 37720892 PMCID: PMC7615093 DOI: 10.1371/journal.pclm.0000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008-2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households' locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09-1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09-1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09-1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08-1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11-1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.
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Affiliation(s)
- Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe P. Ncama
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Yoshan Moodley
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rashieda Davids
- School of Agricultural, Earth and Environmental Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jonathan K. Burns
- Institute of Health Research, University of Exeter, Exeter, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tafadzwanashe Mabhaudhi
- Centre for Transformative Agricultural and Food Systems, School of Agriculture, Earth and Environmental Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- International Water Management Institute (IWMI-GH)—West Africa Regional Office, Accra, Ghana
| | - Albert T. Modi
- Centre for Transformative Agricultural and Food Systems, School of Agriculture, Earth and Environmental Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Rob Slotow
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Genetics, Evolution and Environment, University College, London, United Kingdom
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16
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HIV Service Interruptions During the COVID-19 Pandemic in China: The Role of COVID-19 Challenges and Institutional Response from Healthcare Professional's Perspective. AIDS Behav 2022; 26:1270-1278. [PMID: 34613522 PMCID: PMC8493360 DOI: 10.1007/s10461-021-03484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
During the COVID-19 pandemic, HIV-related services have been unavoidably disrupted and impacted. However, the nature and scope of HIV service disruptions due to COVID-19 has rarely been characterized in China. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China, from April to May 2020. Latent class analysis (LCA) was first used to identify HIV service disruption levels, then hierarchical multilevel logistic regression was conducted to analyze the relationships of COVID-19 challenges, institutional responses, and HIV service disruption levels adjusting for the clustering effect of institutional ownership levels. Four classes of HIV service disruption were identified, with 22.0% complete disruption, 15.4% moderate disruption, 21.9% minor disruption, and 40.7% almost no disruption. COVID-19 challenges were positively associated with the probabilities of service disruption levels. Institutional responses were negatively associated with the probabilities of being classified as “minor disruption” and moderated the association of COVID-19 challenges with complete and moderate disruptions compared with no disruption group. To maintain continuity of core HIV services in face of a pandemic, building a resilient health care system with adequate preparedness is necessary.
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Karamagi HC, Titi-Ofei R, Kipruto HK, Seydi ABW, Droti B, Talisuna A, Tsofa B, Saikat S, Schmets G, Barasa E, Tumusiime P, Makubalo L, Cabore JW, Moeti M. On the resilience of health systems: A methodological exploration across countries in the WHO African Region. PLoS One 2022; 17:e0261904. [PMID: 35130289 PMCID: PMC8820618 DOI: 10.1371/journal.pone.0261904] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 12/14/2021] [Indexed: 01/06/2023] Open
Abstract
The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it". There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.
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Affiliation(s)
| | - Regina Titi-Ofei
- Data, Analytics and Knowledge Management - WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | - Benson Droti
- Health Information Systems team - WHO Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- Emergency Preparedness and Response Cluster - WHO Regional Office for Africa, Brazzaville, Congo
| | - Benjamin Tsofa
- Health Policy and Systems Research Team - KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sohel Saikat
- Health Services Resilience Team - World Health Organization Headquarters, Geneva, Switzerland
| | - Gerard Schmets
- Primary Health Care Special Programme - World Health Organization Headquarters, Geneva, Switzerland
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Lindiwe Makubalo
- Assistant Regional Director, WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Matshidiso Moeti
- Regional Director, WHO Regional Office for Africa, Brazzaville, Congo
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18
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Budiastutik I, Kartasurya MI, Subagio HW, Widjanarko B. High Prevalence of Prediabetes and Associated Risk Factors in Urban Areas of Pontianak, Indonesia: A Cross-Sectional Study. J Obes 2022; 2022:4851044. [PMID: 36536959 PMCID: PMC9759381 DOI: 10.1155/2022/4851044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Uncontrolled prediabetes can develop into Type 2 Diabetes mellitus (T2DM). The incidence of T2DM among adults in Pontianak, Indonesia was reported remarkably high. Therefore, this study aimed to investigate the risk factors for prediabetes in adults living in urban areas of Pontianak, Indonesia. A cross-sectional study was conducted in 5 subdistricts of Pontianak. A total of 506 adults underwent screening to obtain subjects with fasting blood glucose (FBS) of ≤124 mg/dL and aged >30 years. Blood pressure and body mass index (BMI) were measured. Interview using a structured questionnaire were performed to obtain data on predictor variables (age, sex, education, income, health insurance, tobacco use, history of hypertension, gout, high cholesterol level, frequency of exercise per week, and diabetic education). The prevalence of prediabetes among subjects was significantly high (76.4%). Subjects were predominantly above 40 years, female, had low income, low education level, and had health insurance. About a third of the subjects had a history of hypertension, gout, and high cholesterol level, respectively. The exercise frequency was mostly less than 3 times/week, and the BMI was mainly classified as overweight and obese. The result of spearman's rho correlation showed that age (r = 0.146; p=0.022) and BMI (r = 0.130; p=0.041) significantly correlated with prediabetes incidence. Moreover, the chi-square analysis demonstrated that health insurance ownership (OR = 4.473; 95% CI 1.824-10.972; p ≤ 0.001), history of hypertension (OR = 3.096; 95% CI 1.542-6.218; p=0.001), and history of gout (OR = 2.419; 95% CI 1.148-5.099; p=0.018), were associated with prediabetes incidence. For all these significant risk predictors except BMI, the significant associations were found only among female subjects after specific sex analysis. Moreover, multivariate logistic regression showed that health insurance ownerships (OR = 5.956; 95% CI 2.256-15.661; p ≤ 0.001) and history of hypertension (OR = 3.257; 95% CI 1.451-7.311; p=0.004), and systolic blood pressure (OR = 2.141; 95% CI 1.092-4.196; p=0.027) were the risk factors for prediabetes. It is concluded that the prevalence of prediabetes is probably high especially among urban people in Pontianak, Indonesia. Health insurance ownership and hypertension may have an important role in prediabetes management. The risk factors might be different between male and female.
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Affiliation(s)
- Indah Budiastutik
- Doctoral Program, Faculty of Public Health, Diponegoro University, Semarang 50275, Indonesia
| | - Martha I. Kartasurya
- Public Health Nutrition Department, Faculty of Public Health, Diponegoro University, Semarang 50275, Indonesia
| | - Hertanto W. Subagio
- Clinical Nutrition Department, Faculty of Medicine, Diponegoro University, Semarang 50275, Indonesia
| | - Bagoes Widjanarko
- Department of Health Promotion, Faculty of Public Health, Diponegoro University, Semarang 50275, Indonesia
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19
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Wuthisuthimethawee P, Rojsaengroeng R, Krongtrivate T. Development of Hospital MCI and Disaster Preparedness Assessment Tool for Thailand. Risk Manag Healthc Policy 2021; 14:3465-3471. [PMID: 34456593 PMCID: PMC8387310 DOI: 10.2147/rmhp.s314391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Hospital preparedness is a key component to mitigate the effects of mass casualty incidents (MCIs) and disasters. Improving hospital preparedness requires an assessment of the country's current health system capacity, readiness, and preparedness. Although a variety of assessment tools exist, none are entirely suitable for Thailand's healthcare system. Objective To develop an assessment tool to evaluate hospital preparedness for MCI and disaster in Thailand. Methods A cross-sectional study was conducted from 1 March 2015 to December 2016. The contents of the first drafted tool were prepared based on evidence from a systematic search of electronic databases published up to 31 December 2014. Key elements identification, extraction, and further organization were based on the World Health Organization health system framework. Validity was tested by experts and emergency management personnel in four domains using a 5-point scale evaluation form. The feasibility of using this assessment tool was carried out in 41 hospitals on a voluntary basis. The tool was considered valid if the item-objective congruence (IOC) index results were at least 0.6 and feasible for median values of at least 4. Results Seventy-six full texts and guidelines out of 5869 titles and abstracts from a systematic search were enrolled in the study. A constructive literature review was performed to develop a hospital assessment tool. The IOC index results of the assessment tool components were 1.0, 0.9, 0.7, and 1.0 in framework appropriateness, relevance of items, clearness, and usefulness, respectively. The median (interquartile range) values of framework appropriateness, relevance of items, clearness, and usefulness were 4.0 (4.0‒5.0), 4.3 (4.3‒4.5), 4.0 (4.0‒4.0), and 5.0 (4.0‒5.0), respectively. Conclusion An assessment tool to evaluate hospital MCI and disaster preparedness based on the WHO health system framework was valid and feasible at the national level of Thailand.
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Affiliation(s)
- Prasit Wuthisuthimethawee
- Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rapeeporn Rojsaengroeng
- Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Department of Emergency Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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20
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Biddle L, Wahedi K, Bozorgmehr K. Health system resilience: a literature review of empirical research. Health Policy Plan 2021; 35:1084-1109. [PMID: 32529253 PMCID: PMC7553761 DOI: 10.1093/heapol/czaa032] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 11/25/2022] Open
Abstract
The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.
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Affiliation(s)
- Louise Biddle
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany
| | - Katharina Wahedi
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany
| | - Kayvan Bozorgmehr
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
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21
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Goniewicz K, Goniewicz M, Włoszczak-Szubzda A, Burkle FM, Hertelendy AJ, Al-Wathinani A, Molloy MS, Khorram-Manesh A. The importance of pre-training gap analyses and the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training. BMC Public Health 2021; 21:114. [PMID: 33422033 PMCID: PMC7796807 DOI: 10.1186/s12889-021-10165-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals. Methods A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland. Results The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion. Conclusion Pre-Training gap analyses and identification of participants’ competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10165-5.
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Affiliation(s)
- Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521, Dęblin, Poland.
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-059, Lublin, Poland
| | | | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, 33174, USA
| | - Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Michael Sean Molloy
- Department of Emergency Medicine, Wexford General Hospital, Wexford, Y35 Y17D, Ireland.,School of Medicine, University College Dublin, Donnybrook, D4, Ireland.,BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, 457 Brookline Avenue, Boston, MA, 02215, USA
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden.,Research Advisor, Department of Development and Research, Armed Forces Center for Defense Medicine, 426 76, Gothenburg, Västra Frölunda, Sweden
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22
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Bouchard ME, Sheneman N, Hey MT, Hoemeke L, Abdullah F. Investments in surgical systems contribute to pandemic readiness and health system resilience. J Public Health Policy 2021; 42:493-500. [PMID: 34193939 PMCID: PMC8243617 DOI: 10.1057/s41271-021-00292-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
Safe surgical care, including anesthesia, obstetrics, and trauma, is an essential component of a functional health system, yet five billion people lack access to high-quality, timely and affordable surgical care. As health decision makers are grappling with how to make appropriate investments for crisis readiness and resilience, investments in surgical care should be considered for their compounding benefits to meet a country's diverse health goals. National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) are developed through global partnerships and multi-stakeholder consensus and provide a dynamic framework for surgical scale-up that also improves the resilience of the larger health system. Our paper applies principles from the literature on health system resilience to surgical systems and examines the unique capabilities of the surgical workforce and infrastructure to be redeployed during times of crisis, using examples from the current pandemic.
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Affiliation(s)
- Megan E. Bouchard
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
| | | | - Matthew T. Hey
- The G4 Alliance, Chicago, IL USA ,grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Laura Hoemeke
- The G4 Alliance, Chicago, IL USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC USA
| | - Fizan Abdullah
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
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Bang HN, Mbah MF, Ndi HN, Ndzo JA. Gauging Cameroon’s resilience to the COVID-19 pandemic: implications for enduring a novel health crisis. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2020. [DOI: 10.1108/tg-08-2020-0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose
This paper aims to examine Cameroon’s health service resilience in the first five months (March–July 2020) of the coronavirus (COVID-19) outbreak. The motive is to diagnose sub-optimal performance in sustaining health-care services during the pandemic to identify areas for improvement and draw lessons for the future.
Design/methodology/approach
This is principally qualitative, exploratory, analytical and descriptive research that involves the collation of empirical, primary and secondary data. A conceptual framework [health systems resilience for emerging infectious diseases (HSREID)] provides structure to the study and an anchor for interpreting the findings. The research validity has been established by analysing the aims/objectives from multiple perspectives in the research tradition of triangulation.
Findings
Cameroon has exerted much effort to combat the COVID-19 pandemic. Yet, several constraints and gaps exist. The findings reveal limitations in Cameroon’s response to the COVID-19 pandemic in the provision of fundamental health-care services under contextual themes of health infrastructure/medical supplies, human capital, communication/sensitisation/health education, governance and trust/confidence. Analysis of the identified impediments demonstrates that Cameroon’s health-care system is not resilient enough to cope with the COVID-19 pandemic and provides several insights for an enhanced response as the pandemic accelerates in the country.
Originality/value
This is one of the first scholarly articles to examine how Cameroon’s health-care system is faring in COVID-19 combat. Underscored by the novel HSREID model, this study provides initial insights into Cameroon’s resilience to COVID-19 with a view to enhancing the health system’s response as the pandemic unfolds and strengthens readiness for subsequent health crises.
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Goniewicz K, Burkle FM, Khorram-Manesh A. The gap of knowledge and skill - One reason for unsuccessful management of mass casualty incidents and disasters. Am J Emerg Med 2020; 46:744-745. [PMID: 33036863 DOI: 10.1016/j.ajem.2020.09.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland.
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden; Department of Development and Research, Armed Forces Center for Defense Medicine, Gothenburg, 426 76, Västra Frölunda, Sweden
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25
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Fallah-Aliabadi S, Ostadtaghizadeh A, Ardalan A, Fatemi F, Khazai B, Mirjalili MR. Towards developing a model for the evaluation of hospital disaster resilience: a systematic review. BMC Health Serv Res 2020; 20:64. [PMID: 31996213 PMCID: PMC6988294 DOI: 10.1186/s12913-020-4915-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience. METHODS This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters. RESULTS Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR. CONCLUSION Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.
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Affiliation(s)
- Saeed Fallah-Aliabadi
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Harvard Humanitarian Initiative, Harvard University, Cambridge, USA
| | - Farin Fatemi
- Research Center for Health Services and Technologies, Semnan University of Medical Sciences, Semnan, Iran
| | - Bijan Khazai
- Karlsruhe Institute of Technology (KIT), Center for Disaster Management and Risk Reduction Technology, Karlsruhe, Germany
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Talisuna AO, Okiro EA, Yahaya AA, Stephen M, Bonkoungou B, Musa EO, Minkoulou EM, Okeibunor J, Impouma B, Djingarey HM, Yao NKM, Oka S, Yoti Z, Fall IS. Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016-2018. Global Health 2020; 16:9. [PMID: 31941554 DOI: 10.1186/s12992-019-050-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/30/2019] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018. METHODS We abstracted data from several sources, including: the WHO African Region's weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources. DATA ANALYSIS We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5-9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports. RESULTS Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis. CONCLUSIONS The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.
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Affiliation(s)
- Ambrose Otau Talisuna
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo.
| | - Emelda Aluoch Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Mary Stephen
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Boukare Bonkoungou
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Emmanuel Onuche Musa
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Benido Impouma
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Haruna Mamoudou Djingarey
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - N'da Konan Michel Yao
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Sakuya Oka
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Zabulon Yoti
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Ibrahima Socé Fall
- World Health Organization, Emergency Response Department, Health Emergencies programme, Geneva, Switzerland
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27
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Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016-2018. Global Health 2020; 16:9. [PMID: 31941554 PMCID: PMC6964091 DOI: 10.1186/s12992-019-0540-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Emerging and re-emerging diseases with pandemic potential continue to challenge fragile health systems in Africa, creating enormous human and economic toll. To provide evidence for the investment case for public health emergency preparedness, we analysed the spatial and temporal distribution of epidemics, disasters and other potential public health emergencies in the WHO African region between 2016 and 2018. Methods We abstracted data from several sources, including: the WHO African Region’s weekly bulletins on epidemics and emergencies, the WHO-Disease Outbreak News (DON) and the Emergency Events Database (EM-DAT) of the Centre for Research on the Epidemiology of Disasters (CRED). Other sources were: the Program for Monitoring Emerging Diseases (ProMED) and the Global Infectious Disease and Epidemiology Network (GIDEON). We included information on the time and location of the event, the number of cases and deaths and counter-checked the different data sources. Data analysis We used bubble plots for temporal analysis and generated graphs and maps showing the frequency and distribution of each event. Based on the frequency of events, we categorised countries into three: Tier 1, 10 or more events, Tier 2, 5–9 events, and Tier 3, less than 5 or no event. Finally, we compared the event frequencies to a summary International Health Regulations (IHR) index generated from the IHR technical area scores of the 2018 annual reports. Results Over 260 events were identified between 2016 and 2018. Forty-one countries (87%) had at least one epidemic between 2016 and 2018, and 21 of them (45%) had at least one epidemic annually. Twenty-two countries (47%) had disasters/humanitarian crises. Seven countries (the epicentres) experienced over 10 events and all of them had limited or developing IHR capacities. The top five causes of epidemics were: Cholera, Measles, Viral Haemorrhagic Diseases, Malaria and Meningitis. Conclusions The frequent and widespread occurrence of epidemics and disasters in Africa is a clarion call for investing in preparedness. While strengthening preparedness should be guided by global frameworks, it is the responsibility of each government to finance country specific needs. We call upon all African countries to establish governance and predictable financing mechanisms for IHR implementation and to build resilient health systems everywhere.
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Fridell M, Edwin S, von Schreeb J, Saulnier DD. Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords. Int J Health Policy Manag 2020; 9:6-16. [PMID: 31902190 PMCID: PMC6943300 DOI: 10.15171/ijhpm.2019.71] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 09/02/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. DISCUSSION No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.
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Affiliation(s)
- My Fridell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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29
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Olu O, Drameh-Avognon P, Asamoah-Odei E, Kasolo F, Valdez T, Kabaniha G, Karamagi H, Good S, O'Malley H, Yoti Z, Razakazoa N, Minkoulou E, Dangou JM, Mbola Mbassi S, Castellon MS, Cabore J, Moeti M. Community participation and private sector engagement are fundamental to achieving universal health coverage and health security in Africa: reflections from the second Africa health forum. BMC Proc 2019; 13:7. [PMID: 31737089 PMCID: PMC6849158 DOI: 10.1186/s12919-019-0170-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Inadequate access to quality health care services due to weak health systems and recurrent public health emergencies are impediments to the attainment of Universal Health Coverage and health security in Africa. To discuss these challenges and deliberate on plausible solutions, the World Health Organization Regional Office for Africa, in collaboration with the Government of Cabo Verde, convened the second Africa Health Forum in Praia, Cabo Verde on 26–28 March 2019, under the theme Achieving Universal Health Coverage and Health Security: The Africa We Want to See. Methods The Forum was conducted through technical sessions consisting of high-level, moderated panel discussions on specific themes, some of them preceded by keynote addresses. There were booth exhibitions by Member States, World Health Organization and other organizations to facilitate information exchanges. A Communiqué highlighting the recommendations of the Forum was issued during the closing ceremony. More than 750 participants attended. Relevant information from the report of the Forum and notes by the authors were extracted and synthesized into these proceedings. Conclusions The Forum participants agreed that the role of community engagement and participation in the attainment of Universal Health Coverage, health security and ultimately the Sustainable Development Goals cannot be overemphasized. The public sector of Africa alone cannot achieve these three interrelated goals; other partners, such as the private sector, must be engaged. Technological innovations will be a key driver of the attainment of these goals; hence, there is need to harness the comparative advantages that they offer. Attainment of the three goals is also intertwined – achieving one paves the way for achieving the others. Thus, there is need for integrated public health approaches in the planning and implementation of interventions aimed at achieving them. Recommendations To ensure that the recommendations of this Forum are translated into concrete actions in a sustainable manner, we call on African Ministers of Health to ensure their integration into national health sector policies and strategic documents and to provide the necessary leadership required for their implementation. We also call on partners to mainstream these recommendations into their ongoing support to World Health Organization African Member States.
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Affiliation(s)
- Olushayo Olu
- WHO Country Office, Juba, Republic of South Sudan
| | | | - Emil Asamoah-Odei
- 3Consultant, Regional Director's Office, WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Francis Kasolo
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Grace Kabaniha
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Suvajee Good
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Helena O'Malley
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Zabulon Yoti
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Nirina Razakazoa
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | | | | | | | - Joseph Cabore
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Matshidiso Moeti
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
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Abdul-Razik MS, Kaity AM, Banafaa NS, El-Hady GW. Disaster response in a civil war: Lessons on local hospitals capacity. The case of Yemen. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1616386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Abdullah Mubark Kaity
- Department of Public Health, College of Nursing, Hadhramout University, Mukalla, Yemen
| | - Nawal Saeed Banafaa
- Department of Public Health, College of Nursing, Hadhramout University, Mukalla, Yemen
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Chamberland-Rowe C, Chiocchio F, Bourgeault IL. Harnessing instability as an opportunity for health system strengthening: A review of health system resilience. Healthc Manage Forum 2019; 32:128-135. [PMID: 30971130 DOI: 10.1177/0840470419830105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study's intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system's sustainability and integrity.
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Affiliation(s)
| | - François Chiocchio
- 1 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Ivy Lynn Bourgeault
- 1 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
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Turenne CP, Gautier L, Degroote S, Guillard E, Chabrol F, Ridde V. Conceptual analysis of health systems resilience: A scoping review. Soc Sci Med 2019; 232:168-180. [PMID: 31100697 DOI: 10.1016/j.socscimed.2019.04.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
System resilience has long been an area of study, and the term has become increasingly used across different sectors. Studies on resilience in health systems are more recent, multiplying particularly since the 2014 Ebola epidemic in West Africa. The World Health Organization (WHO) is calling for national governments to increase the resilience of their health systems. Concepts help define research objects and guide the analysis. Yet, to be useful, concepts need to be clear and precise. We aimed to improve the conceptual understanding of health systems resilience by conducting a scoping review to describe the state of knowledge in this area. We searched for literature in 10 databases, and analyzed data using a list of themes. We evaluated the clarity and the precision of the concept of health systems resilience using Daigneault & Jacob's three dimensions of a concept: term, sense, and referent. Of the 1091 documents initially identified, 45 met the inclusion criteria. Term: multiple terms are used, switching from one to the other to speak about the same subject. Sense: there is no consensus yet on a unique definition. Referent: the magnitude and nature of events that resilient health systems face differ with context, covering a broad range of situations from sudden crisis to everyday challenges. The lack of clarity in this conceptualization hinders the expansion of knowledge, the creation of reliable analytical tools, and the effectiveness of communication. The current conceptualization of health systems resilience is too scattered to enable the enhancement of this concept with great potential, opening a large avenue for future research.
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Affiliation(s)
- Charlotte Pailliard Turenne
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, 75006, Paris, France.
| | - Lara Gautier
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada; Public Health Research Institute, University of Montreal, 2900, Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada; CESSMA (IRD-Paris-Diderot University), Université Sorbonne Paris Cité, Bâtiment Olympe de Gouges (8ème étage - secrétariat bureau 817) rue Albert Einstein, 75013, PARIS, France.
| | - Stéphanie Degroote
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, 75006, Paris, France.
| | | | - Fanny Chabrol
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, 75006, Paris, France.
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, 75006, Paris, France; Fellow de l'Institut Français des Migrations, Paris, France.
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