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Ragwar V, Brown M. Causal factors of childhood pneumonia high mortalities and the impact of community case management on child survival in Sub-Saharan Africa: a systematic review. Public Health 2023; 223:131-138. [PMID: 37639996 DOI: 10.1016/j.puhe.2023.07.033] [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: 10/14/2022] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aimed to (1) evaluate the effectiveness of community case management (CCM) and validity of its implementation in the context of Sub-Saharan Africa (SSA) region; (2) identify potential differences in pneumonia disease aetiology, geographic region and cultural factors that may impact the implementation and delivery of community-based interventions; and (3) identify strategies that public health practitioners, stakeholders and policymakers could use to implement CCM. STUDY DESIGN This was a systematic review. METHODS Comprehensive searches were conducted in Cochrane Library, MEDLINE, CINAHL and Scopus databases from 2012 to 2023. Google Scholar, World Health Organization/United Nations Children's Fund websites, unpublished grey literature, PROSPERO (International Register of Systematic Reviews) and a manual search of references lists for relevant articles. RESULTS A total of 441 articles were screened, and eight articles were included for the review. Studies were from seven countries in SSA located in three regions: East (Kenya, Tanzania, Ethiopia), West (Nigeria, Senegal, Sierra Leone) and South (South Africa). The study designs of articles included two cluster randomised control trials, four cohorts and two case-control studies. A cross-analysis of the papers identified themes under the subheadings CCM and causal factors and risk factors. CONCLUSION Successful impact of implementation and adoption of CCM in the context of SSA culture and environment can be achieved when focused on creating high-demand, dependable and quality healthcare services. Continual monitoring and evaluation of emerging high trends of viral pathogens and co-infections are critical in reducing childhood pneumonia mortalities.
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Affiliation(s)
- V Ragwar
- University of Hertfordshire, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - M Brown
- University of Hertfordshire, Centre of Postgraduate Medicine and Public Health, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK
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Bagenda F, Wesuta AC, Stone G, Ntaro M, Patel P, Kenney J, Baguma S, Ayebare DS, Bwambale S, Matte M, Kawungezi PC, Mulogo EM. Contribution of community health workers to the treatment of common illnesses among under 5-year-olds in rural Uganda. Malar J 2022; 21:296. [PMID: 36271397 PMCID: PMC9587615 DOI: 10.1186/s12936-022-04316-1] [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: 02/17/2021] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The control of malaria, pneumonia, and diarrhoea is important for the reduction in morbidity and mortality among children under 5 years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers (CHWs) to address this challenge. The extent and trend of these three conditions managed by the CHWs are not well documented. This study was done to describe the epidemiology and trends of the three common illnesses treated by the CHWs in Bugoye Sub-County in rural Uganda. Methods A retrospective review of monthly morbidity data for children less than 5 years of age for the period April 2014–December 2018 for CHWs in rural Bugoye Sub-County in Kasese district, Uganda was done. The total number reviewed was 18,430 records. The data were analysed using STATA version 14. Results In total male were 50.2% of the sample, pneumonia was the highest cause of illness among the infants (< 1 year), while malaria was the highest among the children 1 year–59 months. Infection with a single illness was the commonest recorded cause of presentation but there were some children recorded with multiple illnesses. All the CHWs were managing the three common illnesses among children under 5 years. The trend of the three common illnesses was changing from malaria to pneumonia being the commonest. Children aged 12–24 months and 25–59 months were at 2.1 times (95% CI 1.7–2.4) and 5.2 times (95% CI 4.6–5.9), respectively, more likely to get malaria but less likely to get pneumonia and diarrhoea. Conclusion Community Health Workers in rural Uganda are contributing significantly to the management of all the three commonest illnesses among under-5 years-old children. The trend of the commonest illness is changing from malaria to pneumonia. Children under 1 year are at a higher risk of getting pneumonia and diarrhoea and at a lower risk of getting malaria.
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Affiliation(s)
- Fred Bagenda
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Andrew Christopher Wesuta
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Geren Stone
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Palka Patel
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | - Jessica Kenney
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, USA
| | | | - David Santson Ayebare
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | | | - Michael Matte
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Peter Chris Kawungezi
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Edgar Mugema Mulogo
- Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Werner K, Kak M, Herbst CH, Lin TK. The role of community health worker-based care in post-conflict settings: a systematic review. Health Policy Plan 2022; 38:261-274. [PMID: 36124928 PMCID: PMC9923383 DOI: 10.1093/heapol/czac072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/28/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
Countries affected by conflict often experience the deterioration of health system infrastructure and weaken service delivery. Evidence suggests that healthcare services that leverage local community dynamics may ameliorate health system-related challenges; however, little is known about implementing these interventions in contexts where formal delivery of care is hampered subsequent to conflict. We reviewed the evidence on community health worker (CHW)-delivered healthcare in conflict-affected settings and synthesized reported information on the effectiveness of interventions and characteristics of care delivery. We conducted a systematic review of studies in OVID MedLine, Web of Science, Embase, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINHAL) and Google Scholar databases. Included studies (1) described a context that is post-conflict, conflict-affected or impacted by war or crisis; (2) examined the delivery of healthcare by CHWs in the community; (3) reported a specific outcome connected to CHWs or community-based healthcare; (4) were available in English, Spanish or French and (5) were published between 1 January 2000 and 6 May 2021. We identified 1976 articles, of which 55 met the inclusion criteria. Nineteen countries were represented, and five categories of disease were assessed. Evidence suggests that CHW interventions not only may be effective but also efficient in circumventing the barriers associated with access to care in conflict-affected areas. CHWs may leverage their physical proximity and social connection to the community they serve to improve care by facilitating access to care, strengthening disease detection and improving adherence to care. Specifically, case management (e.g. integrated community case management) was documented to be effective in improving a wide range of health outcomes and should be considered as a strategy to reduce barrier to access in hard-to-reach areas. Furthermore, task-sharing strategies have been emphasized as a common mechanism for incorporating CHWs into health systems.
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Affiliation(s)
- Kalin Werner
- *Corresponding author. Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA. E-mail:
| | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, 1818 H Street, N.W., Washington, DC 20433, USA
| | - Tracy Kuo Lin
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA 94158, USA
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Debel LN, Nigusso FT. Integrated Community Case Management Utilization Status and Associated Factors Among Caretakers of Sick Children Under the Age of 5 Years in West Shewa, Ethiopia. Front Public Health 2022; 10:929764. [PMID: 35937261 PMCID: PMC9347826 DOI: 10.3389/fpubh.2022.929764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the utilization status and associated factors of integrated community case management (ICCM) of caretakers with <5 years of sick children. Methods Community-based cross-sectional study was employed with caretakers whose child was sick in the last 3 months before data collection. Bivariate and multivariable logistic regression analyses were employed. Results About 624 respondents participated in the study; 325 (52.1%) utilized integrated community case management. Caring for children between the ages 24–36 months old, (AOR = 1.26, 95%CI: 0.23, 0.90); women health development army (WHDA) training, (AOR = 5.76, 95%CI: 3.57, 9.30); certified as model family, (AOR = 3.98, 95%CI: 2.45, 6.46); perceived severity, (AOR = 5.29, 95%CI: 2.64, 10.60); awareness of danger sign, (AOR = 2.76, 95%CI: 1.69, 4.50), and awareness of ICCM, (AOR = 5.42, 95%CI: 1.67, 17.58) were associated with ICCM utilization. Conclusion This study revealed that age of the child, caretakers' awareness of ICCM, awareness of danger signs, illness severity, women's health developmental army training, and graduation as a model family were associated with ICCM utilization. Therefore, it is recommended that promote health education using community-level intervention modalities focusing on common childhood illness symptoms, danger signs, severity, and care-seeking behavior.
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Affiliation(s)
- Lemessa Negeri Debel
- Department of HIV and TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fikadu Tadesse Nigusso
- School-Based Programme Unit, World Food Programme, Addis Ababa, Ethiopia
- *Correspondence: Fikadu Tadesse Nigusso
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Allen KC, Whitfield K, Rabinovich R, Sadruddin S. The role of governance in implementing sustainable global health interventions: review of health system integration for integrated community case management (iCCM) of childhood illnesses. BMJ Glob Health 2021; 6:bmjgh-2020-003257. [PMID: 33789866 PMCID: PMC8016094 DOI: 10.1136/bmjgh-2020-003257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Improving health outcomes in countries with the greatest burden of under-5 child mortality requires implementing innovative approaches like integrated community case management (iCCM) to improve coverage and access for hard-to-reach populations. ICCM improves access for hard-to-reach populations by deploying community health workers to manage malaria, diarrhoea and pneumonia. Despite documented impact, challenges remain in programme implementation and sustainability. An analytical review was conducted using evidence from published and grey literature from 2010 to 2019. The goal was to understand the link between governance, policy development and programme sustainability for iCCM. A Governance Analytical Framework revealed thematic challenges and successes for iCCM adaptation to national health systems. Governance in iCCM included the collective problems, actors in coordination and policy-setting, contextual norms and programmatic interactions. Key challenges were country leadership, contextual evidence and information-sharing, dependence on external funding, and disease-specific stovepipes that impede funding and coordination. Countries that tailor and adapt programmes to suit their governance processes and meet their specific needs and capacities are better able to achieve sustainability and impact in iCCM.
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Affiliation(s)
- Koya C Allen
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Kate Whitfield
- Malaria Eradication Scientific Alliance (MESA), Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Regina Rabinovich
- Malaria Elimination Initiative, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalunya, Spain.,ExxonMobil Malaria Scholar in Residence, Department of Immunology and Infectious Diseases, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Salim Sadruddin
- Child Health, MOMENTUM Country and Global Leadership, Washington, DC, USA
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Oliphant NP, Manda S, Daniels K, Odendaal WA, Besada D, Kinney M, White Johansson E, Doherty T. Integrated community case management of childhood illness in low- and middle-income countries. Cochrane Database Syst Rev 2021; 2:CD012882. [PMID: 33565123 PMCID: PMC8094443 DOI: 10.1002/14651858.cd012882.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012). OBJECTIVES To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries. DATA COLLECTION AND ANALYSIS At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison. AUTHORS' CONCLUSIONS iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.
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Affiliation(s)
- Nicholas P Oliphant
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
- School of Public Health, University of the Western Cape, Belleville, South Africa
| | - Samuel Manda
- Biostatistics Unit, South African Medical Research Council, Hatfield, South Africa
- Department of Statistics, University of Pretoria, Hatfield, South Africa
| | - Karen Daniels
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Donela Besada
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mary Kinney
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Emily White Johansson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, University of the Western Cape, Belleville, South Africa
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Hung YW, Hoxha K, Irwin BR, Law MR, Grépin KA. Using routine health information data for research in low- and middle-income countries: a systematic review. BMC Health Serv Res 2020; 20:790. [PMID: 32843033 PMCID: PMC7446185 DOI: 10.1186/s12913-020-05660-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Routine health information systems (RHISs) support resource allocation and management decisions at all levels of the health system, as well as strategy development and policy-making in many low- and middle-income countries (LMICs). Although RHIS data represent a rich source of information, such data are currently underused for research purposes, largely due to concerns over data quality. Given that substantial investments have been made in strengthening RHISs in LMICs in recent years, and that there is a growing demand for more real-time data from researchers, this systematic review builds upon the existing literature to summarize the extent to which RHIS data have been used in peer-reviewed research publications. METHODS Using terms 'routine health information system', 'health information system', or 'health management information system' and a list of LMICs, four electronic peer-review literature databases were searched from inception to February 202,019: PubMed, Scopus, EMBASE, and EconLit. Articles were assessed for inclusion based on pre-determined eligibility criteria and study characteristics were extracted from included articles using a piloted data extraction form. RESULTS We identified 132 studies that met our inclusion criteria, originating in 37 different countries. Overall, the majority of the studies identified were from Sub-Saharan Africa and were published within the last 5 years. Malaria and maternal health were the most commonly studied health conditions, although a number of other health conditions and health services were also explored. CONCLUSIONS Our study identified an increasing use of RHIS data for research purposes, with many studies applying rigorous study designs and analytic methods to advance program evaluation, monitoring and assessing services, and epidemiological studies in LMICs. RHIS data represent an underused source of data and should be made more available and further embraced by the research community in LMIC health systems.
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Affiliation(s)
- Yuen W Hung
- University of Waterloo, School of Public Health and Health Systems, Waterloo, Canada
| | - Klesta Hoxha
- University of Waterloo, School of Public Health and Health Systems, Waterloo, Canada
| | - Bridget R Irwin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, Canada
| | - Karen A Grépin
- School of Public Health, Hong Kong University, Pok Fu Lam, Hong Kong.
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Witter S, Palmer N, Balabanova D, Mounier-Jack S, Martineau T, Klicpera A, Jensen C, Pugliese-Garcia M, Gilson L. Health system strengthening-Reflections on its meaning, assessment, and our state of knowledge. Int J Health Plann Manage 2019; 34:e1980-e1989. [PMID: 31386232 DOI: 10.1002/hpm.2882] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022] Open
Abstract
Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a "strong health system." We highlight that current findings on "what works" are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.
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Affiliation(s)
- Sophie Witter
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | - Dina Balabanova
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tim Martineau
- International Public Health, Liverpool School of Tropical Medicine, London, UK
| | - Anna Klicpera
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Miguel Pugliese-Garcia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Gilson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Division of Health Policy and Systems, University of Cape Town, Cape Town, South Africa
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Soremekun S, Kasteng F, Lingam R, Vassall A, Kertho E, Settumba S, Etou PL, Nanyonjo A, ten Asbroek G, Kallander K, Kirkwood B. Variation in the quality and out-of-pocket cost of treatment for childhood malaria, diarrhoea, and pneumonia: Community and facility based care in rural Uganda. PLoS One 2018; 13:e0200543. [PMID: 30475808 PMCID: PMC6261061 DOI: 10.1371/journal.pone.0200543] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A key barrier to appropriate treatment for malaria, diarrhoea, and pneumonia (MDP) in children under 5 years of age in low income rural settings is the lack of access to quality health care. The WHO and UNICEF have therefore called for the scale-up of integrated community case management (iCCM) using community health workers (CHWs). The current study assessed access to treatment, out-of-pocket expenditure and the quality of treatment provided in the public and private sectors compared to national guidelines, using data collected in a large representative survey of caregivers of children in 205 villages with iCCM-trained CHWs in mid-Western Uganda. RESULTS The prevalence of suspected malaria, diarrhoea and suspected pneumonia in the preceding two weeks in 6501 children in the study sample were 45%, 11% and 24% respectively. Twenty percent of children were first taken to a CHW, 56% to a health facility, 14% to other providers and no care was sought for 11%. The CHW was more likely to provide appropriate treatment compared to any other provider or to those not seeking care for children with MDP (RR 1.51, 95% CI 1.42-1.61, p<0.001). Seeking care from a CHW had the lowest cost outlay (median $0.00, IQR $0.00-$1.80), whilst seeking care to a private doctor or clinic the highest (median $2.80, IQR $1.20-$6.00). We modelled the expected increase in overall treatment coverage if children currently treated in the private sector or not seeking care were taken to the CHW instead. In this scenario, coverage of appropriate treatment for MDP could increase in total from the current rate of 47% up to 64%. CONCLUSION Scale-up of iCCM-trained CHW programmes is key to the provision of affordable, high quality treatment for sick children, and can thus significantly contribute to closing the gap in coverage of appropriate treatment.
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Affiliation(s)
- Seyi Soremekun
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
| | - Frida Kasteng
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London United Kingdom
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Raghu Lingam
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London United Kingdom
| | | | - Stella Settumba
- The Malaria Consortium, Kampala, Uganda
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sidney, Australia
| | - Patrick L. Etou
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Agnes Nanyonjo
- The Malaria Consortium, Kampala, Uganda
- African Population Health Research Centre, Nairobi, Kenya
| | - Guus ten Asbroek
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
- Department of Global Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Karin Kallander
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- The Malaria Consortium, London, United Kingdom
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London United Kingdom
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