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Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Correction: Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:233. [PMID: 38389055 PMCID: PMC10885522 DOI: 10.1186/s12913-024-10713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, 3000 DR, Rotterdam, P.O. Box 1738, The Netherlands
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Sriram V, Yilmaz V, Kaur S, Andres C, Cheng M, Meessen B. The role of private healthcare sector actors in health service delivery and financing policy processes in low-and middle-income countries: a scoping review. BMJ Glob Health 2024; 8:e013408. [PMID: 38316466 DOI: 10.1136/bmjgh-2023-013408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/25/2023] [Indexed: 02/07/2024] Open
Abstract
The expansion of the private healthcare sector in some low-income and middle-income countries (LMICs) has raised key questions and debates regarding the governance of this sector, and the role of actors representing the sector in policy processes. Research on the role played by this sector, understood here as private hospitals, pharmacies and insurance companies, remains underdeveloped in the literature. In this paper, we present the results of a scoping review focused on synthesising scholarship on the role of private healthcare sector actors in health policy processes pertaining to health service delivery and financing in LMICs. We explore the role of organisations or groups-for example, individual companies, corporations or interest groups-representing healthcare sector actors, and use a conceptual framework of institutions, ideas, interests and networks to guide our analysis. The screening process resulted in 15 papers identified for data extraction. We found that the literature in this domain is highly interdisciplinary but nascent, with largely descriptive work and undertheorisation of policy process dynamics. Many studies described institutional mechanisms enabling private sector participation in decision-making in generic terms. Some studies reported competing institutional frameworks for particular policy areas (eg, commerce compared with health in the context of medical tourism). Private healthcare actors showed considerable heterogeneity in their organisation. Papers also referred to a range of strategies used by these actors. Finally, policy outcomes described in the cases were highly context specific and dependent on the interaction between institutions, interests, ideas and networks. Overall, our analysis suggests that the role of private healthcare actors in health policy processes in LMICs, particularly emerging industries such as hospitals, holds key insights that will be crucial to understanding and managing their role in expanding health service access.
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Affiliation(s)
- Veena Sriram
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Volkan Yilmaz
- School of Applied Social and Policy Sciences, Ulster University, Belfast, Northern Ireland, UK
| | - Simran Kaur
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloei Andres
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Cheng
- Western University Faculty of Law, London, Ontario, Canada
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Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:127. [PMID: 38263128 PMCID: PMC10807218 DOI: 10.1186/s12913-023-10464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. METHODS A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). RESULTS We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. CONCLUSION Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. TRIAL REGISTRATION PROSPERO registration number CRD42022340059 .
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Meessen B, Ancia A, Gill D, LaFoucade A, Lalta S, Sandoval G, Waqa G. When one size does not fit all: aid and health system strengthening for Small Island Developing States. Health Policy Plan 2024; 39:i4-i8. [PMID: 38253446 DOI: 10.1093/heapol/czad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 01/24/2024] Open
Abstract
Health System strengthening is high on the agenda of the global health community. We review some of the specific challenges faced by Small Island Developing States in the development of their health systems. We propose a list of action points for aid actors willing to adapt their health programs and interventions.
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Affiliation(s)
- Bruno Meessen
- Department of Health Financing and Economics, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Anne Ancia
- Mauritius Country Office, World Health Organization, Anglo Mauritius House Intendence Street, Port Louis, Mauritius
| | - Danny Gill
- Ministry of Health and Wellness, Frank Walcott Building, Culloden Road, St. Michael BB11114, Barbados
| | - Althea LaFoucade
- Center for Health Economics & Department of Economics, University of the West Indies, 25A Warner Street, St Augustine 00000, Trinidad and Tobago
| | - Stanley Lalta
- Centre for Health Economics, University of the West Indies, 25A Warner Street, St Augustine 00000, Trinidad and Tobago
| | - Guillermo Sandoval
- Caribbean Subregional Program Coordination, Pan American Health Organization -World Health Organization, Dayrells and Navy Garden Roads, Bridgetown, Barbados
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji Institute of Pacific Health Research, Fiji National University, Tamavua Campus, Suva, Fiji
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Brindley C, Wijemunige N, Dieteren C, Bom J, Engel M, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e066213. [PMID: 37620272 PMCID: PMC10450129 DOI: 10.1136/bmjopen-2022-066213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) has increased substantially in low- and middle-income countries (LMICs), and adapting health service delivery models to address this remains a challenge. Many patients with NCD seek private care at different points in their encounters with the health system, but the determinants and outcomes of these choices are insufficiently understood. The proposed systematic review will help inform the governance of mixed health systems towards achieving the goal of universal health coverage. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS AND ANALYSIS Following the PRISMA approach, this systematic review will develop a descriptive synthesis of the determinants and outcomes of private healthcare utilisation for NCDs in LMICs. The databases Embase, Medline, Web of Science Core Collection, EconLit, Global Index Medicus and Google Scholar will be searched for relevant studies published in English between period 1 January 2010 and 30 June 2022 with additional searching of reference lists. The study selection process will involve a title-abstract and full-text review, guided by clearly defined inclusion and exclusion criteria. A quality and risk of bias assessment will be done for each study using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required because this review is based on data collected from publicly available materials. The results will be published in a peer-reviewed journal and presented at related scientific events. PROSPERO REGISTRATION NUMBER CRD42022340059.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten Engel
- Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Millimouno TM, Meessen B, Put WVD, Garcia M, Camara BS, Christou A, Delvaux T, Sidibé S, Beavogui AH, Delamou A. How has Guinea learnt from the response to outbreaks? A learning health system analysis. BMJ Glob Health 2023; 8:bmjgh-2022-010996. [PMID: 36854489 PMCID: PMC9980363 DOI: 10.1136/bmjgh-2022-010996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/23/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.
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Affiliation(s)
- Tamba Mina Millimouno
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea .,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Bruno Meessen
- Health Systems Governance and Financing Department, World Health Organization, Geneva, Switzerland
| | - Willem Van De Put
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Marlon Garcia
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bienvenu Salim Camara
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Aliki Christou
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Therese Delvaux
- Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sidikiba Sidibé
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
| | - Abdoul Habib Beavogui
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Alexandre Delamou
- Research Section, Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence d'Afrique pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Conakry, Guinea
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Kutzin J, Dalil S, Barroy H, Barkley S, Dkhimi F, Jowett M, Marten R, Mathauer I, Meessen B, Sparkes S, Xu K. An assertive, practical, and substantive agenda to catalyse meaningful change. Lancet Glob Health 2022; 10:e606-e608. [PMID: 35390341 PMCID: PMC9005648 DOI: 10.1016/s2214-109x(22)00177-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
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Keugoung B, Bello KOA, Millimouno TM, Sidibé S, Dossou JP, Delamou A, Legrand A, Massat P, Gutierrez NO, Meessen B. Mobilizing health district management teams through digital tools: Lessons from the District.Team initiative in Benin and Guinea using an action research methodology. Learn Health Syst 2021; 5:e10244. [PMID: 34667871 PMCID: PMC8512739 DOI: 10.1002/lrh2.10244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Improving capacities of health systems to quickly respond to emerging health issues, requires a health information system (HIS) that facilitates evidence-informed decision-making at the operational level. In many sub-Saharan African countries, HIS are mostly designed to feed decision-making purposes at the central level with limited feedback and capabilities to take action from data at the operational level. This article presents the case of an eHealth innovation designed to capacitate health district management teams (HDMTs) through participatory evidence production and peer-to-peer exchange. METHODS We used an action research design to develop the eHealth initiative called "District.Team," a web-based and facilitated platform targeting HDMTs that was tested in Benin and Guinea from January 2016 to September 2017. On District.Team, rounds of knowledge sharing processes were organized into cycles of five steps. Quantitative and qualitative data were collected to assess the participation of HDMTs and identify enablers and barriers of using District.Team. RESULTS Participation of HDMTs in District.Team varied between cycles and steps. In Benin, 79% to 94% of HDMTs filled in the online questionnaire per cycle compared to 61% to 100% in Guinea per cycle. In Benin, 26% to 41% of HDMTs shared a commentary on the results published on the platform while 21% to 47% participated in the online discussion forum. In Guinea, only 3% to 8% of HDMTs shared a commentary on the results published on the platform while 8% to 74% participated in the online discussion forum. Five groups of factors affected the participation: characteristics of the digital tools, the quality of the facilitation, profile of participants, shared content and data, and finally support from health authorities. CONCLUSION District.Team has shown that knowledge management platforms and processes valuing horizontal knowledge sharing among peers at the decentralized level of health systems are feasible in limited resource settings.
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Affiliation(s)
- Basile Keugoung
- Health Service Delivery Community of PracticeYaoundeCameroon
| | | | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | - Sidikiba Sidibé
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | - Jean Paul Dossou
- Centre de Recherche en Reproduction Humaine et en DémographieCotonouBenin
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de MaferinyahForécariahGuinea
| | | | | | | | - Bruno Meessen
- Collective HorizonLierBelgium
- Public Health DepartmentInstitute of Tropical MedicineAntwerpBelgium
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Belghiti Alaoui A, De Brouwere V, Meessen B, Bigdeli M. Decision-making and health system strengthening: bringing time frames into perspective. Health Policy Plan 2021; 35:1254-1261. [PMID: 33450766 PMCID: PMC7810387 DOI: 10.1093/heapol/czaa086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 01/20/2023] Open
Abstract
In many low-and middle-income countries, health systems decision-makers are facing a host of new challenges and competing priorities. They must not only plan and implement as they used to do but also deal with discontented citizens and health staff, be responsive and accountable. This contributes to create new political hazards susceptible to disrupt the whole execution of health plans. The starting point of this article is the observation by the first author of the limitations of the building-blocks framework to structure decision-making as for strengthening of the Moroccan health system. The management of a health system is affected by different temporalities, the recognition of which allows a more realistic analysis of the obstacles and successes of health system strengthening approaches. Inspired by practice and enriched thanks a consultation of the literature, our analytical framework revolves around five dynamics: the services dynamic, the programming dynamic, the political dynamic, the reform dynamic and the capacity-building dynamic. These five dynamics are differentiated by their temporalities, their profile, the role of their actors and the nature of their activities. The Moroccan experience suggests that it is possible to strengthen health systems by opening up the analysis of temporalities, which affects both decision-making processes and the dynamics of functioning of health systems.
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Affiliation(s)
| | | | - Bruno Meessen
- World Health Organization, Health Systems, Governance and Financing, Genève
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Korachais C, Nkurunziza S, Nimpagaritse M, Meessen B. Impact of the extension of a performance-based financing scheme to nutrition services in Burundi on malnutrition prevention and management among children below five: A cluster-randomized control trial. PLoS One 2020; 15:e0239036. [PMID: 32946500 PMCID: PMC7500612 DOI: 10.1371/journal.pone.0239036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 08/27/2020] [Indexed: 11/18/2022] Open
Abstract
Malnutrition is a huge problem in Burundi. In order to improve the health system response, the Ministry of Health piloted the introduction of malnutrition prevention and care indicators within its performance-based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services. The objective of this study is to assess the impacts of this intervention, on both child acute malnutrition recovery rates at health centre level and prevalence of chronic and acute malnutrition among children at community level. This study follows a cluster-randomized controlled evaluation design: 90 health centres (HC) were randomly selected for the study, 45 of them were randomly assigned to the intervention and received payment related to their performance in malnutrition activities, while the other 45 constituted the control group and got a simple budget allocation. Data were collected from baseline and follow-up surveys of the 90 health centres and 6,480 households with children aged 6 to 23 months. From the respectively 1,067 and 1,402 moderate and severe acute malnutrition transcribed files and registers, findings suggest that the intervention had a positive impact on moderate acute malnutrition recovery rates (OR: 5.59, p = 0.039 –at the endline, 78% in the control group and 97% in the intervention group) but not on uncomplicated severe acute malnutrition recovery rate (OR: 1.16, p = 0.751 –at the endline, 93% in the control group and 92% in the intervention group). The intervention also had a significant increasing impact on the number of children treated for acute malnutrition. Analyses from the anthropometric data collected among 12,679 children aged 6–23 months suggest improvements at health centre level did not translate into better results at community level: prevalence of both acute and chronic malnutrition remained high, precisely at the endline, acute and chronic malnutrition prevalence were resp. 8.80% and 49.90% in the control group and 8.70% and 52.0% in the intervention group, the differences being non-significant. PBF can contribute to a better management of malnutrition at HC level; yet, to address the huge problem of child malnutrition in Burundi, additional strategies are urgently required.
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Affiliation(s)
| | - Sandra Nkurunziza
- Global Health Institute, University of Antwerp, Belgium.,Health Community Department, University of Burundi, Bujumbura, Burundi
| | - Manassé Nimpagaritse
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium.,Institut National de Santé Publique, Bujumbura, Burundi.,Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Bruno Meessen
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
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Kiendrébéogo JA, De Allegri M, Meessen B. Policy learning and Universal Health Coverage in low- and middle-income countries. Health Res Policy Syst 2020; 18:85. [PMID: 32693808 PMCID: PMC7374847 DOI: 10.1186/s12961-020-00591-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/18/2020] [Indexed: 01/18/2023] Open
Abstract
Learning is increasingly seen as an essential component to spur progress towards universal health coverage (UHC) in low- and middle-income countries (LMICs). However, learning remains an elusive concept, with different understandings and uses that vary from one person or organisation to another. Specifically, it appears that 'learning for UHC' is dominated by the teacher mode - notably scientists and experts as 'teachers' conveying to local decision/policy-makers as 'learners' what to do. This article shows that, to meet countries' needs, it is important to acknowledge that UHC learning situations are not restricted to the most visible epistemic learning approach practiced today. This article draws on an analytical framework proposed by Dunlop and Radaelli, whereby they identified four learning modes that can emerge according to the specific characteristics of the policy process: epistemic learning, learning in the shadow of hierarchy, learning through bargaining and reflexive learning. These learning modes look relevant to help widen the learning prospects that LMICs need to advance their UHC agenda. Actually, they open up new perspectives in a research field that, until now, has appeared scattered and relatively blurry.
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Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, Health Sciences Training and Research Unit, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Bruno Meessen
- Health Systems Governance and Financing, WHO, Geneva, Switzerland
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van Olmen J, Erwin E, García-Ulloa AC, Meessen B, Miranda JJ, Bobrow K, Iwelunmore J, Nwaozuru U, Obiezu Umeh C, Smith C, Harding C, Kumar P, Gonzales C, Hernández-Jiménez S, Yeates K. Implementation barriers for mHealth for non-communicable diseases management in low and middle income countries: a scoping review and field-based views from implementers. Wellcome Open Res 2020; 5:7. [PMID: 32399497 PMCID: PMC7194478 DOI: 10.12688/wellcomeopenres.15581.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMIC). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMIC is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMIC were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 16 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies did not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowed linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMIC. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.
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Affiliation(s)
- Josefien van Olmen
- Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, 1000, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, 1000, Belgium
| | - Erica Erwin
- Global Health Research Office, Queen’s University, Ontario, Canada
- Pamoja Tunaweza Research Center, Moshi, Tanzania
| | | | | | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kirsty Bobrow
- University of CapeTown, Capetown, South Africa
- Oxford University, Oxford, UK
| | - Juliet Iwelunmore
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | | | - Carter Smith
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Pratap Kumar
- Strathmore Business School, Institute of Healthcare Management, Nairobi, Kenya
| | - Clicerio Gonzales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Karen Yeates
- College of Global Public Health, New York University, New York, USA
- Medicine, Queen's University, Ontario, Canada
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van Olmen J, Erwin E, García-Ulloa AC, Meessen B, Miranda JJ, Bobrow K, Iwelunmore J, Nwaozuru U, Obiezu Umeh C, Smith C, Harding C, Kumar P, Gonzales C, Hernández-Jiménez S, Yeates K. Implementation barriers for mHealth for non-communicable diseases prevention and management in low and middle income countries: a scoping review and field-based views from implementers. Wellcome Open Res 2020; 5:7. [PMID: 32399497 PMCID: PMC7194478 DOI: 10.12688/wellcomeopenres.15581.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 03/29/2024] Open
Abstract
Background: Mobile health (mHealth) has been hailed as a potential gamechanger for non-communicable disease (NCD) management, especially in low- and middle-income countries (LMICs). Individual studies illustrate barriers to implementation and scale-up, but an overview of implementation issues for NCD mHealth interventions in LMICs is lacking. This paper explores implementation issues from two perspectives: information in published papers and field-based knowledge by people working in this field. Methods: Through a scoping review publications on mHealth interventions for NCDs in LMICs were identified and assessed with the WHO mHealth Evidence Reporting and Assessment (mERA) tool. A two-stage web-based survey on implementation barriers was performed within a NCD research network and through two online platforms on mHealth targeting researchers and implementors. Results: 18 studies were included in the scoping review. Short Message Service (SMS) messaging was the main implementation tool. Most studies focused on patient-centered outcomes. Most studies do not report on process measures and on contextual conditions influencing implementation decisions. Few publications reported on implementation barriers. The websurvey included twelve projects and the responses revealed additional information, especially on practical barriers related to the patients' characteristics, low demand, technical requirements, integration with health services and with the wider context. Many interventions used low-cost software and devices with limited capacity that not allowing linkage with routine data or patient records, which incurred fragmented delivery and increased workload. Conclusion: Text messaging is a dominant mHealth tool for patient-directed of quality improvement interventions in LMICs. Publications report little on implementation barriers, while a questionnaire among implementors reveals significant barriers and strategies to address them. This information is relevant for decisions on scale-up of mHealth in the domain of NCD. Further knowledge should be gathered on implementation issues, and the conditions that allow universal coverage.
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Affiliation(s)
- Josefien van Olmen
- Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, 1000, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Antwerpen, 1000, Belgium
| | - Erica Erwin
- Global Health Research Office, Queen’s University, Ontario, Canada
- Pamoja Tunaweza Research Center, Moshi, Tanzania
| | | | | | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kirsty Bobrow
- University of CapeTown, Capetown, South Africa
- Oxford University, Oxford, UK
| | - Juliet Iwelunmore
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, St. Louis University Salus Center, Sint Louis, USA
| | | | - Carter Smith
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Pratap Kumar
- Strathmore Business School, Institute of Healthcare Management, Nairobi, Kenya
| | - Clicerio Gonzales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Karen Yeates
- College of Global Public Health, New York University, New York, USA
- Medicine, Queen's University, Ontario, Canada
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Nimpagaritse M, Korachais C, Meessen B. Effects in spite of tough constraints - A theory of change based investigation of contextual and implementation factors affecting the results of a performance based financing scheme extended to malnutrition in Burundi. PLoS One 2020; 15:e0226376. [PMID: 31929554 PMCID: PMC6957191 DOI: 10.1371/journal.pone.0226376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND From January 2015 to December 2016, the health authorities in Burundi piloted the inclusion of child nutrition services into the pre-existing performance-based financing free health care policy (PBF-FHC). An impact evaluation, focused on health centres, found positive effects both in terms of volume of services and quality of care. To some extent, this result is puzzling given the harshness of the contextual constraints related to the fragile setting. METHODS With a multi-methods approach, we explored how contextual and implementation constraints interacted with the pre-identified tracks of effect transmission embodied in the intervention. For our analysis, we used a hypothetical Theory of Change (ToC) that mapped a set of seven tracks through which the intervention might develop positive effects for children suffering from malnutrition. We built our analysis on (1) findings from the facility surveys and (2) extra qualitative data (logbooks, interviews and operational document reviews). FINDINGS Our results suggest that six constraints have weighted upon the intervention: (1) initial low skills of health workers; (2) unavailability of resources (including nutritional dietary inputs and equipment); (3) payment delays; (4) suboptimal information; (5) restrictions on autonomy; and (6) low intensity of supervision. Together, they have affected the intensity of the intervention, especially during its first year. From our analysis of the ToC, we noted that the positive effects largely occurred as a result of the incentive and information tracks. Qualitative data suggests that health centres have circumvented the many constraints by relying on a community-based recruitment strategy and a better management of inputs at the level of the facility and the patient himself. CONCLUSION Frontline actors have agency: when incentives are right, they take the initiative and find solutions. However, they cannot perform miracles: Burundi needs a holistic societal strategy to resolve the structural problem of child malnutrition. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02721160; March 2016 (retrospectively registered).
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Affiliation(s)
- Manassé Nimpagaritse
- Institut National de Santé Publique, Bujumbura, Burundi
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, Bruxelles, Belgique
| | - Catherine Korachais
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Meessen B, Akhnif ELH, Kiendrébéogo JA, Belghiti Alaoui A, Bello K, Bhattacharyya S, Faich Dini HS, Dkhimi F, Dossou JP, Gamble Kelley A, Keugoung B, Millimouno TM, Pfaffmann Zambruni J, Rouve M, Sieleunou I, van Heteren G. Learning for Universal Health Coverage. BMJ Glob Health 2019; 4:e002059. [PMID: 31908875 PMCID: PMC6936401 DOI: 10.1136/bmjgh-2019-002059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 12/04/2022] Open
Abstract
The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. 'Learning for UHC' is a central component of countries' health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes.
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Affiliation(s)
| | | | - Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo,Health Sciences Training and Research Unit, Ouagadougou, Burkina Faso
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Kefilath Bello
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Sanghita Bhattacharyya
- Collective Horizon, New Delhi, India
- Community Health Community of Practice, New Delhi, India
| | | | | | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | | | | | - Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | - Maxime Rouve
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isidore Sieleunou
- Médecine Sociale et Préventive, Université de Montréal, Ecole de Sante Publique, Montreal, Quebec, Canada
- Collective Horizon, Montreal, Québec, Canada
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Korachais C, Ir P, Macouillard E, Meessen B. The impact of reimbursed user fee exemption of health centre outpatient consultations for the poor in pluralistic health systems: lessons from a quasi-experiment in two rural health districts in Cambodia. Health Policy Plan 2019; 34:740-751. [DOI: 10.1093/heapol/czz095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Fees charged at the point of use are a barrier to the health services’ users, especially for the poorest. Two decades ago, Cambodia introduced the so-called health equity fund (HEF) strategy, a waiver scheme which enhances access to public health services for the poor without undermining the economic situation of facilities. Evidence suggests that hospital-based HEF effectively removed financial barriers and reduced out-of-pocket expenditures. There is less evidence on the effectiveness of the HEF when assistance is extended to the primary level of healthcare. This research explores the impact of a HEF extended to health centres in two rural health districts. Two household surveys and 16-month diary data allowed to assess the impact of the intervention on health-seeking behaviours and expenditure of poor households. Though HEF effectively removed user fees at public health facilities, health centre utilization of sick and poor people did not budge much in the intervention district; self-medication and private provider consultations remained the preferred health-seeking behaviours, by far, even if more expensive. Difference-in-difference estimates confirmed that HEF had a slight impact on health-seeking behaviours, but only for the subgroups of HEF beneficiaries living close to the health centre and ready to test their new entitlement. This research reminds on the importance of the context for the effectiveness of any policy: in a highly pluralistic health sector, waiving already low-user fees in public health centres may be insufficient to increase rapidly the use of those facilities and reduce catastrophic spending. In such context, apart from distance to health centres, perceived quality of services at the health centres, which was relatively low compared with other providers, also matters. Although the HEF scheme plays a role in improving perceived and objective quality of care, complementary means are to be deployed.
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Affiliation(s)
- Catherine Korachais
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Por Ir
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium and Technical Bureau, National Institute of Public Health, lot no. 80, Samdach Penn Nouth Blvd (St. 289), Phnom Penh, Cambodia
| | - Elodie Macouillard
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium and GRET, Campus du jardin d'agronomie tropicale, 45 bis avenue de la Belle Gabrielle, 94052 Nogent sur Marne, France
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine of Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
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Kiendrébéogo JA, Meessen B. Ownership of health financing policies in low-income countries: a journey with more than one pathway. BMJ Glob Health 2019; 4:e001762. [PMID: 31646009 PMCID: PMC6782032 DOI: 10.1136/bmjgh-2019-001762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joël Arthur Kiendrébéogo
- Department of Public Health, University Joseph Ki-Zerbo, Health Sciences Training and Research Unit, Ouagadougou, Kadiogo, Burkina Faso.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Nimpagaritse M, Korachais C, Nsengiyumva G, Macq J, Meessen B. Addressing malnutrition among children in routine care: how is the Integrated Management of Childhood Illnesses strategy implemented at health centre level in Burundi? BMC Nutr 2019; 5:22. [PMID: 32153935 PMCID: PMC7050905 DOI: 10.1186/s40795-019-0282-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background The Integrated Management of Childhood Illness (IMCI) strategy was adopted in Burundi in 2003. Our aim was to evaluate to what extent the malnutrition component of the IMCI guidelines is implemented at health facilities level. Methods We carried out direct observations of curative outpatient consultations for children aged 6–59 months in 90 health centres selected randomly. We considered both the child and the health worker (HW) as units of analysis and used bivariate analysis to explore characteristics of HWs associated with tasks systematically or never performed. Results A total of 514 consultations carried out by 145 HWs were observed. Among the 250 children under two years, less than 30% were asked questions on breastfeeding. None of them had all seven nutrition-related questions asked to their caregivers and none of the 200 children over the age of two years had all five nutrition-related questions asked to their caregivers. Only 13 cases (3%) had all of the six examinations/tasks (weight, height/length, mid-upper arm circumference, oedema, filling in and discussing the growth curve and calculating the weight for height z-score) performed as part of their care. 393 cases (76%) reported that they had not being given any nutrition advice. With regards to HWs, among 99 of them who had received children under two, only 21 (21.2%)[14.2–30.5%) systematically asked the question regarding ‘ongoing breastfeeding’. Only 56 (38.6%)[31–46.9%] weighed or discussed the weight taken prior the consultation for each child they reviewed, only 38 (26.2%)[19.6–34.1%] measured the height/length or discussed it for each child reviewed and 23 (15.9%)[10.7–22.8%] performed (systematically?) the WHZ-score. More than 50% never gave nutrition advices to any child reviewed. HWs who daily manage severe acute malnutrition were the most likely to systematically ask the question regarding ‘ongoing breastfeeding’ and to perform a ‘weight examination’. Those who had not received supervision visit on the topic of malnutrition predominantly never performed a ‘weight examination’. The ‘height/length’ examination’ was predominantly performed by female HWs and those who have ‘contract with the government. Conclusion This study has found poor compliance by HWs to IMCI in Burundi. This indicates that a substantial proportion of children do not receive early and appropriate care, especially that pertaining to malnutrition. This alarming situation calls for strong action by actors committed to child health in the country. Trial registration Clinical Trials.gov Identifier: NCT02721160; March 2016 (retrospectively registered).
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Affiliation(s)
- Manassé Nimpagaritse
- Institut National de Santé Publique, Avenue de l'Hôpital n°3/BP, 6807 Bujumbura, Burundi.,2Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.,3Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle-aux-Champs, 30 boîte 3016 -1200, Bruxelles, Belgium
| | - Catherine Korachais
- 2Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Georges Nsengiyumva
- Institut National de Santé Publique, Avenue de l'Hôpital n°3/BP, 6807 Bujumbura, Burundi
| | - Jean Macq
- 3Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle-aux-Champs, 30 boîte 3016 -1200, Bruxelles, Belgium
| | - Bruno Meessen
- 2Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Akhnif E, Macq J, Meessen B. The place of learning in a universal health coverage health policy process: the case of the RAMED policy in Morocco. Health Res Policy Syst 2019; 17:21. [PMID: 30791925 PMCID: PMC6383252 DOI: 10.1186/s12961-019-0421-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To progress towards universal health coverage (UHC), each country will have to develop its systemic learning capacity. This study aims at documenting how, across time, learning can feed into a UHC policy process, and how the latter can itself strengthen (or not) the learning capacity of the health system. It specifically focuses on the development of a major health financing policy aligned with the UHC goal in Morocco, the RAMED, a health financing scheme covering hospital costs for the poorest segment of the population. METHODS We conducted a retrospective analysis of the RAMED policy for the period between 1997 and 2018, along with a case study design. For the data collection and analysis, we developed a framework combining Garvin's learning organisation framework and the heuristic health policy analysis framework. We gathered data from key informants and document reviews. RESULTS The study confirmed the importance of learning during the different stages of the RAMED policy process. There is evidence of a leadership encouraging learning, the introduction and adoption of knowledge management processes, and the start of a transformation of the administrative culture. Yet, our study also showed some major shortcomings, especially the lack of structure of the learning, and insufficient effort to systemise and sustain a transformation of practices within the health administration. Our study also confirms that the learning changes in nature across the different stages of the policy process. CONCLUSION The policy decisions and the implementation strategy create a learning dynamic, though not structured in all cases. Despite the positive interaction between learning and the RAMED policy, the opportunity to push forward a more structural transformation towards a learning system has not been fully seized. Hierarchical logics still largely prevail in the Moroccan health administration. The impact of future health policies for both the target beneficiaries and the health system will be bigger if their design integrates purposeful and structured actions in favour of organisational learning. This recommendation probably applies beyond Morocco.
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Affiliation(s)
- E. Akhnif
- School of Public Health, Rue Lamfadel Cherkaoui, Madinat Al Irfane, BP-6329 Rabat, Morocco
- IRSS - Clos Chapelle-aux-champs 30 bte B1.30.13 à 1200 Woluwe-Saint-Lambert, Université Catholique de Louvain (UCL) Ottignies-Louvain-la-Neuve, Brussels, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
| | - J. Macq
- IRSS - Clos Chapelle-aux-champs 30 bte B1.30.13 à 1200 Woluwe-Saint-Lambert, Université Catholique de Louvain (UCL) Ottignies-Louvain-la-Neuve, Brussels, Belgium
| | - Bruno Meessen
- Institute of Tropical Medicine, Antwerp, Belgium
- Community of Practice ‘Performance-Based Financing’, Antwerp, Belgium
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Millimouno TM, Sidibé S, Delamou A, Bello KOA, Keugoung B, Dossou JP, Beavogui AH, Meessen B. Evaluation of the maternal deaths surveillance and response system at the health district level in Guinea in 2017 through digital communication tools. Reprod Health 2019; 16:5. [PMID: 30658674 PMCID: PMC6339333 DOI: 10.1186/s12978-019-0671-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reducing maternal mortality still remains a major challenge in low-income countries. This study aims to explore how digital communication tools can be used to evaluate the maternal deaths surveillance and response (MDSR) system at the health district level in Guinea. METHODS A descriptive cross-sectional study was conducted, using an innovative digital approach called District.Team, from April to September 2017. This study targeted all 38 district medical officers in Guinea. In addition to district medical officers, the participation of health actors from regional and central levels were also expected in the online discussion forum. Data collected through the questionnaire were mixed and those from the online discussion forum were entirely qualitative. RESULTS In total, 23 (61%) district medical officers (DMOs) participated in the study. Out of health districts (87%) which had updated guidelines and standards for the MDSR, 4 (20%) did not apply the content. In two health districts (8.7%), not all health facilities had maternal deaths notification forms. Three districts (13%) did not have maternal death review committees. In 2016, only half (50.2%) of reported maternal deaths were reviewed. The main recommendation formulated was related to quality of care. Other needs were also highlighted including continuous training of health care providers on emergency obstetric and neonatal care. Less than half (45%) of the review committee's recommendations were implemented. Six health districts (26.1%) did not have a response plan to reported maternal deaths and no district annual report on the MDSR was published in 2016. The weaknesses identified were, among others, insufficiency of human resources and lack of financial resources. Fifty-eight messages related to MDSR weaknesses and improvement solutions were posted in the online discussion forum by 28 participants (23 DMOs and 5 health actors from regional and central levels). CONCLUSION Digital tools can be used to assess the functioning of a system like maternal deaths surveillance and response. Moreover, the findings of the evaluation conducted will help stakeholders (starting from the health districts themselves) to design strategies and interventions for an effective MDSR.
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Affiliation(s)
- Tamba Mina Millimouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Health Services Delivery Community of Practice, Antwerp, Belgium
| | - Sidikiba Sidibé
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Health Services Delivery Community of Practice, Antwerp, Belgium
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Kéfilath Olatoyossi Akankè Bello
- Health Services Delivery Community of Practice, Antwerp, Belgium
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Basile Keugoung
- Health Services Delivery Community of Practice, Antwerp, Belgium
| | - Jean Paul Dossou
- Health Services Delivery Community of Practice, Antwerp, Belgium
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Bruno Meessen
- Health Services Delivery Community of Practice, Antwerp, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
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Meessen B. The Role of Digital Strategies in Financing Health Care for Universal Health Coverage in Low- and Middle-Income Countries. Glob Health Sci Pract 2018; 6:S29-S40. [PMID: 30305337 PMCID: PMC6203415 DOI: 10.9745/ghsp-d-18-00271] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/12/2018] [Indexed: 11/15/2022]
Abstract
Countries finance health care using a combination of 3 main functions: raising resources for health, pooling resources, and purchasing health services. In this paper, we examine how digital health technologies can be used to enhance these health financing functions in low- and middle-income countries and can thus contribute to progress toward universal health coverage. We illustrate our points by presenting some recent innovations in digital technologies for financing health care, identifying their contributions and their limits. Some examples include a mobile-health wallet application used in Kenya that encourages households to put money aside for future health expenses; an online software platform developed by a startup in Tanzania in partnership with a private insurance provider to give individuals and families the opportunity to choose among different health coverage options; and digital maps by a number of startups that bring together data on health facility locations and capacity, including equipment, staff, and types of services offered. We also sketch an agenda for future research and action for digital strategies for health financing. The development and adoption of effective solutions that align well with the universal health coverage agenda will require strong partnerships between stakeholders and enough proactive stewardship by authorities.
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Akhnif E, Kiendrebeogo JA, Idrissi Azouzzi A, Adam Z, Makoutode CP, Mayaka Manitu S, Njoumemi Z, Gamble Kelley A, Meessen B. Are our 'UHC systems' learning systems? Piloting an assessment tool and process in six African countries. Health Res Policy Syst 2018; 16:78. [PMID: 30081918 PMCID: PMC6080559 DOI: 10.1186/s12961-018-0340-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If there is one universal recommendation to countries wanting to make progress towards Universal Health Coverage (UHC), it is to develop the learning capacities that will enable them to 'find their own way' - this is especially true for countries struggling with fragmented health financing systems. This paper explores results from a multi-country study whose main aim was to assess the extent to which UHC systems and processes at country level operate as 'learning systems'. METHOD This study is part of a multi-year action-research project implemented by two communities of practice active in Africa. For this specific investigation, we adapted the concept of the learning organisation to so-called 'UHC systems'. Our framework organises the assessment around 92 questions divided into blocks, sub-blocks and levels of learning, with a seven scale score in a standardised questionnaire developed during a protocol and methodology workshop attended by all the research teams. The study was implemented in six francophone African countries by national research teams involving researchers and cadres of the ministries involved in the UHC policy. Across the six countries, the questionnaire was administrated to 239 UHC actors. Data were analysed per country, per blocks and sub-blocks, by levels of learning and per question. RESULTS The study confirms the feasibility and relevance of adapting the learning organisation framework to UHC systems. All countries scored between 4 and 5 for all the sub-blocks of the learning system. The study and the validation workshops organised in the six countries indicate that the tool is particularly powerful to assess weaknesses within a specific country. However, some remarkable patterns also emerge from the cross-country analysis. Our respondents recognise the leadership developed at governmental level for UHC, but they also report some major weaknesses in the UHC system, especially the absence of a learning agenda and the limited use of data. CONCLUSION Countries will not progress towards UHC without strong learning systems. Our tool has allowed us to document the situation in six countries, create some awareness at country level and initiate a participatory action-oriented process.
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Affiliation(s)
- E. Akhnif
- Ministry of Health, Rabat, Morocco
- Université Catholique de Louvain, Rabat, Morocco
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Z. Adam
- Ministry of Health, Rabat, Morocco
| | - C. P. Makoutode
- Regional Public Health Institute Comlan Alfred Quenum, Cotonou, Benin
| | - S. Mayaka Manitu
- School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Z. Njoumemi
- Health Economics Research and Evaluation for Development Results Group, Yaoundé, Cameroon
- Department of Public Health Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Rabat, Morocco
| | | | - B. Meessen
- Institute of Tropical Medicine, Antwerp, Belgium
- Community of Practice “Performance Based Financing”, Antwerp, Belgium
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Van Assche K, Nebot Giralt A, Caudron JM, Schiavetti B, Pouget C, Tsoumanis A, Meessen B, Ravinetto R. Pharmaceutical quality assurance of local private distributors: a secondary analysis in 13 low-income and middle-income countries. BMJ Glob Health 2018; 3:e000771. [PMID: 29915671 PMCID: PMC6001909 DOI: 10.1136/bmjgh-2018-000771] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The rapid globalisation of the pharmaceutical production and distribution has not been supported by harmonisation of regulatory systems worldwide. Thus, the supply systems in low-income and middle-income countries (LMICs) remain exposed to the risk of poor-quality medicines. To contribute to estimating this risk in the private sector in LMICs, we assessed the quality assurance system of a convenient sample of local private pharmaceutical distributors. Methods This descriptive study uses secondary data derived from the audits conducted by the QUAMED group at 60 local private pharmaceutical distributors in 13 LMICs. We assessed the distributors’ compliance with good distribution practices (GDP), general quality requirements (GQR) and cold chain management (CCM), based on an evaluation tool inspired by the WHO guidelines ’Model Quality Assurance System (MQAS) for procurement agencies'. Descriptive statistics describe the compliance for the whole sample, for distributors in sub-Saharan Africa (SSA) versus those in non-SSA, and for those in low-income countries (LICs) versus middle-income countries (MICs). Results Local private pharmaceutical distributors in our sample were non-compliant, very low-compliant or low-compliant for GQR (70%), GDP (60%) and CCM (41%). Only 7/60 showed good to full compliance for at least two criteria. Observed compliance varies by geographical region and by income group: maximum values are higher in non-SSA versus SSA and in MICs versus LICs, while minimum values are the same across different groups. Conclusion The poor compliance with WHO quality standards observed in our sample indicates a concrete risk that patients in LMICs are exposed to poor-quality or degraded medicines. Significant investments are needed to strengthen the regulatory supervision, including on private pharmaceutical distributors. An adapted standardised evaluation tool inspired by the WHO MQAS would be helpful for self-evaluation, audit and inspection purposes.
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Affiliation(s)
- Kerlijn Van Assche
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | - Achilleas Tsoumanis
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Public Health Department, Institute of Tropical Medicine, Antwerp, Belgium
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Schiavetti B, Wynendaele E, De Spiegeleer B, Mbinze GJ, Kalenda N, Marini R, Melotte V, Hasker E, Meessen B, Ravinetto R, Van der Elst J, Mutolo Ngeleka D. The Quality of Medicines Used in Children and Supplied by Private Pharmaceutical Wholesalers in Kinshasa, Democratic Republic of Congo: A Prospective Survey. Am J Trop Med Hyg 2018; 98:894-903. [PMID: 29313479 PMCID: PMC5930909 DOI: 10.4269/ajtmh.17-0732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Poor-quality medicines are a threat to public health in many low- and middle-income countries, and prospective surveys are needed to inform corrective actions. Therefore, we conducted a cross-sectional survey on a sample of products used for children and available in the private market in Kinshasa, Democratic Republic Congo: amoxicillin (AX) and artemether/lumefantrine (AL), powders for suspension, and paracetamol (PC) tablets 500 mg. Overall, 417 products were covertly purchased from 61 wholesalers. To obtain a representative sample, the products were weighted on their market shares and a subset of 239 samples was randomly extracted to undergo in-depth visual inspection locally, and they were chemically assessed at two accredited laboratories in Belgium. Samples were defined of “poor-quality” if they failed to comply with at least one specification of the International Pharmacopoeia (for AL) or United States Pharmacopoeia 37 (for AX and PC). Results are reported according to the Medicine Quality Assessment Reporting Guideline. The visual inspection detected nonconformities in the aspects of antimalarial powders for suspension, and poor-quality labels across all medicine types. According to chemical analysis, 27.2% samples were of poor quality and 59.5% of AL samples were underdosed in artemether. Poor quality was more frequent for locally manufactured antimalarials (83.3%, P = 0.021; 86.4%, P = 0.022) and PC (4.8%, P = 0.000). The poor quality of the surveyed products may decrease the treatment’s efficacy and favor the development of resistances to antimalarials. It is hoped that these findings may guide the corrective actions of the Democratic Republic of Congo Regulatory Authority, which was the main partner in the research.
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Affiliation(s)
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Geremie J Mbinze
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nicodème Kalenda
- Faculty of Pharmaceutical Sciences, Laboratory of Drug Analysis, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Roland Marini
- Department of Pharmacy, CIRM, Laboratory of Analytical Chemistry, University of Liege (ULg), Liege, Belgium
| | - Vera Melotte
- Belgian Technical Cooperation (BTC), Bruxelles, Belgium
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josiane Van der Elst
- Belgian Federal Agency for Medicines and Health Products (FAGG-AFMPS), Bruxelles, Belgium
| | - Daniel Mutolo Ngeleka
- Direction de la Pharmacie et du Médicament (DPM), Kinshasa, Democratic Republic of Congo
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Nkurunziza S, Meessen B, Van Geertruyden JP, Korachais C. Determinants of stunting and severe stunting among Burundian children aged 6-23 months: evidence from a national cross-sectional household survey, 2014. BMC Pediatr 2017; 17:176. [PMID: 28743238 PMCID: PMC5526249 DOI: 10.1186/s12887-017-0929-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
Background Burundi is one of the poorest countries and is among the four countries with the highest prevalence of stunting (58%) among children aged less than 5 years. This situation undermines the economic growth of the country as undernutrition is strongly associated with less schooling and reduced economic productivity. Identifying the determinants of stunting and severe stunting may help policy-makers to direct the limited Burundian resources to the most vulnerable segments of the population, and thus make it more cost effective. This study aimed to identify predictors of stunting and severe stunting among children aged less than two years in Burundi. Methods The sample is made up of 6199 children aged 6 to 23 months with complete anthropometric measurements from the baseline survey of an impact evaluation study of the Performance-Based financing (PBF) scheme applied to nutrition services in Burundi from 2015 to 2017. Binary and multivariable logistic regression analyses were used to examine stunting and severe stunting against a set of child, parental and household variables such as child’s age or breastfeeding pattern, mother’s age or knowledge of malnutrition, household size or socio-economic status. Results The prevalence of stunting and severe stunting were 53% [95%CI: 51.8-54.3] and 20.9% [95%CI: 19.9-22.0] respectively. Compared to children from 6-11 months, children of 12-17 months and 18-23 months had a higher risk of stunting (AdjOR:2.1; 95% CI: 1.8-2.4 and 3.2; 95% CI: 2.8-3.7). Other predictors for stunting were small babies (AdjOR=1.5; 95% CI: 1.3-1.7 for medium-size babies at birth and AdjOR=2.9; 95% CI: 2.4-3.6 for small-size babies at birth) and male children (AdjOR=1.5, 95% CI: 1.4-1.8). In addition, having no education for mothers (AdjOR=1.6; 95% CI: 1.2-2.1), incorrect mothers’ child nutrition status assessment (AdjOR=3.3; 95% CI: 2.8-4), delivering at home (AdjOR=1.4; 95% CI: 1.2-1.6) were found to be predictors for stunting. More than to 2 under five children in the household (AdjOR=1.45; 95% CI: 1.1-1.9 for stunting and AdjOR= 1.5; 95% CI: 1.2-1.9 for severe stunting) and wealth were found to be predictors for both stunting and severe stunting. The factors associated with stunting were found to be applicable for severe stunting as well. Conclusion Mother’s education level, mother’s knowledge about child nutrition status assessment and health facility delivery were predictors of child stunting. Our study confirms that stunting and severe stunting is in Burundi, as elsewhere, a multi-sectorial problem. Some determinants relate to the general development of Burundi: education of girls, poverty, and food security; will be addressed by a large array of actions. Some others relate to the health sector and its performance – we think in particular of the number of children under five in the household (birth spacing), the relationship with the health center and the knowledge of the mother on malnutrition. Our findings confirm that the Ministry of Health and its partners should strive for better performing and holistic nutrition services: they can contribute to better nutrition outcomes.
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Affiliation(s)
- Sandra Nkurunziza
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergencentrum, Doornstraat 331-, -2610, Wilrijk, BE, Belgium. .,Health Community Department, University of Burundi, Boulevard du 28 Novembre, BP, 1020, Bujumbura, Burundi.
| | - Bruno Meessen
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Jean-Pierre Van Geertruyden
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergencentrum, Doornstraat 331-, -2610, Wilrijk, BE, Belgium
| | - Catherine Korachais
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Nebot Giralt A, Schiavetti B, Meessen B, Pouget C, Caudron JM, Marchal B, Massat P, Thys S, Ravinetto R. Quality assurance of medicines supplied to low-income and middle-income countries: poor products in shiny boxes? BMJ Glob Health 2017; 2:e000172. [PMID: 28589013 PMCID: PMC5435257 DOI: 10.1136/bmjgh-2016-000172] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 11/15/2022] Open
Abstract
Objective In today's context of globalisation of pharmaceutical production and distribution, international and national procurement agencies play a de facto key role in defining the quality of medicines available in sub-Saharan Africa. We evaluated the compliance of a sample of pharmaceutical distributors active in sub-Saharan Africa with the standards of the WHO guideline ‘Model Quality Assurance System (WHO MQAS) for procurement agencies’, and we investigated factors favouring or hindering the adequate implementation of the guideline. Methods We used mixed-methods methodology to analyse quantitative and qualitative data. The quantitative study consisted of a retrospective secondary analysis of data collected by QUAMED (Quality Medicines for all), a partnership that pleads for universal access to quality-assured medicines. The qualitative survey consisted of formal and informal interviews with key informants. We adopted an embedded multiple-case study design. Findings Our analysis suggests that international distributors based in Europe perform, on average, better than sub-Saharan African distributors. However, some weaknesses are ubiquitous and concern critical processes, such as the initial selection of the products and the ongoing reassessment of their quality. This is due to several different factors: weak regulatory oversight, insufficient human/financial resources, weak negotiating power, limited judicial autonomy and/or lack of institutional commitment to quality. Conclusions Our findings suggest that pharmaceutical distributors active in sub-Saharan Africa generally do not apply stringent criteria for selecting products and suppliers. Therefore, product quality is not consistently assured but depends on the requirements of purchasers. While long-term solutions are awaited, the WHO MQAS guideline should be used as an evaluation and training tool to upgrade current standards.
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Affiliation(s)
- A Nebot Giralt
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Schiavetti
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - B Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - P Massat
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - S Thys
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - R Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Meessen B, Shroff ZC, Ir P, Bigdeli M. From Scheme to System (Part 1): Notes on Conceptual and Methodological Innovations in the Multicountry Research Program on Scaling Up Results-Based Financing in Health Systems. Health Syst Reform 2017; 3:129-136. [PMID: 31514678 DOI: 10.1080/23288604.2017.1303561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract-This article presents conceptual and methodological developments made in analyzing the scale up of results-based financing (RBF) as part of a multicountry research program supported by the Alliance for Health Policy and Systems Research. Following a brief overview of the research process, the article proposes a new five-dimensional conceptualization of scale-up (population coverage, service coverage, health system integration, cross-sectoral diffusion, and knowledge expansion) to capture various facets of RBF scale-up. It also presents how Walt and Gilson's health policy triangle framework was modified to identify the enablers and barriers to scale-up in the country case studies included in this research program. The article then puts forth a four-phase model of scale-up, including phases of generation, adoption, institutionalization, and expansion, developed for the purpose of this research program. The article concludes by providing some lessons learned on the use of the methods and theoretical frameworks developed for this multicountry research program.
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Affiliation(s)
- Bruno Meessen
- Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium
| | | | - Por Ir
- National Institute of Public Health , Phnom Penh , Cambodia
| | - Maryam Bigdeli
- Health System Governance, Policy and Aid Effectiveness, World Health Organization , Geneva , Switzerland
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Renmans D, Holvoet N, Criel B, Meessen B. Performance-based financing: the same is different. Health Policy Plan 2017; 32:860-868. [DOI: 10.1093/heapol/czx030] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
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Shroff ZC, Bigdeli M, Meessen B. From Scheme to System (Part 2): Findings from Ten Countries on the Policy Evolution of Results-Based Financing in Health Systems. Health Syst Reform 2017; 3:137-147. [PMID: 31514674 DOI: 10.1080/23288604.2017.1304190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract- This article presents the enablers and barriers to the scaling-up of results-based financing (RBF) programs. It draws on the Alliance for Health Policy and Systems Research's multicountry program of research Taking Results Based Financing From Scheme to System, which compared the scale-up of RBF interventions over four phases-generation, adoption, institutionalization, and expansion-across ten countries. Comparing country experiences reveals broad lessons on scale up of RBF for each of the scale-up phases. Though the coming together of global, national, and regional contextual factors was key to the development of pilot projects, national factors were important to scale up these pilots to national programs, including a political context favoring results and transparency, the presence of enabling policies and institutions, and the presence of policy entrepreneurs at the national level. The third transition, from program to policy, was enabled by the availability of domestic financial resources, legislative and financing arrangements to enhance health facility autonomy, and technical and political leadership within and beyond the Ministry of Health. The article provides lessons learned on RBF policy evolution, emphasizing the importance of phase-specific groups of actors, the need to tailor advocacy messages to enable scale-up, the influence of political feasibility on policy content, and policy processes to build national ownership and enable health system strengthening.
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Affiliation(s)
- Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Maryam Bigdeli
- Health Systems Governance, Policy and Aid Effectiveness , World Health Organization, Geneva , Switzerland
| | - Bruno Meessen
- Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium
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Affiliation(s)
- Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
| | - Bruno Meessen
- Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium
| | - Maryam Bigdeli
- Health Systems Governance, Policy and Aid Effectiveness, World Health Organization , Geneva , Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization , Geneva , Switzerland
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Akhnif E, Macq J, Idrissi Fakhreddine M, Meessen B. Scoping literature review on the Learning Organisation concept as applied to the health system. Health Res Policy Syst 2017; 15:16. [PMID: 28249608 PMCID: PMC5333423 DOI: 10.1186/s12961-017-0176-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/03/2017] [Indexed: 12/05/2022] Open
Abstract
ᅟ: There is growing interest in the use of the management concept of a 'learning organisation'. The objective of this review is to explore work undertaken towards the application of this concept to the health sector in general and to reach the goal of universal health coverage in particular. Of interest are the exploration of evaluation frameworks and their application in health. METHOD We used a scoping literature review based on the York methodology. We conducted an online search using selected keywords on some of the main databases on health science, selected websites and main reference books on learning organisations. We restricted the focus of our search on sources in the English language only. Inclusive and exclusive criteria were applied to arrive at a final list of articles, from which information was extracted and then selected and inserted in a chart. RESULTS We identified 263 articles and other documents from our search. From these, 50 articles were selected for a full analysis and 27 articles were used for the summary. The majority of the articles concerned hospital settings (15 articles, 55%). Seven articles (25%) were related to the application of the concept to the health centre setting. Four articles discussed the application of the concept to the health system (14%). Most of the applications involved high-income countries (21 articles, 78%), with only one article being related to a low-income country. We found 13 different frameworks that were applied to different health organisations. CONCLUSIONS The scoping review allowed us to assess applications of the learning organisation concept to the health sector to date. Such applications are still rare, but are increasingly being used. There is no uniform framework thus far, but convergence as for the dimensions that matter is increasing. Many methodological questions remain unanswered. We also identified a gap in terms of the use of this concept in low- and middle-income countries and to the health system as a whole.
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Affiliation(s)
- E. Akhnif
- Ministry of Health, Rabat, Morocco
- Université Catholique de Louvain, Louvain-la-Neuve, Brussels, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
| | - J. Macq
- Université Catholique de Louvain, Louvain-la-Neuve, Brussels, Belgium
| | | | - B. Meessen
- Institute of Tropical Medicine, Antwerp, Belgium
- Community of Practice “Performance Based Financing”, Antwerp, Belgium
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Kiendrébéogo JA, Shroff ZC, Berthé A, Yonli L, Béchir M, Meessen B. Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda. Health Syst Reform 2017; 3:80-90. [DOI: 10.1080/23288604.2017.1280115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Abdramane Berthé
- Department of Public Health, Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | - Lamoudi Yonli
- Department of Public Health and Development, Centre de Support en Santé Internationale, N'Djamena, Chad
| | - Mahamat Béchir
- Department of Public Health and Development, Centre de Support en Santé Internationale, N'Djamena, Chad
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Ravinetto R, De Weggheleire A, Dorlo TP, Francque S, Sokkab A, Pouget C, Meessen B, Tabernero P, Newton PN, Lynen L. Predictable threats to public health through delaying universal access to innovative medicines for hepatitis C: a pharmaceutical standpoint. Trop Med Int Health 2016; 21:1490-1495. [PMID: 27671365 PMCID: PMC5244681 DOI: 10.1111/tmi.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Raffaella Ravinetto
- Clinical Sciences DepartmentInstitute of Tropical MedicineAntwerpBelgium
- Clinical Pharmacology and PharmacotherapyKU LeuvenLeuvenBelgium
| | | | - Thomas P.C. Dorlo
- Department Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
- Division of Pharmacoepidemiology & Clinical PharmacologyUtrecht UniversityUtrechtThe Netherlands
| | | | - An Sokkab
- Sihanouk Hospital Centre of HopePhnom PenhCambodia
| | | | - Bruno Meessen
- Public Health DepartmentInstitute of Tropical MedicineAntwerpBelgium
| | | | - Paul N. Newton
- Lao‐Oxford‐Mahosot Hospital‐Wellcome Trust Research UnitMahosot HospitalVientianeLao PDR
- Centre for Tropical Medicine & Global HealthNuffield Department of MedicineOxford UniversityOxfordUK
- Worldwide Antimalarial Resistance NetworkChurchill HospitalOxford UniversityOxfordUK
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lut Lynen
- Clinical Sciences DepartmentInstitute of Tropical MedicineAntwerpBelgium
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Abstract
Accessible and quality reproductive health services are critical for low‐ and middle‐income countries (LMICs). After a decade of waning investment in family planning, interest and funding are growing once again. This article assesses whether introducing, removing, or changing user fees for contraception has an effect on contraceptive use. We conducted a search of 14 international databases. We included randomized controlled trials, interrupted‐time series analyses, controlled before‐and‐after study designs, and cohort studies that reported contraception‐related variables as an outcome and a change in the price of contraceptives as an intervention. Four studies were eligible but none was at low risk of bias overall. Most of these, as well as other studies not included in the present research, found that demand for contraception was not cost‐sensitive. We could draw no robust summary of evidence, strongly suggesting that further research in this area is needed.
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Affiliation(s)
- Catherine Korachais
- Catherine Korachais is Researcher in the Department of Public Health at the Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Bruno Meessen
- Bruno Meessen is Professor of Health Economics in the Department of Public Health at the Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Nimpagaritse M, Korachais C, Roberfroid D, Kolsteren P, Zine Eddine El Idrissi MD, Meessen B. Measuring and understanding the effects of a performance based financing scheme applied to nutrition services in Burundi-a mixed method impact evaluation design. Int J Equity Health 2016; 15:93. [PMID: 27301741 PMCID: PMC4908705 DOI: 10.1186/s12939-016-0382-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background Malnutrition is a huge problem in Burundi. In order to improve the provision of services at hospital, health centre and community levels, the Ministry of Health is piloting the introduction of malnutrition prevention and care indicators within its performance based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services, as PBF has done, in Burundi and elsewhere, for several other services. Methods This paper presents the protocol for the impact evaluation of the PBF scheme applied to malnutrition. The research design consists in a mixed methods model adopting a sequential explanatory design. The quantitative component is a cluster-randomized controlled evaluation design: among the 90 health centres selected for the study, half receive payment related to their results in malnutrition activities, while the other half get a budget allocation. Qualitative research will be carried out both during the intervention period and at the end of the quantitative evaluation. Data are collected from 1) baseline and follow-up surveys of 90 health centres and 6,480 households with children aged 6 to 23 months, 2) logbooks filled in weekly in health centres, and 3) in-depth interviews and focus group discussions. The evaluation aims to provide the best estimate of the impact of the project on malnutrition outcomes in the community as well as outputs at the health centre level (malnutrition care outputs) and to describe quantitatively and qualitatively the changes that took place (or did not take place) within health centres as a result of the program. Discussion Although PBF schemes are blooming in low in-come countries, there is still a need for evidence, especially on the impact of revising the list of remunerated indicators. It is expected that this impact evaluation will be helpful for the national policy dialogue in Burundi, but it will also provide key evidence for countries with an existing PBF scheme and confronted with malnutrition problems on the appropriateness to extend the strategy to nutrition services. Trial registration ClinicalTrials.gov PRS Identifier: NCT02721160; registered March 2016
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Affiliation(s)
- Manassé Nimpagaritse
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. .,Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30 boîte 3016-1200, Bruxelles, Belgique. .,Direction de la Recherche, Institut National de Santé Publique, avenue de l'Hôpital n°3, BP, 6807, Bujumbura, Burundi.
| | - Catherine Korachais
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.,Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium
| | - Dominique Roberfroid
- Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000, Brussels, Belgium
| | | | | | - Bruno Meessen
- Health Economics Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Ir P, Korachais C, Chheng K, Horemans D, Van Damme W, Meessen B. Boosting facility deliveries with results-based financing: a mixed-methods evaluation of the government midwifery incentive scheme in Cambodia. BMC Pregnancy Childbirth 2015; 15:170. [PMID: 26276138 PMCID: PMC4537578 DOI: 10.1186/s12884-015-0589-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the coverage of skilled attendance at births in a health facility (facility delivery) is crucial for saving the lives of mothers and achieving Millennium Development Goal five. Cambodia has significantly increased the coverage of facility deliveries and reduced the maternal mortality ratio in the last decade. The introduction of a nationwide government implemented and funded results-based financing initiative, known as the Government Midwifery Incentive Scheme (GMIS), is considered one of the most important contributors to this. We evaluated GMIS to explore its effects on facility deliveries and the health system. METHODS We used a mixed-methods design. An interrupted time series model was applied, using routine longitudinal data on reported deliveries between 2006 and 2011 that were extracted from the health information system. In addition, we interviewed 56 key informants and performed 12 focus group discussions with 124 women who had given birth (once or more) since 2006. Findings from the quantitative data were carefully interpreted and triangulated with those from qualitative data. RESULTS We found that facility deliveries have tripled from 19% of the estimated number of births in 2006 to 57% in 2011 and this increase was more substantial at health centres as compared to hospitals. Segmented linear regressions showed that the introduction of GMIS in October 2007 made the increase in facility deliveries and deliveries with skilled attendants significantly jump by 18 and 10% respectively. Results from qualitative data also suggest that the introduction of GMIS together with other interventions that aimed to improve access to essential maternal health services led to considerable improvements in public health facilities and a steep increase in facility deliveries. Home deliveries attended by traditional birth attendants decreased concomitantly. We also outline several operational issues and limitations of GMIS. CONCLUSIONS The available evidence strongly suggests that GMIS is an effective mechanism to complement other interventions to improve health system performance and boost facility deliveries as well as skilled birth attendance; thereby contributing to the reduction of maternal mortality. Our findings provide useful lessons for Cambodia to further improve GMIS and for other low-income countries to implement similar results-based financing mechanisms.
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Affiliation(s)
- Por Ir
- National Institute of Public Health, Ministry of Health, PO BOX 1300, Phnom Penh, Cambodia.
| | - Catherine Korachais
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, B-2000, Antwerp, Belgium.
| | - Kannarath Chheng
- National Institute of Public Health, Ministry of Health, PO BOX 1300, Phnom Penh, Cambodia.
| | - Dirk Horemans
- Health Sector Support Programme, Belgian Technical Cooperation, Phnom Penh, Cambodia.
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, B-2000, Antwerp, Belgium.
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, B-2000, Antwerp, Belgium.
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Lannes L, Meessen B, Soucat A, Basinga P. Can performance-based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda. Int J Health Plann Manage 2015; 31:309-48. [DOI: 10.1002/hpm.2297] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Laurence Lannes
- The London School of Economics and Political Science; Department of Social Policy; London UK
| | | | | | - Paulin Basinga
- Global Health Program; Bill & Melinda Gates Foundation; Seattle WA USA
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Manitu SM, Lushimba MM, Macq J, Meessen B. [Negotiation of a heath policy controversy: application of an indirect dialogue approach to performance-based financing in sub-Saharan Africa]. Sante Publique 2015; 27:425-434. [PMID: 26414144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This article assesses the controversy around performance-based financing (PBF) and its contribution to the reform of health systems. It aims to reduce tensions between the different camps by restructuring the debate. METHODS Our approach was to organize an indirect dialogue between critics and supporters of PBF, based on the framework developed by Norman Daniels. This analytical framework is non-partisan and uses clear and objective criteria. The interviews were carried out in two rounds (first the critics, then the supporters) and were then analyzed. Parts of answers were regrouped according to the most common sectoral themes while also highlighting major areas of disagreement. RESULTS The interviews revealed some areas of convergence around PBF; the strategy is considered to be a complementary strategy to other strategies; such as those which aim to improving financial access to health care. The analysis also revealed disagreements based on misunderstandings of claims often ascribed to PBF, or lack of sufficient evidence, or asymmetrical information between experts. CONCLUSIONS Several questions polarize PBF discussions. However, better structuring of convergent and divergent areas and arguments should facilitate a synthesis, at least to some extent. Experts need to adopt an objective approach with universally accepted criteria, for the benefit of all.
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Mayaka Manitu S, Meessen B, Muvudi Lushimba M, Macq J. Le débat autour du financement basé sur la performance en Afrique subsaharienne : analyse de la nature des tensions. Santé Publique 2015. [DOI: 10.3917/spub.151.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mayaka Manitu S, Muvudi Lushimba M, Macq J, Meessen B. Arbitrage d’une controverse de politique de santé : application d’une démarche délibérative au Financement basé sur la Performance en Afrique subsaharienne. Santé Publique 2015. [DOI: 10.3917/spub.153.0425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Manitu SM, Meessen B, Lushimba MM, Macq J. [The debate concerning performance-based financing in Africa South of the Sahara: analysis of the nature]. Sante Publique 2015; 27:117-128. [PMID: 26164962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Performance-based financing (PBF) is a strategy designed to link thefunding of health services to predetermined results. Payment by an independent strategic purchaser is subject to verification of effective achievement of health outcomes in terms ofquantity and quality. This article investigates the complex tensions observed in relation to performance based financing (PBF) and identifies some reasons for disagreement on this approach. METHODS This study was essentially qualitative. Interviews were conducted with a panel of experts on PBF mobilizing their ability to reflect on the various arguments and positions concerning this financing mechanism. To enhance our analyses, we proposed a framework based on the main reasonsfor scientific or political controversies and factors involved in their emergence. Analysis of the information collected therefore consisted of combining experts verbatim reports with corresponding factors of controversies of our framework. Graphic representations of the differences were also established. RESULTS Tensions concerning PBF are based on facts (experts' interpretation ofPBF), principles and values (around each expert's conceptual framework), balances of power between experts but also inappropriate behavior in the discussion process. Viewpoints remain isolated, each individual experience and an overview are lacking, which can interfere with decision-making and maintain the Health system reform crisis. Potential solutions to reduce these tensions are proposed. CONCLUSIONS Our study shows that experts have difficulties agreeing on a theoretical priority approach to PBE. A good understanding of the nature of the tensions and an improvement in the quality of dialogue will promote a real dynamic of change and the proposal of an agenda of PBF actions.
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Meessen B. Setting targets, achieving goals: can analysis of past progress help? The Lancet Global Health 2014; 2:e673-4. [DOI: 10.1016/s2214-109x(14)70336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Affiliation(s)
- Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Meessen B, van Heteren G, Soeters R, Fritsche G, van Damme W. Time for innovative dialogue on health systems research. Bull World Health Organ 2013; 90:715-715A. [PMID: 23109736 DOI: 10.2471/blt.12.112326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bertone MP, Meessen B, Clarysse G, Hercot D, Kelley A, Kafando Y, Lange I, Pfaffmann J, Ridde V, Sieleunou I, Witter S. Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research. Health Res Policy Syst 2013; 11:39. [PMID: 24139662 PMCID: PMC3819672 DOI: 10.1186/1478-4505-11-39] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 10/03/2013] [Indexed: 11/24/2022] Open
Abstract
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a 'transnational' membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different 'knowledge holders' contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.). CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.The framework is developed based on the findings of a literature review as well as on our experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework.
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Affiliation(s)
- Maria Paola Bertone
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000, Antwerp, Belgium
| | - Bruno Meessen
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000, Antwerp, Belgium
- Facilitator of one of the Harmonization for Health in Africa Communities of Practice
| | - Guy Clarysse
- UNICEF West and Central Africa Regional Office (WCARO)BP 29720, Dakar-Yoff, Senegal
| | - David Hercot
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000, Antwerp, Belgium
- Facilitator of one of the Harmonization for Health in Africa Communities of Practice
| | - Allison Kelley
- Facilitator of one of the Harmonization for Health in Africa Communities of Practice
| | - Yamba Kafando
- Facilitator of one of the Harmonization for Health in Africa Communities of Practice
- Département de Santé Publique et de Biologie Médicale, Institut de Recherche en Sciences de la Santé (IRSS)03 BP 7192, Ouagadougou, Burkina Faso
| | - Isabelle Lange
- Maternal and Neonatal Health Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Jérôme Pfaffmann
- UNICEF West and Central Africa Regional Office (WCARO)BP 29720, Dakar-Yoff, Senegal
| | - Valéry Ridde
- Département de Santé Publique et de Biologie Médicale, Institut de Recherche en Sciences de la Santé (IRSS)03 BP 7192, Ouagadougou, Burkina Faso
- Research Centre of the University of Montreal Hospital Centre (CRCHUM)Tour Saint-Antoine, 850 rue Saint-Denis, Montréal H2X 0A9, Canada
| | - Isidore Sieleunou
- Department of Public Health, Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000, Antwerp, Belgium
- Facilitator of one of the Harmonization for Health in Africa Communities of Practice
| | - Sophie Witter
- FEMHealth project coordinator, Immpact, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Witter S, Toonen J, Meessen B, Kagubare J, Fritsche G, Vaughan K. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation. BMC Health Serv Res 2013; 13:367. [PMID: 24073625 PMCID: PMC3849795 DOI: 10.1186/1472-6963-13-367] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. Methods This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. Results The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. Conclusions The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task.
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Affiliation(s)
- Sophie Witter
- ReBUILD programme, Queen Margaret University, Edinburgh, Scotland.
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Bertone MP, Meessen B. Studying the link between institutions and health system performance: a framework and an illustration with the analysis of two performance-based financing schemes in Burundi. Health Policy Plan 2012; 28:847-57. [DOI: 10.1093/heapol/czs124] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ir P, Jacobs B, Meessen B, Van Damme W. Toward a typology of health-related informal credit: an exploration of borrowing practices for paying for health care by the poor in Cambodia. BMC Health Serv Res 2012; 12:383. [PMID: 23134845 PMCID: PMC3507708 DOI: 10.1186/1472-6963-12-383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 10/30/2012] [Indexed: 11/22/2022] Open
Abstract
Background Borrowing money is a common strategy to cope with health care costs. The impact of borrowing on households can be severe, leading to indebtedness and further impoverishment. However, the available literature on borrowing practices for health is limited. We explore borrowing practices for paying for health care by the poor in Cambodia and provide a typology, associated conditions, and the extent of the phenomenon. Methods In addition to a semi-structured literature review, in-depth interviews were conducted with representatives of 47 households with health-related debt and 19 managers of formal or informal credit schemes. Results A large proportion of Cambodians, especially the poor, resort to borrowing to meet the cost of health care. Because of limited cash flow and access to formal creditors, the majority take out loans with high interest rates from informal money lenders. The most common type of informal credit is locally known as Changkar and consists of five kinds of loans: short-term loans, medium-term loans, seasonal loans, loans for an unspecified period, and loans with repayment in labour, each with different lending and repayment conditions and interest rates. Conclusion This study suggests the importance of informal credit for coping with the cost of treatment and its potentially negative impact on the livelihood of Cambodian people. We provide directions for further studies on financial protection interventions to mitigate harmful borrowing practices to pay for health care in Cambodia.
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Affiliation(s)
- Por Ir
- National Institute of Public Health, Ministry of Health, PO BOX 1300, Phnom Penh, Cambodia.
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Ridde V, Robert E, Meessen B. A literature review of the disruptive effects of user fee exemption policies on health systems. BMC Public Health 2012; 12:289. [PMID: 22521207 PMCID: PMC3370991 DOI: 10.1186/1471-2458-12-289] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several low- and middle-income countries have exempted patients from user fees in certain categories of population or of services. These exemptions are very effective in lifting part of the financial barrier to access to services, but they have been organized within unstable health systems where there are sometimes numerous dysfunctions. The objective of this article is to bring to light the disruptions triggered by exemption policies in health systems of low- and middle-income countries. METHODS Scoping review of 23 scientific articles. The data were synthesized according to the six essential functions of health systems. RESULTS The disruptions included specifically: 1) immediate and significant increases in service utilization; 2) perceived heavier workloads for health workers, feelings of being exploited and overworked, and decline in morale; 3) lack of information about free services provided and their reimbursement; 4) unavailability of drugs and delays in the distribution of consumables; 5) unpredictable and insufficient funding, revenue losses for health centres, reimbursement delays; 6) the multiplicity of actors and the difficulty of identifying who is responsible ('no blame' game), and deficiencies in planning and communication. CONCLUSIONS These disruptive elements give us an idea of what is to be expected if exemption policies do not put in place all the required conditions in terms of preparation, planning and complementary measures. There is a lack of knowledge on the effects of exemptions on all the functions of health systems because so few studies have been carried out from this perspective.
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Affiliation(s)
- Valéry Ridde
- Department of Preventive and Social Medicine, Medical Faculty, University of Montréal, 3875, rue Saint-Urbain, Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal (CRCHUM), Montréal, Canada
| | - Emilie Robert
- Department of Preventive and Social Medicine, Medical Faculty, University of Montréal, 3875, rue Saint-Urbain, Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal (CRCHUM), Montréal, Canada
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