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Bozorgmehr K, McKee M, Azzopardi-Muscat N, Bartovic J, Campos-Matos I, Gerganova TI, Hannigan A, Janković J, Kállayová D, Kaplan J, Kayi I, Kondilis E, Lundberg L, Mata IDL, Medarević A, Suvada J, Wickramage K, Puthoopparambil SJ. Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100744. [PMID: 37927430 PMCID: PMC10625017 DOI: 10.1016/j.lanepe.2023.100744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. Funding No specific funding received.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Lancet Migration European Hub
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Medicine & Tropical Hygiene, London, UK
| | | | | | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | | | - Ailish Hannigan
- WHO Collaborating Centre for Migrant’s Involvement in Health Research, School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Daniela Kállayová
- Lancet Migration European Hub
- Department of Public Health, Screening and Prevention, Ministry of Health, Slovak Republic
- Trnava University, Trnava, Slovak Republic
| | - Josiah Kaplan
- UNICEF Global Office of Research and Foresight, Florence, Italy
| | - Ilker Kayi
- Department of Public Health, School of Medicine, Koç University, Istanbul, Türkiye
| | - Elias Kondilis
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lene Lundberg
- Lancet Migration European Hub
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Aleksandar Medarević
- Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut', Belgrade, Serbia
| | - Jozef Suvada
- St. Elizabeth University of Public Health and Social Work, Slovak Republic
- WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, and McMaster GRADE Centre, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Kolitha Wickramage
- UN Migration Agency Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany
| | - Soorej Jose Puthoopparambil
- WHO Collaborating Centre on Migration and Health Data and Evidence, Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Sweden
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Karreinen S, Paananen H, Kihlström L, Janhonen K, Huhtakangas M, Viita-Aho M, Tynkkynen LK. Living through uncertainty: a qualitative study on leadership and resilience in primary healthcare during COVID-19. BMC Health Serv Res 2023; 23:233. [PMID: 36894990 PMCID: PMC9997436 DOI: 10.1186/s12913-023-09223-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Resilience is often referred to when assessing the ability of health systems to maintain their functions during unexpected events. Primary healthcare forms the basis for the health system and thus its resilient responses are vital for the outcomes of the whole system. Understanding how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks, is key to public health preparedness. This study aims to identify how leaders responsible for local health systems interpreted changes in their operational environment during the first year of COVID-19, and to elucidate how these views reflect aspects of resilience in healthcare. METHODS The data consist of 14 semi-structured individual interviews with leaders of local health systems in Finland representing primary healthcare. The participants were recruited from four regions. An abductive thematic analysis was used to identify entities from the viewpoints of the purpose, resources, and processes of resilience in the healthcare organisation. RESULTS Results were summarised as six themes, which suggest that embracing uncertainty is viewed by the interviewees a basis for primary healthcare functioning. Leading towards adaptability was regarded a distinct leadership task enabling the organisation to modify its functions according to demands of the changing operational environment. Workforce, knowledge and sensemaking, as well as collaboration represented what the leaders viewed as the means for achieving adaptability. The ability to adapt functioned to comprehensively meet the population's service needs built on a holistic approach. CONCLUSIONS The results showed how the leaders who participated in this study adapted their work during changes brought on by the pandemic, and what they viewed as critical for maintaining organisational resilience. The leaders considered embracing uncertainty as a principal feature of their work rather than viewing uncertainty as aberrant and something to avoid. These notions, along with what the leaders considered as critical means for building resilience and adaptability should be addressed and elaborated in future research. Research on resilience and leadership should be conducted more in the complex context of primary healthcare, where cumulative stresses are encountered and processed continuously.
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Affiliation(s)
- Soila Karreinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Henna Paananen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Laura Kihlström
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland.,Cultural, Behavioral & Media Insights Centre, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kristiina Janhonen
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Moona Huhtakangas
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.,Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
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Kihlström L, Siemes L, Huhtakangas M, Keskimäki I, Tynkkynen LK. Power and politics in a pandemic: Insights from Finnish health system leaders during COVID-19. Soc Sci Med 2023; 321:115783. [PMID: 36863240 PMCID: PMC9933459 DOI: 10.1016/j.socscimed.2023.115783] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Power and politics are both critical concepts to engage with in health systems and policy research, as they impact actions, processes, and outcomes at all levels in health systems. Building on the conceptualization of health systems as social systems, we investigate how power and politics manifested in the Finnish health system during COVID-19, posing the following research question: in what ways did health system leaders and experts experience issues of power and politics during COVID-19, and how did power and politics impact health system governance? We completed online interviews with health system leaders and experts (n = 53) at the local, regional, and national level in Finland from March 2021 to February 2022. The analysis followed an iterative thematic analysis process in which the data guided the codebook. The results demonstrate that power and politics affected health system governance in Finland during COVID-19 in a multitude of ways. These can be summarized through the themes of credit and blame, frame contestation, and transparency and trust. Overall, political leaders at the national level were heavily involved in the governance of COVID-19 in Finland, which was perceived as having both negative and positive impacts. The politicization of the pandemic took health officials and civil servants by surprise, and events during the first year of COVID-19 in Finland reflect recurring vertical and horizontal power dynamics between local, regional, and national actors. The paper contributes to the growing call for power-focused health systems and policy research. The results suggest that analyses of pandemic governance and lessons learned are likely to leave out critical factors if left absent of an explicit analysis of power and politics, and that such analyses are needed to ensure accountability in health systems.
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Affiliation(s)
- Laura Kihlström
- Cultural, Behavioral, and Media Insights Centre, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland; Department of Anthropology, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33602, United States.
| | - Lea Siemes
- Maastricht University, Minderbroedersberg 4-6, 6211, LK Maastricht, Netherlands; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland.
| | - Moona Huhtakangas
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland.
| | - Ilmo Keskimäki
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, Finland.
| | - Liina-Kaisa Tynkkynen
- Welfare State Research and Reform, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Kalevantie 4, 33100, Tampere, Finland.
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“Local cooperation has been the cornerstone”: facilitators and barriers to resilience in a decentralized health system during COVID-19 in Finland. J Health Organ Manag 2022; ahead-of-print. [DOI: 10.1108/jhom-02-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PurposeThe purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland.Design/methodology/approachThe authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis.FindingsThe findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions.Originality/valueFactors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.
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Smaggus A, Long JC, Ellis LA, Clay-Williams R, Braithwaite J. Investigating Resilience in Healthcare: Easier Said Than Done? A Response to the Recent Commentaries. Int J Health Policy Manag 2022; 12:7682. [PMID: 37579451 PMCID: PMC10125065 DOI: 10.34172/ijhpm.2022.7682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 08/16/2023] Open
Affiliation(s)
| | - Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A. Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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