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Essue BM, Kapiriri L, Mohamud H, Veléz MC, Kiwanuka S. Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa. Health Policy Open 2024; 6:100113. [PMID: 38274670 PMCID: PMC10809111 DOI: 10.1016/j.hpopen.2023.100113] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 01/27/2024] Open
Abstract
Background Health planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa. Methods Multi-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis. Results All plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries. Conclusions The plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.
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Affiliation(s)
- Beverley M. Essue
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street, West Toronto, ON M5T 3M6, Canada
| | - Lydia Kapiriri
- McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario Postal Code L8S 4M4, Canada
| | - Hodan Mohamud
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street, West Toronto, ON M5T 3M6, Canada
| | - Marcela Claudia Veléz
- McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario Postal Code L8S 4M4, Canada
| | - Suzanne Kiwanuka
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Uganda
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Essue BM, Kapiriri L, Mohamud H, Vélez CM, Nouvet E, Aguilera B, Williams I, Kiwanuka S. Priority setting in times of crises: an analysis of priority setting for the COVID-19 response in the Western Pacific Region. Health Policy 2024; 142:105010. [PMID: 38364637 DOI: 10.1016/j.healthpol.2024.105010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/13/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND While priority setting is recognized as critical for promoting accountability and transparency in health system planning, its role in supporting rational, equitable and fair pandemic planning and responses is less well understood. This study aims to describe how priority setting was used to support planning in the initial stage of the pandemic response in a subset of countries in the Western Pacific Region (WPR). METHODS We purposively sampled a subset of countries from WPR and undertook a critical document review of the initial national COVID-19 pandemic response plans. A pre-specified tool guided data extraction and the analysis examined the use of quality parameters of priority setting, and equity considerations. RESULTS Nine plans were included in this analysis, from the following countries: Papua New Guinea, Tonga, The Philippines, Fiji, China, Australia, New Zealand, Japan, and Taiwan. Most commonly the plans described strong political will to respond swiftly, resource needs, stakeholder engagement, and defined the roles of institutions that guided COVID-19 response decision-making. The initial plans did not reflect strong evidence of public engagement or considerations of equity informing the early responses to the pandemic. CONCLUSION This study advances an understanding of how priority setting and equity considerations were integrated to support the development of the initial COVID-19 responses in nine countries in WPR and contributes to the literature on health system planning during emergencies. This baseline assessment reveals evidence of the common priority setting parameters that were deployed in the initial responses, the prioritized resources and equity considerations and reinforces the importance of strengthening health system capacity for priority setting to support future pandemic preparedness.
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Affiliation(s)
- Beverley M Essue
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street West Toronto ON M5T 3M6, Canada.
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, L8S 4M4, Hamilton, Ontario, Canada
| | - Hodan Mohamud
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, 155 College Street West Toronto ON M5T 3M6, Canada
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, L8S 4M4, Hamilton, Ontario, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, N6A 3K7, London, Ontario, Canada
| | - Bernardo Aguilera
- Faculty of Medicine and Science at the Universidad San Sebastian, Santiago de Chile, Providencia, Región Metropolitana, Chile
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Rd, B15 2RT, Birmingham, UK
| | - Suzanne Kiwanuka
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Uganda
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Aguilera B, Donya RS, Vélez CM, Kapiriri L, Abelson J, Nouvet E, Danis M, Goold S, Williams I, Noorulhuda M. Stakeholder participation in the COVID-19 pandemic preparedness and response plans: A synthesis of findings from 70 countries. Health Policy 2024; 142:105013. [PMID: 38401332 DOI: 10.1016/j.healthpol.2024.105013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Stakeholder participation is a key component of a fair and equitable priority-setting in health. The COVID-19 pandemic highlighted the need for fair and equitable priority setting, and hence, stakeholder participation. To date, there is limited literature on stakeholder participation in the development of the pandemic plans (including the priority setting plans) that were rapidly developed during the pandemic. Drawing on a global study of national COVID-19 preparedness and response plans, we present a secondary analysis of COVID-19 national plans from 70 countries from the six WHO regions, focusing on stakeholder participation. We found that most plans were prepared by the Ministry of Health and acknowledged WHO guidance, however less than half mentioned that additional stakeholders were involved. Few plans described a strategy for stakeholder participation and/or accounted for public participation in the plan preparation. However, diverse stakeholders (including multiple governmental, non-governmental, and international organizations) were proposed to participate in the implementation of the plans. Overall, there was a lack of transparency about who participated in decision-making and limited evidence of meaningful participation of the community, including marginalized groups. The critical relevance of stakeholder participation in priority setting requires that governments develop strategies for meaningful participation of diverse stakeholders during pandemics such as COVID-19, and in routine healthcare priority setting.
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Affiliation(s)
- Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
| | - Razavi S Donya
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, KTH-226, Hamilton, Ontario L8S 4M4, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, KTH-226, Hamilton, Ontario L8S 4M4, Canada.
| | - Julia Abelson
- Health Policy Program, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Marion Danis
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Susan Goold
- Internal Medicine and Health Management and Policy, Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Ieystn Williams
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
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Williams I, Kapiriri L, Vélez CM, Aguilera B, Danis M, Essue B, Goold S, Noorulhuda M, Nouvet E, Razavi D, Sandman L. How did European countries set health priorities in response to the COVID-19 threat? A comparative document analysis of 24 pandemic preparedness plans across the EURO region. Health Policy 2024; 141:104998. [PMID: 38295675 DOI: 10.1016/j.healthpol.2024.104998] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
The COVID-19 pandemic has forced governments across the world to consider how to prioritise the allocation of scarce resources. There are many tools and frameworks that have been designed to assist with the challenges of priority setting in health care. The purpose of this study was to examine the extent to which formal priority setting was evident in the pandemic plans produced by countries in the World Health Organisation's EURO region, during the first wave of the COVID-19 pandemic. This compliments analysis of similar plans produced in other regions of the world. Twenty four pandemic preparedness plans were obtained that had been published between March and September 2020. For data extraction, we applied a framework for identifying and assessing the elements of good priority setting to each plan, before conducting comparative analysis across the sample. Our findings suggest that while some pre-requisites for effective priority setting were present in many cases - including political commitment and a recognition of the need for allocation decisions - many other hallmarks were less evident, such as explicit ethical criteria, decision making frameworks, and engagement processes. This study provides a unique insight into the role of priority setting in the European response to the onset of the COVID-19 pandemic.
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Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham Park house, 40 Edgbaston Park Rd Birmingham, B15 2RT, UK.
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Bernardo Aguilera
- Faculty of Medicine and Science at the Universidad San Sebastian, Providencia, Santiago de Chile, Región Metropolitana, Chile
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - Beverley Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Susan Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road Building 14, G016, Ann Arbor, MI 48109, USA
| | - Mariam Noorulhuda
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Donya Razavi
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada
| | - Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Kapiriri L, Vélez CM, Aguilera B, Essue BM, Nouvet E, Donya RS, Ieystn W, Marion D, Susan G, Abelson J, Suzanne K. A global comparative analysis of the the inclusion of priority setting in national COVID-19 pandemic plans: A reflection on the methods and the accessibility of the plans. Health Policy 2024; 141:105011. [PMID: 38350210 DOI: 10.1016/j.healthpol.2024.105011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Despite the swift governments' response to the COVID-19 pandemic, there remains a paucity of literature assessing the degree to which; priority setting (PS) was included in the pandemic plans and the pandemic plans were publicly accessible. This paper reflects on the methods employed in a global comparative analysis of the degree to which countries integrated PS into their COVID-19 pandemic plans based on Kapiriri & Martin's framework. We also assessed if the accessibility of the plans was related to the country's transparency index. METHODS Through a three stage search strategy, we accessed and reviewed 86 national COVID-19 pandemic plans (and 11 Canadian provinces and territories). Secondary analysis assessed any alignment between the readily accessible plans and the country's transparency index. RESULTS AND CONCLUSION 71 national plans were readily accessible while 43 were not. There were no systematic differences between the countries whose plans were readily available and those whose plans were 'missing'. However, most of the countries with 'missing' plans tended to have a low transparency index. The framework was adapted to the pandemic context by adding a parameter on the need to plan for continuity of priority routine services. While document review may be the most feasible and appropriate approach to conducting policy analysis during health emergencies, interviews and follow up document review would assess policy implementation.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada.
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Razavi S Donya
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Danis Marion
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Goold Susan
- Internal Medicine and Health Management and Policy, Center for Bioethics and Social Sciences in Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Julia Abelson
- Health Policy Program, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Kiwanuka Suzanne
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, P.O. Box 7062, Kampala, Uganda
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Kapiriri L, Ieystn W, Vélez CM, Essue BM, Susan G, Danis M, Aguilera B. A global comparative analysis of the criteria and equity considerations included in eighty-six national COVID-19 plans. Health Policy 2024; 140:104961. [PMID: 38228031 DOI: 10.1016/j.healthpol.2023.104961] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
Systematic priority setting (PS), based on explicit criteria, is thought to improve the quality and consistency of the PS decisions. Among the PS criteria, there is increased focus on the importance of equity considerations and vulnerable populations. This paper discusses the PS criteria that were included in the national COVID-19 pandemic plans, with specific focus on equity and on the vulnerable populations considered. Secondary synthesis of data, from a global comparative study that examined the degree to which the COVID-19 plans included PS, was conducted. Only 32 % of the plans identified explicit criteria. Severity of the disease and/or disease burden were the commonly mentioned criteria. With regards to equity considerations and prioritizing vulnerable populations, 22 countries identified people with co-morbidities others mentioned children, women etc. Low social-economic status and internally displaced population were not identified in any of the reviewed national plans. The limited inclusion of explicit criteria and equity considerations highlight a need for policy makers, in all contexts, to consider instituting and equipping PS institutions who can engage diverse stakeholders in identifying the relevant PS criteria during the post pandemic period. While vulnerability will vary with the type of health emergency- awareness of this and having mechanisms for identifying and prioritizing the most vulnerable will support equitable pandemic responses.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada.
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada
| | - Goold Susan
- Internal Medicine and Health Management and Policy. Center for Bioethics and Social Sciences in Medicine, University of Michigan. 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Marion Danis
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Chile
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Neil-Sztramko SE, Belita E, Hopkins S, Sherifali D, Anderson L, Apatu E, Kapiriri L, Tarride JE, Bellefleur O, Kaasalainen S, Marr S, Dobbins M. What are effective strategies to respond to the psychological impacts of working on the frontlines of a public health emergency? Front Public Health 2023; 11:1282296. [PMID: 38131026 PMCID: PMC10733471 DOI: 10.3389/fpubh.2023.1282296] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background The COVID-19 pandemic has disrupted the healthcare and public health sectors. The impact of working on the frontlines as a healthcare or public health professional has been well documented. Healthcare organizations must support the psychological and mental health of those responding to future public health emergencies. Objective This systematic review aims to identify effective interventions to support healthcare workers' mental health and wellbeing during and following a public health emergency. Methods Eight scientific databases were searched from inception to 1 November 2022. Studies that described strategies to address the psychological impacts experienced by those responding to a public health emergency (i.e., a pandemic, epidemic, natural disaster, or mass casualty event) were eligible for inclusion. No limitations were placed based on study design, language, publication status, or publication date. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Discrepancies were resolved through discussion and a third reviewer when needed. Results were synthesized narratively due to the heterogeneity of populations and interventions. Outcomes were displayed graphically using harvest plots. Results A total of 20,018 records were screened, with 36 unique studies included in the review, 15 randomized controlled trials, and 21 quasi-experimental studies. Results indicate that psychotherapy, psychoeducation, and mind-body interventions may reduce symptoms of anxiety, burnout, depression, and Post Traumatic Stress Disorder, with the lowest risk of bias found among psychotherapy interventions. Psychoeducation appears most promising to increase resilience, with mind-body interventions having the most substantial evidence for increases in quality of life. Few organizational interventions were identified, with highly heterogeneous components. Conclusion Promoting healthcare workers' mental health is essential at an individual and health system level. This review identifies several promising practices that could be used to support healthcare workers at risk of adverse mental health outcomes as they respond to future public health emergencies.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=203810, identifier #CRD42020203810 (PROSPERO).
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Affiliation(s)
- Sarah E. Neil-Sztramko
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, ON, Canada
| | - Emily Belita
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Stephanie Hopkins
- National Collaborating Centre for Methods and Tools, Hamilton, ON, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Laura Anderson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Health, Aging & Society, McMaster University, Hamilton, ON, Canada
| | - Jean Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Olivier Bellefleur
- National Collaborating Centre for Healthy Public Policy, Montreal, QC, Canada
| | | | | | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Kapiriri L, Essue BM, Velez CM, Julia A, Elysee N, Bernardo A, Marion D, Susan G, Ieystn W. Was priority setting included in the Canadian COVID-19 pandemic planning and preparedness? A comparative analysis of COVID-19 pandemic plans from Eight provinces and Three territories. Health Policy 2023; 133:104817. [PMID: 37150048 PMCID: PMC10074731 DOI: 10.1016/j.healthpol.2023.104817] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Background Variation in priorities during pandemic planning among the federal, provincial and territorial jurisdictions are thought to have impacted Canada's ability to effectively control the spread of the COVID-19 virus, and protect the most vulnerable. The potential influence of diverse and divergent political, cultural, and behavioural factors, regarding inclusion of priority setting (PS) in pandemic preparedness planning across the country is not well understood. This study aimed to examine how the Canadian federal, provincial and territorial COVID-19 pandemic preparedness planning documents integrated PS. Methods A documentary analysis of the federal, eight provincial, three territorial COVID-19 preparedness and response plans. We assessed the degree to which the documented PS processes fulfilled established quality requirements of effective PS using the Kapiriri & Martin framework. Results While the federal plan included most of the parameters of effective PS, the provinces and territories reflected few. The lack of obligation for the provinces and territories to emulate the federal plan is one of the possible reasons for the varying inclusion of these parameters. The parameters included did not vary systematically with the jurisdiction's context. Conclusion Provinces could consider using the framework of the federal plan and the WHO guidelines to guide future pandemic planning. Regular evaluation of the instituted PS would provide a mechanism through which lessons can be harnessed and improvement strategies developed. Future studies should describe and evaluate what PS mechanisms were implemented.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada.
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Claudia M Velez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, KTH-226, Hamilton, Ontario L8S 4M4, Canada; Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Abelson Julia
- Health Policy Program, McMaster University, 1280 Main Street West, L8S 4M4, Hamilton, Ontario, Canada
| | - Nouvet Elysee
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Aguilera Bernardo
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago
| | - Danis Marion
- Section on Ethics and Health Policy, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Goold Susan
- Internal Medicine and Health Management and Policy, Center for Bioethics and social sciences in medicine, University of Michigan, 2800 Plymouth Road, Bldg. 14, G016, Ann Arbor, MI 48109-2800, USA
| | - Williams Ieystn
- School of Social Policy, HSMC, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
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Foster N, Kapiriri L, Grignon M, McKenzie K. "But…I survived": A phenomenological study of the health and wellbeing of aging Black women in the Greater Toronto Area, Canada. J Women Aging 2023; 35:22-37. [PMID: 35635795 DOI: 10.1080/08952841.2022.2079925] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies that assess the association between race and health have focused intently on the cumulative impact of continuous exposure to racism over an extended period. While these studies have contributed significantly to the general understanding of the life experiences and health status of racialized people, few studies have explicitly bridged the experiences of aging with gender and the wide structural barriers and social factors that have shaped the lives of racialized older women. This study aimed to investigate the origins of health inequities to highlight factors that intersect to affect the health and wellbeing of older Black women across their life course. Descriptive phenomenology was used to describe older Black women's health and wellbeing, and factors that impact their health across their life course. Criteria-based sampling was used to recruit study participants (n = 27). To be eligible women needed to be 55 years or older, speak English, self-identify as a Black female, and live in the Greater Toronto Area. Data analysis was guided by phenomenology. Themes identified demonstrated that participants' health and wellbeing were influenced by gender bias, racism, abuse, and retirement later in life. Participants reported having poor mental health during childhood and adulthood due to anxiety and depression. Other chronic illnesses reported included hypertension, diabetes, and cancer. Qualitative methods provided details regarding events and exposures that illuminate pathways through which health inequities emerge across the life course.
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Affiliation(s)
- Nicoda Foster
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Razavi S, Noorulhuda M, Marcela Velez C, Kapiriri L, Dreyse BA, Danis M, Essue B, Goold SD, Nouvet E, Williams I. Priority setting for pandemic preparedness and response: A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region. Health Policy Open 2022; 3:100084. [PMID: 36415539 PMCID: PMC9673227 DOI: 10.1016/j.hpopen.2022.100084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO. Methods An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS. Results While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen's plan included the highest number (9) of quality parameters, while Egypt's addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable. Conclusion PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation.
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Affiliation(s)
- S.Donya Razavi
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Mariam Noorulhuda
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - C. Marcela Velez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, Ontario L8S 4M4, Canada
| | | | - Marion Danis
- Department of Bioethics, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20812, USA
| | - Beverly Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road Building 14, G016, Ann Arbor, MI 48109, USA
| | - Elysée Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT, UK
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11
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Vélez CM, Kapiriri L, Nouvet E, Goold S, Aguilera B, Williams I, Danis M, Essue BM. Examining priority setting in the national COVID-19 pandemic plans: A case study from countries in the WHO- South-East Asia Region (WHO-SEARO). Health Policy Open 2022; 3:100086. [PMID: 36447637 PMCID: PMC9683850 DOI: 10.1016/j.hpopen.2022.100086] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 07/28/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background The World Health Organization- South-East Asia Region (WHO-SEARO) accounted for almost 17% of all the confirmed cases and deaths of COVID-19 worldwide. While the literature has documented a weak COVID-19 response in the WHO-SEARO, there has been no discussion of the degree to which this could have been influenced/ mitigated with the integration of priority setting (PS) in the region's COVID-19 response. The purpose of this paper is to describe the degree to which the COVID-19 plans from a sample of WHO-SEARO countries included priority setting. Methods The study was based on an analysis of national COVID-19 pandemic response and preparedness planning documents from a sample of seven (of the eleven) countries in WHO-SEARO. We described the degree to which the documented priority setting processes adhered to twenty established quality indicators of effective PS and conducted a cross-country comparison. Results All of the reviewed plans described the required resources during the COVID-19 pandemic. Most, but not all of the plans demonstrated political will, and described stakeholder involvement. However, none of the plans presented a clear description of the PS process including a formal PS framework, and PS criteria. Overall, most of the plans included only a limited number of quality indicators for effective PS. Discussion and conclusion There was wide variation in the parameters of effective PS in the reviewed plans. However, there were no systematic variations between the parameters presented in the plans and the country's economic, health system and pandemic and PS context and experiences. The political nature of the pandemic, and its high resource demands could have influenced the inclusion of the parameters that were apparent in all the plans. The finding that the plans did not include most of the evidence-based parameters of effective PS highlights the need for further research on how countries operationalize priority setting in their respective contexts as well as deeper understanding of the parameters that are deemed relevant. Further research should explore and describe the experiences of implementing defined priorities and the impact of this decision-making on the pandemic outcomes in each country.
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Affiliation(s)
- Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Postal code L8S 4M4, Hamilton, Ontario, Canada,Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Postal code L8S 4M4, Hamilton, Ontario, Canada,Corresponding author at: 1280 Main Street West, Kenneth Taylor Hall Room 226, Postal code L8S 4M4, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, Postal code N6A 3K7, London, Ontario, Canada
| | - Susan Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Santiago, Chile
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Rd, Postal code B15 2RT, Birmingham, UK
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
| | - Beverley M. Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 155 College Street W, Toronto ON M5T 3M6, Canada
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12
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Ojembe BU, Kalu ME, Donatus Ezulike C, Iwuagwu AO, Ekoh PC, Oyinlola O, Osifeso T, Makanjuola JO, Kapiriri L. Understanding Social and Emotional Loneliness among Black Older Adults: A Scoping Review. J Appl Gerontol 2022; 41:2594-2608. [PMID: 36007108 PMCID: PMC9669730 DOI: 10.1177/07334648221118357] [Citation(s) in RCA: 4] [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] [Indexed: 11/30/2022] Open
Abstract
Black older adults’ (BOAs) experience of loneliness differs from other ethnic
groups because of the disproportionate disadvantages faced across their life
course. This scoping review aimed to describe the range of research on
loneliness or subjective social isolation among BOAs, identifying the
contributing factors to loneliness in this population, based on Weiss’ Social
provision Framework. Of the 15,345 initial retrieved citations from seven
databases and corporate websites, we included 27 studies conducted in the USA,
Nigeria, South Africa, Ghana, Canada, the United Kingdom, and Uganda. Studies
reporting on BOAs’ experience of loneliness focused on the influence of
attachment, social integration, opportunity for nurturance, reassurance of
worth, guidance, socio-economic factors, health-related factors and behaviors,
and technology, media device possession and usage. There is a need for future
studies to identify which social provisions (when targeted) could reduce
loneliness, allowing clinicians to develop relevant interventions.
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Affiliation(s)
- Blessing Ugochi Ojembe
- Department of Health, Aging & Society, 248191McMaster University, Hamilton, ON, Canada.,Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria
| | - Michael Ebe Kalu
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria
| | - Chigozie Donatus Ezulike
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Department of Social Work, 355428University of Nigeria, Nsukka, Nigeria.,Department of Social and Behavioural Sciences, 53025City University of Hong Kong, Hong Kong
| | - Anthony Obinna Iwuagwu
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Department of Social Work, 355428University of Nigeria, Nsukka, Nigeria
| | - Prince Chiagozie Ekoh
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Department of Social Work, 355428University of Nigeria, Nsukka, Nigeria.,Faculty of Social Work, 210169University of Calgary, Calgary, AB, Canada
| | - Oluwagbemiga Oyinlola
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Medical Social Services Department, University College Hospital, Ibadan, Nigeria.,School of Social Work, 5620McGill University, Montreal, QC, Canada
| | - Temitope Osifeso
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Health and Rehabilitation Science, 6221Western University, London, ON, Canada
| | - John Osuolale Makanjuola
- Emerging Researchers & Professionals in Ageing- African Network, Abuja, Nigeria.,Department of Adult and Mental Health Psychiatric Nursing, Faculty of Nursing Sciences, 584611University of Medical Science, Ondo, Nigeria
| | - Lydia Kapiriri
- Department of Health, Aging & Society, 248191McMaster University, Hamilton, ON, Canada
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13
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Vélez CM, Aguilera B, Kapiriri L, Essue BM, Nouvet E, Sandman L, Williams I. Correction to: An analysis of how health systems integrated priority-setting in the pandemic planning in a sample of Latin America and the Caribbean countries. Health Res Policy Syst 2022; 20:84. [PMID: 35906654 PMCID: PMC9336097 DOI: 10.1186/s12961-022-00882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Claudia-Marcela Vélez
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada.,Faculty of Medicine, University of Antioquia, Cra 51d #62-29, Medellín, Antioquia, Colombia
| | - Bernardo Aguilera
- Facultad de Medicina y Ciencia, Universidad San Sebastian, Providencia, Santiago, Región Metropolitana, Chile
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main Street West, Kenneth Taylor Hall Room 226, Hamilton, ON, L8S 4M4, Canada.
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Iestyn Williams
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Rd, Birmingham, B15 2RT, UK
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14
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Razavi SD, Kapiriri L, Abelson J, Wilson M. Barriers to Equitable Public Participation in Health-System Priority Setting Within the Context of Decentralization: The Case of Vulnerable Women in a Ugandan District. Int J Health Policy Manag 2022; 11:1047-1057. [PMID: 33590740 PMCID: PMC9808191 DOI: 10.34172/ijhpm.2020.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Decentralization of healthcare decision-making in Uganda led to the promotion of public participation. To facilitate this, participatory structures have been developed at sub-national levels. However, the degree to which the participation structures have contributed to improving the participation of vulnerable populations, specifically vulnerable women, remains unclear. We aim to understand whether and how vulnerable women participate in health-system priority setting; identify any barriers to vulnerable women's participation; and to establish how the barriers to vulnerable women's participation can be addressed. METHODS We used a qualitative description study design involving interviews with district decision-makers (n=12), sub-county leaders (n=10), and vulnerable women (n=35) living in Tororo District, Uganda. Data was collected between May and June 2017. The analysis was conducting using an editing analysis style. RESULTS The vulnerable women expressed interest in participating in priority setting, believing they would make valuable contributions. However, both decision-makers and vulnerable women reported that vulnerable women did not consistently participate in decision-making, despite participatory structures that were instituted through decentralization. There are financial (transportation and lack of incentives), biomedical (illness/disability and menstruation), knowledge-based (lack of knowledge and/or information about participation), motivational (perceived disinterest, lack of feedback, and competing needs), socio-cultural (lack of decision-making power), and structural (hunger and poverty) barriers which hamper vulnerable women's participation. CONCLUSION The identified barriers hinder vulnerable women's participation in health-system priority setting. Some of the barriers could be addressed through the existing decentralization participatory structures. Respondents made both short-term, feasible recommendations and more systemic, ideational recommendations to improve vulnerable women's participation. Integrating the vulnerable women's creative and feasible ideas to enhance their participation in health-system decision-making should be prioritized.
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Affiliation(s)
- S. Donya Razavi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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15
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Belita E, Neil-Sztramko SE, Miller A, Anderson LN, Apatu E, Bellefleur O, Kapiriri L, Read K, Sherifali D, Tarride JÉ, Dobbins M. A scoping review of strategies to support public health recovery in the transition to a "new normal" in the age of COVID-19. BMC Public Health 2022; 22:1244. [PMID: 35739496 PMCID: PMC9219400 DOI: 10.1186/s12889-022-13663-2] [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: 12/17/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response. Methods The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members. Results Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement. Conclusion Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13663-2.
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Affiliation(s)
- Emily Belita
- School of Nursing, McMaster University, 1280 Main St. West, HSC 2J22, Hamilton, ON, L8S 4K1, Canada.
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Alanna Miller
- National Collaborating Centre for Methods and Tools, McMaster Innovation Park, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Olivier Bellefleur
- Centre de collaboration nationale sur les politiques publiques et la santé (CCNPPS), National Collaborating Centre for Healthy Public Policy (NCCHPP) , 190, boulevard Crémazie Est, Montréal, Québec, H2P 1E2, Canada
| | - Lydia Kapiriri
- Department of Health, Aging & Society, McMaster University, 1280 Main St. W. KTH 236, Hamilton, ON, L8S 4M4, Canada
| | - Kristin Read
- National Collaborating Centre for Methods and Tools, McMaster Innovation Park, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, 1280 Main Street West , Hamilton, ON, L8S 4K1, Canada
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, National Collaborating Centre for Methods and Tools , 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada
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16
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Nowshin N, Kapiriri L, Davison CM, Harms S, Kwagala B, Mutabazi MG, Niec A. Sexual and reproductive health and rights of "last mile" adolescents: a scoping review. Sex Reprod Health Matters 2022; 30:2077283. [PMID: 35666196 PMCID: PMC9176670 DOI: 10.1080/26410397.2022.2077283] [Citation(s) in RCA: 2] [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] [Indexed: 10/29/2022] Open
Abstract
Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.
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Affiliation(s)
- Nahela Nowshin
- PhD Student, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada. Correspondence:
| | - Lydia Kapiriri
- Associate Professor, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Colleen M Davison
- Associate Professor, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheila Harms
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Betty Kwagala
- Associate Professor, Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Anne Niec
- Professor, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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17
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Kapiriri L, Razavi SD. Equity, justice, and social values in priority setting: a qualitative study of resource allocation criteria for global donor organizations working in low-income countries. Int J Equity Health 2022; 21:17. [PMID: 35135553 PMCID: PMC8822856 DOI: 10.1186/s12939-021-01565-5] [Citation(s) in RCA: 2] [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: 04/09/2021] [Accepted: 10/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing acceptance of the importance of social values such as equity and fairness in health care priority setting (PS). However, equity is difficult to define: the term means different things to different people, and the ways it is understood in theory often may not align with how it is operationalized. There is limited literature on how development assistance partner organizations (DAP) conceptualize and operationalize equity in their health care prioritization decisions that affect low-income countries (LIC). This paper explores whether and how equity is a consideration in DAP priority setting processes. Methods This was a qualitative study involving 38 in-depth interviews with DAPs involved in health-system PS for LICs and a review of their respective webpages. Results While several PS criteria were identified, direct articulation of equity as an explicit criterion was lacking. However, the criterion was implied in some of the responses in terms of prioritizing vulnerable populations. Where mentioned, respondents discussed the difficulties of operationalizing equity as a PS criterion since vulnerability is associated with several varying and competing factors including gender, age, geography, and income. Some respondents also suggested that equity could be operationalized in terms of an organization not supporting the pre-existing inequities. Although several organizations’ webpages identify addressing inequities as a guiding principle, there were variations in how they spoke about its operationalization. While intersectionalities in vulnerabilities complicate its operationalization, if organizations explicitly articulate their equity focus the other organizations who also have equity as a guiding principle may, instead of focusing on the same aspect, concentrate on other dimensions of vulnerability. That way, all organizations will contribute to achieving equity in all the relevant dimensions. Conclusions Since most development organizations support some form of equity, this paper highlights a need for an internationally recognized framework that recognizes the intersectionalities of vulnerability, for mainstreaming and operationalizing equity in DAP priority setting and resource allocation. Such a framework will support consistency in the conceptualization of and operationalization of equity in global health programs. There is a need for studies which to assess the degree to which equity is actually integrated in these programs. Equity has become an increasingly important focus in the health and social science literature, however, equity is a contested concept. While development assistance partners supporting health development subscribe to equity as a guiding principle, they struggle with its operationalization. There is need for a general framework that explicitly conceptualizes the operationalization of equity in health development.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada.
| | - S Donya Razavi
- Department of Health, Aging and Society, McMaster University, 1280 Main street West, Hamilton, Ontario, Canada
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18
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Chukwu OA, Kapiriri L, Essue B. OUP accepted manuscript. International Journal of Pharmacy Practice 2022; 30:284-287. [PMID: 35468198 PMCID: PMC9129110 DOI: 10.1093/ijpp/riac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
Priority setting and health system governance are critical for optimising healthcare interventions and determining how best to allocate limited resources. The COVID-19 pandemic has buttressed the need for these especially now that vaccines are available to curb the spread of the disease. In many low- and middle-income countries (LMICs), vaccine coverage remains low, due in large part to sub-optimal priority setting and health system governance which has led to inequities in access and has fuelled vaccine hesitancy. An analysis of the situation in Nigeria identified key issues that have affected the health system response to COVID-19 and impeded timely access to the vaccine. These include weak vaccine procurement strategies, limited evidence on strategies for prioritising recipients and approaches for rolling out mass vaccination programmes for the entire population, lack of a communication strategy to reduce the incidence of vaccine hesitancy and failures to proactively address vaccine hesitancy through the implementation of vaccination programmes. Nigeria and other many other LMICs are still facing the prospect of subsequent and potentially worsening waves of the COVID-19 pandemic. Without effective priority setting, there is a risk that the country will not accelerate vaccine rollout quickly enough to achieve high coverage rates that will ensure herd immunity. In the context of existing weaknesses in health system governance, there is an urgent need to strengthen priority settings in Nigeria and identify and implement context-specific solutions that can improve vaccine coverage for the population.
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Affiliation(s)
- Otuto Amarauche Chukwu
- Correspondence: Otuto Amarauche Chukwu, Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmacy Building, University of Nigeria Nsukka, Nsukka 410001, Nigeria. Tel: +234-706-609-1019;
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Kapiriri L, Donya Razavi S. Salient stakeholders: Using the salience stakeholder model to assess stakeholders’ influence in healthcare priority setting. Health Policy OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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20
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Kapiriri L, Kiwanuka S, Biemba G, Velez C, Razavi SD, Abelson J, Essue B, Danis M, Goold S, Noorulhuda M, Nouvet E, Sandman L, Williams I. Priority Setting and Equity in COVID-19 Pandemic Plans: A Comparative Analysis of eighteen African Countries. Health Policy Plan 2021; 37:297-309. [PMID: 34545395 PMCID: PMC8500007 DOI: 10.1093/heapol/czab113] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/09/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programmes for the available health resources, strain health systems and shift health-care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study, the aim of which is to evaluate the degree to which national COVID-19 preparedness and response plans incorporated priority setting concepts. It provides important insights into what and how priority decisions were made in the context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (1) explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (2) examine if there is a relationship between the number of quality indicators present in the pandemic plans and the country’s economic context, health system and prior experiences with disease outbreaks. All the reviewed plans contained some aspects of expected priority setting processes but none of the national plans addressed all quality parameters. Most of the parameters were mentioned by less than 10 of the 18 country plans reviewed, and several plans identified one or two aspects of fair priority setting processes. Very few plans identified equity as a criterion for priority setting. Since the parameters are relevant to the quality of priority setting that is implemented during public health emergencies and most of the countries have pre-existing pandemic plans; it would be advisable that, for the future (if not already happening), countries consider priority setting as a critical part of their routine health emergency and disease outbreak plans. Such an approach would ensure that priority setting is integral to pandemic planning, response and recovery.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | - Lars Sandman
- Sweden and the Swedish Department of Priority Setting, Linköping University
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Kapiriri L, Essue B, Bwire G, Nouvet E, Kiwanuka S, Sengooba F, Reeleder D. A framework to support the integration of priority setting in the preparedness, alert, control and evaluation stages of a disease pandemic. Glob Public Health 2021; 17:1479-1491. [PMID: 34293263 DOI: 10.1080/17441692.2021.1931402] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic, where the need-resource gap has necessitated decision makers in some contexts to ration access to life-saving interventions, has demonstrated the critical need for systematic and fair priority setting and resource allocation mechanisms. Disease outbreaks are becoming increasingly common and priority setting lessons from previous disease outbreaks could be better harnessed to inform decision making and planning for future disease outbreaks. The purpose of this paper is to discuss how priority setting and resource allocation could, ideally, be integrated into the WHO pandemic planning and preparedness framework and used to inform the COVID-19 pandemic recovery plans and plans for future outbreaks. Priority setting and resource allocation during disease outbreaks tend to evoke a process similar to the 'rule of rescue'. This results in inefficient and unfair resource allocation, negative effects on health and non-health programs and increased health inequities. Integrating priority setting and resource allocation activities throughout the four phases of the WHO emergency preparedness framework could ensure that priority setting during health emergencies is systematic, evidence informed and fair.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | | | - Godfrey Bwire
- Department of Integrated Epidemiology Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | | | - Suzanne Kiwanuka
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Thizy D, Pare Toe L, Mbogo C, Matoke-Muhia D, Alibu VP, Barnhill-Dilling SK, Chantler T, Chongwe G, Delborne J, Kapiriri L, Nassonko Kavuma E, Koloi-Keaikitse S, Kormos A, Littler K, Lwetoijera D, Vargas de Moraes R, Mumba N, Mutengu L, Mwichuli S, Nabukenya SE, Nakigudde J, Ndebele P, Ngara C, Ochomo E, Odiwuor Ondiek S, Rivera S, Roberts AJ, Robinson B, Sambakunsi R, Saxena A, Sykes N, Tarimo BB, Tiffin N, Tountas KH. Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria. Gates Open Res 2021; 5:19. [PMID: 33884362 PMCID: PMC8042295 DOI: 10.12688/gatesopenres.13221.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/10/2021] [Indexed: 01/02/2023] Open
Abstract
Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed.
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Affiliation(s)
| | - Lea Pare Toe
- Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso
| | - Charles Mbogo
- Kenyan Institute of Medical Research, Kilifi, Kenya.,Pan African Mosquito Control Association, Nairobi, Kenya
| | - Damaris Matoke-Muhia
- Pan African Mosquito Control Association, Nairobi, Kenya.,Kenyan Institute of Medical Research, Nairobi, Kenya
| | | | | | | | | | | | - Lydia Kapiriri
- Department of Health, Ageing and Society, McMaster University, Hamilton, Canada
| | | | | | - Ana Kormos
- University of California Irvine Malaria Initiative, Irvine, USA
| | - Katherine Littler
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | | | - Roberta Vargas de Moraes
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Noni Mumba
- Kenyan Institute of Medical Research, Kilifi, Kenya
| | | | - Sylvia Mwichuli
- International Center for Evaluation and Development, nairobi, Kenya
| | | | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Ndebele
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | | | - Eric Ochomo
- Kenyan Institute of Medical Research, Kisumu, Kenya
| | | | - Stephany Rivera
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Aaron J Roberts
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Canada
| | | | - Rodrick Sambakunsi
- Malawi Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Abha Saxena
- The INCLEN Trust International, Delhi, India.,Institut Ethique Histoire Humanités, University of Geneva, Geneva, Switzerland
| | | | - Brian B Tarimo
- Vector Immunity and Transmission Biology Unit, Department of Environmental Health and Ecological Sciences,, ifakara Health Institute, Bagamoyo, Tanzania
| | - Nicki Tiffin
- Division of Computational Biology, and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Karen H Tountas
- Foundation for the National Institutes of Health, Bethesda, USA
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23
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Thizy D, Pare Toe L, Mbogo C, Matoke-Muhia D, Alibu VP, Barnhill-Dilling SK, Chantler T, Chongwe G, Delborne J, Kapiriri L, Nassonko Kavuma E, Koloi-Keaikitse S, Kormos A, Littler K, Lwetoijera D, Vargas de Moraes R, Mumba N, Mutengu L, Mwichuli S, Nabukenya SE, Nakigudde J, Ndebele P, Ngara C, Ochomo E, Odiwuor Ondiek S, Rivera S, Roberts AJ, Sambakunsi R, Saxena A, Sykes N, Tarimo BB, Tiffin N, Tountas KH. Proceedings of an expert workshop on community agreement for gene drive research in Africa - Co-organised by KEMRI, PAMCA and Target Malaria. Gates Open Res 2021; 5:19. [DOI: 10.12688/gatesopenres.13221.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential best practices. This paper shares the outcomes of that workshop and highlights the remaining topics for discussion before a comprehensive model can be designed.
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24
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Williams I, Essue B, Nouvet E, Sandman L, Razavi SD, Noorulhuda M, Goold S, Danis M, Biemba G, Abelson J, Kapiriri L. Priority setting during the COVID-19 pandemic: going beyond vaccines. BMJ Glob Health 2021; 6:e004686. [PMID: 33461979 PMCID: PMC7816921 DOI: 10.1136/bmjgh-2020-004686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 12/07/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, Ontario, Canada
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - S Donya Razavi
- Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
| | - Mariam Noorulhuda
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Godfrey Biemba
- National Health Research Authority and Public Health, Lusaka Apex Medical University, Lusaka, Zambia
| | - Julia Abelson
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
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Kapiriri L. Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System. Int J Health Policy Manag 2020; 9:448-458. [PMID: 32610742 PMCID: PMC7719212 DOI: 10.15171/ijhpm.2019.133] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported.
Objectives: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers’ reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence.
Methods: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach.
Results: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting.
Conclusion: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging, and Society, McMaster University, Hamilton, ON, Canada
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26
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Oortwijn W, van Oosterhout S, Kapiriri L. Application of evidence-informed deliberative processes in health technology assessment in low- and middle-income countries. Int J Technol Assess Health Care 2020; 36:1-5. [PMID: 32715993 DOI: 10.1017/s0266462320000549] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evidence-informed deliberative processes (EDPs) were introduced to guide health technology assessment (HTA) agencies to improve their processes toward more legitimate decision making. A survey among members of the International Network of Agencies for HTA (INAHTA) showed that EDPs can also be relevant for countries that have not (yet) established such an agency. Therefore, we explored to what extent low- and middle-income countries (LMIC) applied the steps and elements stipulated in the EDP framework and their need for guidance. METHODS The survey among INAHTA members was slightly adapted to address LMIC context and sent to 416 experts identified through several HTA sources. The questions focused on contextual factors and the EDP steps (installation of an appraisal committee, selecting technologies and criteria, assessment, appraisal, communication and appeal). Data collection took place between 21 May and 1 September 2019. Descriptive statistics and qualitative analyses were used to summarize the findings. RESULTS We received sixty-six meaningful responses from experts in thirty-two LMIC. We found that contextual factors to support HTA development are overall not present or only present to some extent. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, assessment, appraisal, as well as communication and appeal. CONCLUSIONS EDPs have the potential to provide steps for improving HTA processes. The results of this study can serve as a baseline measurement for future monitoring and evaluation of EDP application in the responding LMIC. This could support the countries in improving their processes and enhancing legitimate decision making when using HTA.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500 HBNijmegen, The Netherlands
| | - Sanne van Oosterhout
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500 HBNijmegen, The Netherlands
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Main Street West 1280, Hamilton, ON, Canada
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Essue BM, Kapiriri L. Priority setting for health system strengthening in low income countries. A qualitative case study illustrating the complexities. Health Syst (Basingstoke) 2020; 10:222-237. [PMID: 34377445 DOI: 10.1080/20476965.2020.1758596] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Health systems are critical to the realisation of Universal Health Coverage. There has been insufficient attention to the evaluation of priority setting for health system strengthening within low income countries, including evaluation of the local capacity to implement priorities. This study evaluated the extent to which health system strengthening was prioritized in Uganda. The Kapiriri & Martin framework was used to evaluate health system priority setting from 2005-2015. A document analysis was triangulated with interview data (n = 67) from global, national and subnational stakeholders and analysed using content analysis. Health system strengthening was perceived to be circumvented by a lack of resources as well as influential actors with disease focused, rather than system-oriented, interests. There were defined processes with explicit criteria for identifying priorities and evidence was highly valued. But sub-optimal transparency and weak accountability often compromised the integrity of priority setting and contributed to stalling progress on health system strengthening and achieving health system outcomes. The strengths in the current planning processes should be harnessed. In addition, a systematic approach to priority setting, potentially through the establishment of an independent body, and stronger oversight mechanisms, would strengthen health system planning in this setting.
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Affiliation(s)
- Beverley M Essue
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
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Razavi SD, Kapiriri L, Abelson J, Wilson M. Who is in and who is out? A qualitative analysis of stakeholder participation in priority setting for health in three districts in Uganda. Health Policy Plan 2020; 34:358-369. [PMID: 31180489 DOI: 10.1093/heapol/czz049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/12/2022] Open
Abstract
Stakeholder participation is relevant in strengthening priority setting processes for health worldwide, since it allows for inclusion of alternative perspectives and values that can enhance the fairness, legitimacy and acceptability of decisions. Low-income countries operating within decentralized systems recognize the role played by sub-national administrative levels (such as districts) in healthcare priority setting. In Uganda, decentralization is a vehicle for facilitating stakeholder participation. Our objective was to examine district-level decision-makers' perspectives on the participation of different stakeholders, including challenges related to their participation. We further sought to understand the leverages that allow these stakeholders to influence priority setting processes. We used an interpretive description methodology involving qualitative interviews. A total of 27 district-level decision-makers from three districts in Uganda were interviewed. Respondents identified the following stakeholder groups: politicians, technical experts, donors, non-governmental organizations (NGO)/civil society organizations (CSO), cultural and traditional leaders, and the public. Politicians, technical experts and donors are the principal contributors to district-level priority setting and the public is largely excluded. The main leverages for politicians were control over the district budget and support of their electorate. Expertise was a cross-cutting leverage for technical experts, donors and NGO/CSOs, while financial and technical resources were leverages for donors and NGO/CSOs. Cultural and traditional leaders' leverages were cultural knowledge and influence over their followers. The public's leverage was indirect and exerted through electoral power. Respondents made no mention of participation for vulnerable groups. The public, particularly vulnerable groups, are left out of the priority setting process for health at the district. Conflicting priorities, interests and values are the main challenges facing stakeholders engaged in district-level priority setting. Our findings have important implications for understanding how different stakeholder groups shape the prioritization process and whether representation can be an effective mechanism for participation in health-system priority setting.
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Affiliation(s)
- S Donya Razavi
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
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Razavi SD, Kapiriri L, Wilson M, Abelson J. Applying priority-setting frameworks: A review of public and vulnerable populations' participation in health-system priority setting. Health Policy 2019; 124:133-142. [PMID: 31874742 DOI: 10.1016/j.healthpol.2019.12.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a growing body of literature that describes, applies, and evaluates applications of health-system priority-setting frameworks in different contexts. However, little explicit focus has been given to examining operationalization of the stakeholder participation component of these frameworks. The literature identifies the public as a stakeholder group and recommends their participation when applying the frameworks. METHODS We conducted a scoping review to search the PubMed, EMBASE, HealthSTAR, Medline, and PsycINFO databases for cases where priority-setting frameworks were applied (2000-2017). We aimed to synthesize current literature to examine the degree to which the public and vulnerable populations have been engaged through applications of these frameworks FINDINGS: The following stakeholders commonly participated: managers, administrators/coordinators, clinicians/physicians, non-physician health care providers, health economists, academics/researchers, experts, decision-makers, and policy-makers. Few papers reported on public participation, and even fewer identified vulnerable groups that participate. Stakeholders were most commonly reported to participate in identifying areas for prioritization. CONCLUSIONS While the frameworks were developed with stakeholder participation in mind, in practice not all stakeholders are participating in priority-setting processes as envisioned by the frameworks. The public and vulnerable groups do not consistently participate, challenging the utility of the participation component of frameworks in guiding stakeholder participation in health-system priority setting. Frameworks can be more explicit about which stakeholders should participate and detailing how their participation should be operationalized.
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Affiliation(s)
- S Donya Razavi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| | - Lydia Kapiriri
- Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael Wilson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Wallace LJ, Kapiriri L. Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice. BMC Health Serv Res 2019; 19:465. [PMID: 31286950 PMCID: PMC6615092 DOI: 10.1186/s12913-019-4170-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/14/2018] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda. Methods Fifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate priority setting for MNCH. Results There were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity. Conclusions Stronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies. Electronic supplementary material The online version of this article (10.1186/s12913-019-4170-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren J Wallace
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada.
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Kapiriri L, Lee NM, Wallace LJ, Kwesiga B. Beyond cost-effectiveness, morbidity and mortality: a comprehensive evaluation of priority setting for HIV programming in Uganda. BMC Public Health 2019; 19:359. [PMID: 30935380 PMCID: PMC6444420 DOI: 10.1186/s12889-019-6690-8] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there has been progress in controlling the HIV epidemic, HIV still remains a disease of global concern. Some of the progress has been attributed to increased public awareness and uptake of public health interventions, as well as increased access to anti- retroviral treatment and the prevention of vertical HIV transmission. These interventions would not have been possible without substantial investments in HIV programs. However, donor fatigue introduces the need for low income countries to maximize the benefits of the available resources. This necessitates identification of priorities that should be funded. Evaluating prioritization processes would enable decision makers to assess the effectiveness of their processes, thereby designing intervention strategies. To date most evaluations have focused on cost-benefit analyses, which overlooks additional critical impacts of priority setting decisions. Kapiriri & Martin (2010) developed and validated a comprehensive framework for evaluating PS in low income countries. The objective of this paper report findings from a comprehensive evaluation of priority setting for HIV in Uganda, using the framework; and to identify lessons of good practice and areas for improvement. METHODS This was a qualitative study based on forty interviews with decision makers and policy document review. Data were analysed using INVIVO 10, and based on the parameters in Kapiriri et al's evaluation framework. RESULTS We found that HIV enjoys political support, which contributes to the availability of resources, strong planning institutions, and participatory prioritization process based on some criteria. Some of the identified limitations included; undue donor and political influence, priorities not being publicized, and lack of mechanisms for appealing the decisions. HIV prioritization had both positive and negative impacts on the health system. CONCLUSIONS The framework facilitated a more comprehensive evaluation of HIV priority setting. While there were successful areas, the process could be strengthened by minimizing undue influence of external actors, and support the legitimate institutions to set priorities and implement them. These should also institute mechanisms for publicizing the decisions, appeals and increased accountability. While this paper looked at HIV, the framework is flexible enough to be used in evaluating priority setting for other health programs within similar context.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society KTH-236, McMaster University, Main Street West, Hamilton, ON, 1280, Canada.
| | - Na-Mee Lee
- Global Health program, McMaster University, Hamilton, ON, Canada
| | - Lauren Jean Wallace
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Brendan Kwesiga
- World Health Organisation, Uganda Country Office, Kampala, Uganda
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Thizy D, Emerson C, Gibbs J, Hartley S, Kapiriri L, Lavery J, Lunshof J, Ramsey J, Shapiro J, Singh JA, Toe LP, Coche I, Robinson B. Guidance on stakeholder engagement practices to inform the development of area-wide vector control methods. PLoS Negl Trop Dis 2019; 13:e0007286. [PMID: 31022177 PMCID: PMC6483156 DOI: 10.1371/journal.pntd.0007286] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Delphine Thizy
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Claudia Emerson
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - Johanna Gibbs
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Sarah Hartley
- Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, Devon, United Kingdom
| | - Lydia Kapiriri
- Department of Health, Ageing and Society, McMaster University, Hamilton, Ontario, Canada
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Jeantine Lunshof
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janine Ramsey
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julie Shapiro
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Jerome Amir Singh
- Center for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lea Pare Toe
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Kapiriri L, Schuster-Wallace C, Chanda-Kapata P. Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia. Health Res Policy Syst 2018; 16:105. [PMID: 30404639 PMCID: PMC6223066 DOI: 10.1186/s12961-018-0384-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
Priority-setting (PS) for health research presents an opportunity for the relevant stakeholders to identify and create a list of priorities that reflects the country's knowledge needs. Zambia has conducted several health research prioritisation exercises that have never been evaluated. Evaluation would facilitate gleaning of lessons of good practices that can be shared as well as the identification of areas of improvement. This paper describes and evaluates health research PS in Zambia from the perspectives of key stakeholders using an internationally validated evaluation framework. METHODS This was a qualitative study based on 28 in-depth interviews with stakeholders who had participated in the PS exercises. An interview guide was employed. Data were analysed using NVIVO 10. Emerging themes were, in turn, compared to the framework parameters. RESULTS Respondents reported that, while the Zambian political, economic, social and cultural context was conducive, there was a lack of co-ordination of funding sources, partners and research priorities. Although participatory, the process lacked community involvement, dissemination strategies and appeals mechanisms. Limited funding hampered implementation, monitoring and evaluation. Research was largely driven by the research funders. CONCLUSIONS Although there is apparent commitment to health research in Zambia, health research PS is limited by lack of funding, and consistently used explicit and fair processes. The designated national research organisation and the availability of tools that have been validated and pilot tested within Zambia provide an opportunity for focused capacity strengthening for systematic prioritisation, monitoring and evaluation. The utility of the evaluation framework in Zambia could indicate potential usefulness in similar low-income countries.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and society, McMaster University, 1280 Main Street West, Hamilton, ON Canada
| | | | - Pascalina Chanda-Kapata
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia
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Kapiriri L. Stakeholder involvement in health research priority setting in low income countries: the case of Zambia. Res Involv Engagem 2018; 4:41. [PMID: 30460042 PMCID: PMC6234591 DOI: 10.1186/s40900-018-0121-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
SUMMARY While there is increasing recognition of the importance of stakeholder involvement in health research priority setting there is a paucity of literature reporting on stakeholder involvement in health research priority setting in low income countries. This paper fills this gap by identifying and discussing the roles and legitimacy of different stakeholders (including the public and patients) involved in the health research priority setting process in Zambia; identifying the barriers to public participation and proposing improvement strategies.We interviewed 28 policy makers and practitioners who had participated in the national level health research priority setting in Zambia. Reported participants in health research priority setting included research users, researchers, research funders and the community/ public. Research funders were thought to have undue influence while the public and patients were not effectively involved. This could be due to the public's lack of education, lack of resources to facilitate public involvement and limited skills to meaningfully engage the public. Participation of people from rural areas, women and young professionals was also limited.While there is a commitment to broad stakeholder involvement in health research priority setting, there's limited public/patient involvement. Public education, availing more resources, and skills to meaningfully engage the public need to be explored. The undue influence of research funders should be mitigated and incentives availed to ensure that they align their research funding with the national priorities. These efforts would strengthen meaningful stakeholder engagement in health research prioritization within Zambia and other similar contexts. ABSTRACT Background Stakeholder involvement in health research priority setting contributes to the legitimacy and acceptability of the priorities. Hence legitimate priority setting should involve a broad representation of stakeholders including the public. While there is a growing body of literature on health research prioritization in low income countries, there is a paucity of literature reporting on stakeholder involvement in the process. The objectives of this paper are to; 1) identify the stakeholders who were involved in the health research priority setting process in Zambia; 2) discuss the roles and perceived legitimacy of the stakeholders and analyze the degree to which patients/ public was involved; 3) To discuss some of the barriers to stakeholder participation in Zambia and similar contexts and to propose improvement strategies.Methods This was a qualitative study involving 28 in-depth interviews with stakeholders who had participated in the national level health research priority setting exercises in Zambia. An interview guide was used. Audio recorded interviews were transcribed and analyzed using INVIVO 10. Analysis of the Stakeholders' theme involved identifying the different dimensions of stakeholder involvement as discussed in the interviews.Results Identified stakeholders included; research users, researchers, research funders and the community/ public. We found that health research priority setting involved research users, researchers, research funders and the community/ public. However, research funders were thought to have undue influence while the public and patients were not effectively involved. While the respondents recognized the advantages of involving the public and patients, they were not effectively involved. This could be due to the public's limited understanding of the technicalities of priority setting, lack of resources to facilitate public involvement and limited skills to meaningfully engage the public. Participation from rural areas, women, and young professionals was also limited.Conclusions While there is a commitment to broad stakeholder involvement in health research priority setting, the public is left out. Efforts such as public education, availing more resources, and skills to meaningfully engage the public need to be explored. The undue influence of research funders should be mitigated through their direct involvement in the prioritization process and incentives to ensure that they align their research funding with the national priorities. These efforts would strengthen meaningful stakeholder engagement in health research prioritization within Zambia and other similar contexts.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health and Aging, McMaster University, 1280 Main Street West, Hamilton, ON Canada
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Abstract
Over the past few decades, disease outbreaks have become increasingly frequent and widespread. The epicenters of these outbreaks have differed, and could be linked to different economic contexts. Arguably, the responses to these outbreaks have been "political" and inherently burdensome to marginalized populations. Key lessons can be learned from exploring the narratives about the different epidemics in varying income settings. Based on a review of the published medical, social, and political literature, which was accessed using four electronic databases-PubMed, Sociological Abstracts, Scholars Portal, and Web of Science, the overall objective of this paper discuss scholars' narratives on the "politics" of Ebola in a low-income setting, Zika virus in a middle-income setting, and SARS in a high-income setting. Various themes of the politics of epidemics were prominent in the literature. The narratives demonstrated the influence of power in whose narratives and what narratives are presented in the literature. While marginalized populations were reported to have borne the brunt of all disease outbreaks in the different contexts, the prevalence of their narratives within the reviewed literature was limited. Regardless of income setting, there is a need to give voice to the most marginalized communities during an epidemic. The experiences and narratives of those most vulnerable to an epidemic-specifically poor communities-need to be represented in the literature. This could contribute to mitigating some of the negative impact of the politics in epidemics.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Alison Ross
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
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Abstract
Priority setting (PS) and resource allocation during health emergencies are key factors influencing an effective response. However, there is limited understanding of how priorities and resource allocation during disease outbreaks occur and the extent to which these processes are successful. This paper, based on 23 in-depth interviews with policy makers and a review of policy and emergency preparedness documents, used a PS evaluation framework to evaluate PS for disease outbreaks in Uganda. With regard to PS for disease outbreaks in Uganda, we identified a conducive socio-political-economical context, credible institutions, formal participatory prioritisation processes, evidence informed the processes, demonstrated implementation capacity, institutional strengthening and positive health outcomes. Factors that compromised the success of PS included limited resources - especially in between disease outbreaks and unfair processes. Investment in sustaining the established prioritisation infrastructure to oversee preparedness activities between the outbreaks would strengthen the prioritisation process. This should be supported with health system strengthening. The framework enabled us to evaluate some aspects of PS during disease outbreaks. The framework's inability to evaluate all aspects, and reported as opposed to actual PS calls for the integration of evaluation throughout the planning and implementation process to ensure validity and continuous implementation of improvement strategies.
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Affiliation(s)
- Lydia Kapiriri
- a Department of Health , Aging and Society, McMaster University , Hamilton , ON , Canada
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Hall W, Williams I, Smith N, Gold M, Coast J, Kapiriri L, Danis M, Mitton C. Past, present and future challenges in health care priority setting. J Health Organ Manag 2018; 32:444-462. [PMID: 29771204 DOI: 10.1108/jhom-01-2018-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a "magic bullet" is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues. Design/methodology/approach An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015. Findings "Decision-making frameworks" and "Engagement" were the two most frequently mentioned notable achievements. "Priority setting in practice" and "Awareness and education" were the two most frequently mentioned policy and practical challenges. "Priority setting in practice" and "Engagement" were the two most frequently mentioned areas in need of future research. Research limitations/implications Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly. Practical implications Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area. Originality/value Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.
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Affiliation(s)
- William Hall
- Department of Medicine, University of British Columbia , Vancouver, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | - Neale Smith
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Marthe Gold
- The City College of New York, New York, New York, USA
| | | | - Lydia Kapiriri
- Department of Medicine, McMaster University , Hamilton, Canada
| | - M Danis
- Howard Hughes Medical Institute, University of Chicago , Chicago, Illinois, USA
| | - Craig Mitton
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.,School of Population and Public Health, University of British Columbia , Vancouver, Canada
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Essue BM, Kapiriri L. The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda. Global Health 2018; 14:22. [PMID: 29463270 PMCID: PMC5819649 DOI: 10.1186/s12992-018-0324-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/22/2017] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful. METHODS A mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005-2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework. RESULTS Priority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement. CONCLUSIONS This evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.
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Affiliation(s)
- Beverley M. Essue
- University of Sydney, Sydney, NSW 2006 Australia
- McMaster University, 1280 Main Street W, Hamilton, ON L8S 4K1 Canada
| | - Lydia Kapiriri
- McMaster University, 1280 Main Street W, Hamilton, ON L8S 4K1 Canada
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Kapiriri L, Chanda-Kapata P. The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia. Health Res Policy Syst 2018; 16:11. [PMID: 29452602 PMCID: PMC5816391 DOI: 10.1186/s12961-017-0268-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/23/2016] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Methods Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Results Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. Conclusion While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers’ understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability. Electronic supplementary material The online version of this article (10.1186/s12961-017-0268-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health and Aging, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada.
| | - Pascalina Chanda-Kapata
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia
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Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, Bayarsaikhan D, Chentaf I, Eyal N, Folsom A, Halina Tun Hussein R, Morales C, Ostmann F, Ottersen T, Prakongsai P, Saenz C, Saleh K, Sommanustweechai A, Wikler D, Zakariah A. Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases. Health Syst Reform 2017; 3:301-312. [DOI: 10.1080/23288604.2017.1324938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Alex Voorhoeve
- Department of Philosophy, Logic, and Scientific Method, London School of Economics, London, UK
- Department for Bioethics at the National Institutes of Health, Bethesda, MD, USA
| | | | - Lydia Kapiriri
- Department of Health, Aging, and Society, McMaster University, Hamilton, ON, Canada
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - James Snowden
- Giving What We Can, Centre for Effective Altruism, Oxford, UK
| | | | - Dorjsuren Bayarsaikhan
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ikram Chentaf
- Cooperation Division at the Ministry of Health, Rabat, Morocco
| | - Nir Eyal
- Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amanda Folsom
- Results for Development Institute, Washington, DC, USA
| | - Rozita Halina Tun Hussein
- National Health Financing, Planning and Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Cristian Morales
- Pan American Health Organization/World Health Organization in Cuba, Havana, Cuba
| | - Florian Ostmann
- Kennedy School of Government, Harvard University, Boston, MA, USA
| | | | - Phusit Prakongsai
- Bureau of International Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Carla Saenz
- Pan American Health Organization, Washington, DC, USA
| | | | | | - Daniel Wikler
- Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Abstract
Background While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Health Care Anal 18:129-147, 2010) developed a framework for evaluating priority setting in low and middle income countries. This framework provides BOTH parameters for successful priority setting and proposes means of their verification. Before its use in real life contexts, this paper presents results from a validation process of the framework. Methods The framework validation involved 53 policy makers and priority setting researchers at the global, national and sub-national levels (in Uganda). They were requested to indicate the relative importance of the proposed parameters as well as the feasibility of obtaining the related information. We also pilot tested the proposed means of verification. Results Almost all the respondents evaluated all the parameters, including the contextual factors, as ‘very important’. However, some respondents at the global level thought ‘presence of incentives to comply’, ‘reduced disagreements’, ‘increased public understanding,’ ‘improved institutional accountability’ and ‘meeting the ministry of health objectives’, which could be a reflection of their levels of decision making. All the proposed means of verification were assessed as feasible with the exception of meeting observations which would require an insider. These findings results were consistent with those obtained from the pilot testing. Conclusions These findings are relevant to policy makers and researchers involved in priority setting in low and middle income countries. To the best of our knowledge, this is one of the few initiatives that has involved potential users of a framework (at the global and in a Low Income Country) in its validation. The favorable validation of all the parameters at the national and sub-national levels implies that the framework has potential usefulness at those levels, as is. The parameters that were disputed at the global level necessitate further discussion when using the framework at that level. The next step is to use the validated framework in evaluating actual priority setting at the different levels. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2360-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
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Kapiriri L, Tharao W, Muchenje M, Khatundi IM, Ongoiba F. How acceptable is it for HIV positive African, Caribbean and Black women to provide breast milk/fluid samples for research purposes? BMC Res Notes 2017; 10:7. [PMID: 28057074 PMCID: PMC5217306 DOI: 10.1186/s13104-016-2326-6] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background The African, Caribbean and Black communities have been found to be reluctant to participate in health research in North America. This is partly attributed to historical experiences as well as their cultural beliefs. Cultural beliefs about the uses of breast milk/fluids could further hinder the participation of African, Caribbean, and Black communities in research involving the collection of breast milk/fluids samples. Methods We conducted 17 in-depth interviews and three group interviews (n = 10) with HIV+ African, Caribbean and Black women living in Ontario, Canada to explore their cultural beliefs about breast milk/fluids and their acceptance of participating in research that involves the provision of breast fluid samples. Study design Qualitative study involving in-depth interviews. Results Our respondents believed that breast milk/fluids should be used for infant feeding and for curative purposes for a variety of children’s health ailments as well as ailments experienced by other family members. The cultural belief that breast milk/fluids could be used to bewitch the baby and mother and the perception that it is intrusive (equating breast milk/fluids research to DNA testing), could prevent African, Caribbean and Black women from participating in research involving the collection of breast milk/fluids. Despite these fears, some respondents expressed that they would participate if the research results would benefit them directly, for example, by finding a cure for HIV, enabling HIV+ mothers to breastfeed, or contributing to developing new drugs or vaccines for HIV. Women’s recommendations to facilitate successful recruitment included giving incentives to participants, and employing a recruiter who was trustworthy, informed, and culturally sensitive. Conclusion Cultural beliefs could present barriers to recruitment and participation of Africa, Caribbean and Black communities in health research involving breast milk/fluid samples. Successful recruitment for future studies would necessitate researchers to be culturally aware of the beliefs held by African, Caribbean and Black women, to build trust, and use an appropriate recruiter. While the findings relate to breast milk/fluids, the suggested recommendations for facilitating recruitment of research participants from these communities may be useful to consider when recruiting ethnically and culturally similar participants for research involving biological samples. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2326-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4M4, Canada.
| | - W Tharao
- Women's Health in Women's Hands, Carlton Toronto, ON, M5B 1J3, Canada
| | - M Muchenje
- Women's Health in Women's Hands, Carlton Toronto, ON, M5B 1J3, Canada
| | | | - F Ongoiba
- Africans in Partnership Against AIDS, 314 Jarvis Street. Suite 101, Toronto, ON, M5B 2C5, Canada
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Voorhoeve A, Edejer TT, Kapiriri L, Norheim OF, Snowden J, Basenya O, Bayarsaikhan D, Chentaf I, Eyal N, Folsom A, Tun Hussein RH, Morales C, Ostmann F, Ottersen T, Prakongsai P, Saenz C, Saleh K, Sommanustweechai A, Wikler D, Zakariah A. Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage. Health Hum Rights 2016; 18:11-22. [PMID: 28559673 PMCID: PMC5395011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity, and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for those who are worse off in a number of dimensions (including health, access to health services, and social and economic status), and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting.
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Affiliation(s)
- Alex Voorhoeve
- Department of Philosophy, Logic, and Scientific Method, London School of Economics, London, UK and Visiting Scholar in the Department of Bioethics at the National Institutes of Health, Bethesda, US
| | - Tessa T.T. Edejer
- Coordinator of Costs, Effectiveness, Expenditure and Priority Setting, Health Systems Governance and Financing, and Health Systems and Innovation, World Health Organization, Geneva, Switzerland
| | - Lydia Kapiriri
- Associate Professor in the Department of Health, Aging, and Society, McMaster University, Hamilton, Ontario, Canada
| | - Ole F. Norheim
- Director of Global Health Priorities in the Department of Global Public Health and Primary Care University of Bergen, Bergen, Norway
| | - James Snowden
- Research Analyst at Giving What We Can, Centre for Effective Altruism, Oxford, UK
| | - Olivier Basenya
- Performance-Based Financing Expert in the Ministry of Health, Bujumbura, Burundi
| | - Dorjsuren Bayarsaikhan
- Health Economist in the Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ikram Chentaf
- International and Intergovernmental Cooperation Program Manager in the Cooperation Division at the Ministry of Health, Rabat, Morocco
| | - Nir Eyal
- Associate Professor, Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, US
| | - Amanda Folsom
- Program Director at the Results for Development Institute, Washington, DC, US
| | - Rozita Halina Tun Hussein
- Deputy Director, Unit for National Health Financing, Planning and Development Division, Ministry of Health, Putrajaya, Malaysia
| | | | - Florian Ostmann
- School of Public Policy, University College London, London, UK
| | - Trygve Ottersen
- Research Fellow, Department of Global Public Health and Primary Care, University of Bergen and Associate Professor, Oslo Group on Global Health Policy, Centre for Global Health, University of Oslo, Bergen, Norway
| | - Phusit Prakongsai
- Director, Bureau of International Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Carla Saenz
- Bioethics Regional Advisor, Pan American Health Organization, Washington, DC, US
| | - Karima Saleh
- Senior Economist in Health at the World Bank, Washington, DC, US
| | | | - Daniel Wikler
- Saltonstall Professor of Ethics and Population Health, Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, US
| | - Afisah Zakariah
- Director, Policy, Planning, Monitoring and Evaluation, Ministry of Health, Accra, Ghana
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Chanda-Kapata P, Ngosa W, Hamainza B, Kapiriri L. Health research priority setting in Zambia: a stock taking of approaches conducted from 1998 to 2015. Health Res Policy Syst 2016; 14:72. [PMID: 27663308 PMCID: PMC5035471 DOI: 10.1186/s12961-016-0142-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Priority setting in health research is an emerging field. In Zambia, like many other African countries, various priority setting activities have been undertaken with a view to identify research activities to which the available resources can be targeted while at the same time maximising the health impact for resource allocation to support evidence-based decision-making. The aim of this paper is to document the key elements of the various priority setting activities that have been conducted since 1998, identifying the key lessons and providing recommendations to improve the process. Methods A comprehensive review of the previous priority setting activities and processes in Zambia was conducted. Both published and unpublished reports were reviewed in order to identify any research priority setting processes that have been undertaken in Zambia. We developed a framework, based on the priority setting literature, to guide our abstraction and synthesis of the literature. Result The earliest record of priority setting was conducted in 1998. Various priority setting approaches have been implemented in Zambia; ranging from externally driven, once-off activities to locally (in country) initiated comprehensive processes. However, there has been no systematic national process for priority setting. These priority setting processes in Zambia were characterised by limited stakeholder buy-in of the resulting national research or programmatic research agenda. Most striking was the lack of linkages between the different initiatives. There seems to have been no conscious recognition and building on previous priority-setting experiences of previous initiatives. Conclusion There were gaps in the priority setting processes, stakeholder engagement and application of a defined criterion. There is a need for a priority setting framework coupled with local capacity developed across a range of stakeholders.
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Affiliation(s)
- Pascalina Chanda-Kapata
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia.
| | - William Ngosa
- Department of Diseases Surveillance Control and Research, Ministry of Health, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Control Centre, Ministry of Health, Lusaka, Zambia
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, L8S 4L8, Canada
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Abstract
Purpose. The purpose of this study was to describe bedside rationing by health practitioners in a teaching hospital in Uganda. Methods. This was a case study involving in-depth interviews. A modified thematic approach was used in data analysis. Types of decisions, the decision-making process, key players, and hospital-, medical-, and patient-related considerations in the process were identified. Klein’s 6 forms of rationing were used to identify the forms of rationing used. The setting was a tertiary hospital in Uganda. Theoretical sampling was used to identify 40 doctors and 16 nurses from the Departments of Medicine, Surgery, Paediatrics, and Obstetric and Gynaecology. Results. Four types of bedside rationing decisions were identified: 1) which patients are seen first, 2) which treatment the patients receive, 3) which patients are admitted, and 4) which patients are taken to the operating theatre first. Hospital-related considerations regarding bedside rationing included the hospital budget and number of beds; medical-related considerations included the patient’s diagnosis and effectiveness of treatment; and patient-related considerations included poverty, social status, and age. All forms of rationing (denial, dilution, deflection, deterrence, delay, and termination) were practiced. Conclusion. Although bedside rationing decisions in the study hospital seem somewhat similar to that in developed countries, the rationing of 1st-line drugs by health practitioners in Uganda is complex, difficult, and different from what has been described in industrialized countries. The complexity and severity of the consequences of the bedside decisions necessitate the development of resource-sensitive clinical guidelines and transparent decision-making processes to foster patients’ understanding of the reasons and the procedures and to ensure fair decision-making processes.
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Affiliation(s)
- Lydia Kapiriri
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.
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Amoako E, Kapiriri L. How immigrant women living in Ontario experience culturally competent
care during pregnancy. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.015] [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: 10/21/2022] Open
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Kapiriri L, Tharao W, Muchenje M, Masinde KI, Ongoiba F. ' … They should understand why … ' The knowledge, attitudes and impact of the HIV criminalisation law on a sample of HIV+ women living in Ontario. Glob Public Health 2016; 11:1231-1245. [PMID: 26983582 DOI: 10.1080/17441692.2016.1146318] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over 60 countries criminalise 'the "willful" transmission of HIV'. Such a law has the potential to hinder public health interventions. There is limited literature discussing the perceptions of this law and the impact, it has had on HIV-positive women. This paper describes the knowledge of and attitudes of this law by HIV-positive women living in Ontario; and their experiences with its application. Three group discussions (n = 10) and 17 in-depth interviews with HIV-positive women age: 21-56 years. Data were analysed using a modified thematic approach. Most of the respondents knew about the law with regard to adult HIV transmission. However, very few knew about any laws related to mother to child HIV transmission, although some reported having had their children taken away because of breastfeeding. Respondents felt that the law could be fair and protective if there were means of providing a priori support to those women who have been disadvantaged social-culturally and structurally. Without this support, the law could potentially lead HIV-positive women into hiding and not accessing services that could help them. There is need for the law implementers to consider these findings if they are to support the public health efforts to control HIV.
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Affiliation(s)
- Lydia Kapiriri
- a Department of Health , Aging and Society, McMaster University , Hamilton , Ontario , Canada
| | | | | | | | - Fanta Ongoiba
- d Africans in Partnership Against AIDS , Toronto , Canada
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Kapiriri L, Tharao WE, Muchenje M, Masinde KI, Siegel S, Ongoiba F. The experiences of making infant feeding choices by African, Caribbean and Black HIV-positive mothers in Ontario, Canada. ACTA ACUST UNITED AC 2015; 15:14-22. [PMID: 25144786 DOI: 10.12927/whp.2014.23860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Mothers in HIV-endemic countries are advised to exclusively breastfeed their babies until six months because of lack of resources and better chances for child survival, while in developed countries, replacement feeding is advised. What are the experiences of HIV-positive women who migrate from HIV-endemic countries to developed countries, when making infant feeding choices? METHODS In-depth interviews and focus group discussions with a total of 25 women living with HIV in Toronto and Hamilton, Ontario. RESULTS Free infant formula alleviates the practical constraints in making infant feeding choices. However, cultural beliefs and social expectations constrain HIV-positive mothers' decision not to breastfeed. This is further complicated by the different policies. Service providers should understand the psychological and emotional experiences of the mothers in order to provide the appropriate support. Peers could be potential sources of support. The differences in policies are issues of global justice that need to be addressed.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
| | | | - Marvelous Muchenje
- Community Health coordinator, Women's Health in Women's Hands, Toronto, Ontario, Canada
| | | | - Sandi Siegel
- McMaster University, Faculty of Health Science, Department of Pediatrics and Infectious Diseases, Hamilton, Ontario, Canada
| | - Fanta Ongoiba
- Executive Director, Africans in Partnership against AIDS, Toronto, Ontario, Canada
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Norheim OF, Baltussen R, Johri M, Chisholm D, Nord E, Brock D, Carlsson P, Cookson R, Daniels N, Danis M, Fleurbaey M, Johansson KA, Kapiriri L, Littlejohns P, Mbeeli T, Rao KD, Edejer TTT, Wikler D. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc 2014; 12:18. [PMID: 25246855 PMCID: PMC4171087 DOI: 10.1186/1478-7547-12-18] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [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: 04/05/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria. THE GUIDANCE WAS DEVELOP THROUGH A SERIES OF EXPERT CONSULTATION MEETINGS AND INVOLVED THREE STEPS: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders. The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others).
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Affiliation(s)
- Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Rob Baltussen
- Nijmegen International Centre for Health Systems Research and Education (NICHE), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Dan Chisholm
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
| | - Erik Nord
- Norwegian Institute of Public Health, Oslo, Norway
| | - DanW Brock
- Harvard Medical School, Harvard University, Cambridge, USA
| | - Per Carlsson
- National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden
| | | | - Norman Daniels
- Harvard School of Public Health, Harvard University, Cambridge, USA
| | - Marion Danis
- Section on Ethics and Health Policy, NIH Clinical Centre, Bethesda, USA
| | - Marc Fleurbaey
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, USA
| | - Kjell A Johansson
- Department of Global Public Health and Primary Care, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Lydia Kapiriri
- Department of Health, Aging, and Society, McMaster University, Hamilton, Canada
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, Previous affiliation the National Institute for Health and Care Excellence (NICE), London, England, UK
| | - Thomas Mbeeli
- Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Tessa Tan-Torres Edejer
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Québec, Canada
| | - Dan Wikler
- Harvard School of Public Health, Harvard University, Cambridge, USA
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Kapiriri L. How effective has the essential health package been in improving priority setting in low income countries? Soc Sci Med 2013; 85:38-42. [PMID: 23540364 DOI: 10.1016/j.socscimed.2013.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 01/31/2013] [Accepted: 02/15/2013] [Indexed: 12/17/2022]
Abstract
The Essential Health Care Package (EHP) approach has been promoted as a tool for guiding priority setting (PS) in Low Income Countries (LICs). This approach was expected to improve PS by; (i) providing credible evidence, (ii) improving efficiency, (iii) making PS more transparent, explicit and objective, (iv) increasing public empowerment and accountability; and (v) improving equity. To date, there is paucity of literature discussing the degree to which the EHP approach has met these expectations. This review paper fills this gap. We demonstrate that the EHP approach has only marginally met some of the above expectations. While this has been blamed on the lack of resources and capacity to deliver the package, we argue that limited attention paid to the PS process and the context, failure to institute and strengthen the capacity of PS institutions, and lack of an inbuilt process of monitoring and evaluating the implementation of the approach, may have also contributed to the EHP's not meeting its expectations. While we use the example of the EHP approach, this discussion is relevant to any PS approach and the proposed recommendations (if implemented), would contribute to strengthening PS in LICs.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, 1280 Main St. W. Hamilton, Ontario, Canada L8S 4M4.
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