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Farsaci L, Fleming P, Almirall-Sanchez A, O'Donoghue C, Thomas S. Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy. Health Policy 2024; 143:105063. [PMID: 38583364 DOI: 10.1016/j.healthpol.2024.105063] [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: 11/16/2023] [Revised: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
This paper contrasts the Irish experience of the 2008 economic crisis and the Covid-19 pandemic, and the health system responses to these shocks, from the perspective of health system leaders working across both time periods. Based on semi-structured interviews with seven senior national and international officials, the research presented here forms the qualitative component of RESTORE, a five-year research project examining health system resilience and reform, funded through the Health Research Board's Research Leader Award in Ireland. Findings indicate that the financial crisis deeply impacted the Irish health system in relation to infrastructure and capacity, service delivery and workforce. Due to these legacy issues, Ireland's health system was in a relatively weak position when faced with the Covid-19 pandemic but the system proved adaptive and innovative during this time. Furthermore, the pandemic proved to be a catalyst for positive change, providing opportunities for long-term reform, alongside an immediate response to the crisis. This was facilitated by increased funding, a devolution in decision-making structures and a political commitment to the health system. Exploring lessons from the Irish response to these crises provides a case study for developing appropriate policy responses around financing and resource allocation, fostering support for healthcare among political leaders and policy makers, and preparing for future shocks. Furthermore, examining these experiences facilitates understanding around the impact of each crisis on the health system, exploring options for addressing legacy issues and considering practical steps to improve health system performance.
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Affiliation(s)
- Liz Farsaci
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Padraic Fleming
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Arianna Almirall-Sanchez
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Catherine O'Donoghue
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Steve Thomas
- Edward Kennedy Professor of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
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Schut FT, Franken FME, van der Geest SA, Varkevisser M. Financing COVID-19-related health care costs in the Dutch competitive health system during 2020 and 2021: Overall experiences and policy recommendations for improving health system resilience. Health Policy 2024; 141:104969. [PMID: 38281456 DOI: 10.1016/j.healthpol.2023.104969] [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: 04/26/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
The Dutch health system is based on the principles of managed (or regulated) competition, meaning that competing risk bearing insurers and providers negotiate contracts on the price, quantity and quality of care. The COVID-19 pandemic caused a huge external shock to the health system which potentially distorted the conditions required for fair competition. Therefore, an important question is to what extent was the competitive Dutch health system resilient to the financial shock caused by the pandemic? Overall, the Dutch competitive health system proved to be sufficiently flexible and resilient at absorbing the financial shock caused by the COVID-19 pandemic in 2020 and 2021 due to an effective combination of regulatory and self-regulatory measures. However, based on the overall experiences in the Netherlands, from the health policy perspective improvements are needed aimed at (i) refining the catastrophic costs clause included in the Health Insurance Act, (ii) reducing the vulnerability of the Dutch risk equalisation system to distortions due to unforeseen catastrophic health care costs, and (iii) establishing more equal financial risk sharing between health insurers and health care providers. These improvements are also relevant for other countries with a health system based on the principles of managed (or regulated) competition.
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Affiliation(s)
- Frederik T Schut
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
| | - Frédérique M E Franken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
| | - Stéphanie A van der Geest
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
| | - Marco Varkevisser
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
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Kringos D, Ivanković D, Barbazza E, Klazinga N, Brito Fernandes Ó. Health system performance assessment: embedding resilience through performance intelligence. Int J Qual Health Care 2024; 36:mzae010. [PMID: 38334753 PMCID: PMC10873822 DOI: 10.1093/intqhc/mzae010] [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: 07/31/2023] [Revised: 12/18/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Health systems around the world are facing challenges in achieving their goals. In the wake of the coronavirus disease pandemic, the need for resilient health systems has become even more apparent. This article argues that embedding resilience into health system performance assessment (HSPA) frameworks can be a valuable approach for improving health system performance. This perspective examines key challenges threatening health systems and makes a case for the continued relevance of HSPA by embedding resilience-related performance intelligence.
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Affiliation(s)
- Dionne Kringos
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, University of Amsterdam, Amsterdam, the Netherlands
| | - Damir Ivanković
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, University of Amsterdam, Amsterdam, the Netherlands
| | - Erica Barbazza
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, University of Amsterdam, Amsterdam, the Netherlands
| | - Niek Klazinga
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, University of Amsterdam, Amsterdam, the Netherlands
| | - Óscar Brito Fernandes
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Quality of Care, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- WHO Collaborating Centre for Quality and Equity in Primary Health Care Systems, University of Amsterdam, Amsterdam, the Netherlands
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Hernandez-Pineda E, Amaya CA, González-Uribe C, Herrera A, Velasco N. Covid-19 vaccination: a mixed methods analysis of health system resilience in Latin America. Int J Equity Health 2024; 23:27. [PMID: 38347545 PMCID: PMC10863163 DOI: 10.1186/s12939-023-02073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This paper discusses the stages of health system resilience (HSR) and the factors underlying differences in HSR during the covid-19 pandemic, especially the vaccination challenge. We studied the relationship between vaccination strategies and macro-context backgrounds in 21 Latin American countries. Our objective was to capture the impact of those aspects in the SR and identify potential improvements for future crises and for vaccination programs in general. METHODS The study uses mixed-methods research to provide insights into how the countries' backgrounds and vaccination strategies impact the HSR. Particularly, we used explanatory sequential mixed methods, which entails a quantitative-qualitative two-phase sequence. The quantitative phase was conducted using cluster and variance analysis, in which the HSR was measured using as a proxy the covid-19 vaccination outcomes in three cut-offs of reaching 25%, 50%, and 75% of population coverage. This approach allows us to discriminate covid-19 vaccination progress by stages and contrast it to the qualitative stage, in which we performed a country-case analysis of the background conditions and the changes in vaccination strategies that occurred during the corresponding dates. RESULTS The paper provides a rich comparative case analysis of countries, classifying them by early, prompt, and delayed performers. The results show that differences in vaccination performance are due to flexibility in adapting strategies, cooperation, and the ability to design multilevel solutions that consider the needs of various actors in the health ecosystem. These differences vary depending on the vaccination stage, which suggests the importance of acknowledging learning, diffusion, and feedback processes at the regional level. CONCLUSIONS We identified the importance of societal well-being as an ideal country antecedent for high and sustained levels of performance in covid-19 vaccination. Whereas in other countries where the set-up and beginning phases were rough, the value of the operational decisions and the learning on the move regarding their own and their peers' trajectories were crucial and were reflected in performance improvement. A contribution of this study is that the above-mentioned analysis was done using vaccination coverage cut-off points that allow a performance view that takes into consideration the stages of the vaccination progress and the learning process that goes with it. As well as framing this into the HSR shock cycles that allow to differentiate the stages of resilience on which countries must act.
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Affiliation(s)
| | - Ciro-Alberto Amaya
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Catalina González-Uribe
- School of Medicine, Universidad de Los Andes, Carrera 1 No 18 A - 10 42 Bloque Q Piso 8, Bogotá, 111711, Colombia
| | - Andrea Herrera
- School of Engineering, Universidad de Los Andes, Cra 1 E ste N° 19A - 40, Bogotá, 111711, Colombia
| | - Nubia Velasco
- School of Management, Universidad de Los Andes, Calle 21 # 1-20, Bogotá, 111711, Colombia
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Götz P, Auping WL, Hinrichs-Krapels S. Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach. BMC Health Serv Res 2024; 24:130. [PMID: 38267945 PMCID: PMC10807148 DOI: 10.1186/s12913-023-10487-7] [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: 01/31/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Health systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study's aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises. METHODS We developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients' critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector. RESULTS We found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up. CONCLUSION We demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems' resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.
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Affiliation(s)
- Paula Götz
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Willem L Auping
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Saba Hinrichs-Krapels
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
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Amarakoon PM, Gundersen RB, Muhire A, Utvik VA, Braa J. Exploring health information system resilience during COVID-19 pandemic: case studies from Norway, Sri Lanka & Rwanda. BMC Health Serv Res 2023; 23:1433. [PMID: 38110892 PMCID: PMC10726492 DOI: 10.1186/s12913-023-10232-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023] Open
Abstract
The study aims at exploring health system resilience by defining the scope on health information systems, one of the six building blocks of the health system. The empirical evidence is derived using qualitative data collection and analysis in the context of Norway, Sri Lanka and Rwanda during the COVID-19 pandemic. The case studies elicit bounce back and bounce forward properties as well as the agility as major attributes of resilience present across the countries. Existing local capacity, networking and collaborations, flexible digital platforms and enabling antecedent conditions are identified as socio-technical determinants of information system resilience based on the case studies across the countries.
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Bigirinama RN, Makali SL, Mothupi MC, Chiribagula CZ, St Louis P, Mwene-Batu PL, Bisimwa GB, Mwembo AT, Porignon DG. Ensuring leadership at the operational level of a health system in protracted crisis context: a cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo. BMC Health Serv Res 2023; 23:1362. [PMID: 38057862 DOI: 10.1186/s12913-023-10336-7] [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: 05/18/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC. METHODS A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC's health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service's Leadership Academy. From these themes, a secondary analysis extracted emerging subthemes. RESULTS The study has revealed deficiencies regarding management and organization of the health zones, internal collaboration within their management teams as well as collaboration between these teams and the health zone's external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership. CONCLUSIONS Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.
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Affiliation(s)
- Rosine N Bigirinama
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo.
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | - Samuel L Makali
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Mamothena C Mothupi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Christian Z Chiribagula
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Patricia St Louis
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Pacifique L Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université de Kaziba, Bukavu, Democratic Republic of Congo
| | - Ghislain B Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Albert T Mwembo
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Denis G Porignon
- Département des Sciences de la Santé Publique, School of Medicine, Université de Liège, Liège, Belgium
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Bou-Orm IR, Moussallem M, Karam J, deLara M, Varma V, Diaconu K, Apaydin MCB, Van den Bergh R, Ager A, Witter S. Provision of mental health and psychosocial support services to health workers and community members in conflict-affected Northwest Syria: a mixed-methods study. Confl Health 2023; 17:46. [PMID: 37794393 PMCID: PMC10548701 DOI: 10.1186/s13031-023-00547-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Northwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services. METHODS The study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries. RESULTS Findings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services-especially among health workers seeking MHPSS services-findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach. CONCLUSION The study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.
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Affiliation(s)
- Ibrahim R Bou-Orm
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Marianne Moussallem
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Joelle Karam
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Vinod Varma
- World Health Organization, Gaziantep, Turkey
| | - Karin Diaconu
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | - Rafael Van den Bergh
- Attacks On Health Care Initiative, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sophie Witter
- ReBUILD for Resilience, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Dafallah A, Elmahi OKO, Ibrahim ME, Elsheikh RE, Blanchet K. Destruction, disruption and disaster: Sudan's health system amidst armed conflict. Confl Health 2023; 17:43. [PMID: 37752590 PMCID: PMC10523736 DOI: 10.1186/s13031-023-00542-9] [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: 05/19/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
The ongoing armed conflict in Sudan has resulted in a deepening humanitarian crisis with significant implications for the country's health system, threatening its collapse. This article examines the destruction, disruption, and disastrous consequences inflicted upon Sudan's health system. The conflict has led to the severe compromise of healthcare facilities, with only one-third of hospitals in conflict zones operational. Artillery attacks, forced militarization, power outages, and shortages of medical supplies and personnel have further crippled the health system. The exodus of health workers and escalating violence have exacerbated the crisis. Disrupted service delivery has resulted in the interruption of essential health services, including obstetric care, emergency services, and dialysis. Financial losses to the health system are estimated at $700 million, impacting an already underfunded sector. We identify that in addition to restoration of peace and mobilization of urgent aid, immediate prioritization of the reconstruction of the health system is crucial to mitigate the long-term consequences of the war. Rebuilding a resilient health system is sine qua non for Sudan's progress towards universal health.
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Affiliation(s)
- Alaa Dafallah
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK.
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | | | | | | | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Michael GC, Grema BA, Tanimu ST. COVID-19 Pandemic Response: A Primary Care Experience in Northwest Nigeria. West Afr J Med 2023; 40:562-564. [PMID: 37247376] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The effectiveness of healthcare systems during this COVID-19 pandemic will largely depend on their resilience in the face of untold challenges. Hence, we share the ongoing experience of the response of a primary care facility to challenges of the increasing number of undifferentiated patient load in the context of rising COVID-19 cases, infrastructural gap, limited personal protective equipment, and the health workforce in a densely populated town.
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Affiliation(s)
- G C Michael
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria.
| | - B A Grema
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria.
| | - S T Tanimu
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria.
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Reddy T, Kapoor NR, Kubota S, Doubova SV, Asai D, Mariam DH, Ayele W, Mebratie AD, Thermidor R, Sapag JC, Bedregal P, Passi-Solar Á, Gordon-Strachan G, Dulal M, Gadeka DD, Mehata S, Margozzini P, Leerapan B, Rittiphairoj T, Kaewkamjornchai P, Nega A, Awoonor-Williams JK, Kruk ME, Arsenault C. Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries. BMC Health Serv Res 2023; 23:363. [PMID: 37046260 PMCID: PMC10096103 DOI: 10.1186/s12913-023-09363-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. METHODS Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. FINDINGS Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. CONCLUSIONS Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.
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Affiliation(s)
- Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu Natal, Durban, South Africa
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-Au-Prince, Haiti
| | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | - Suresh Mehata
- Ministry of Health, Koshi Province, Biratnagar, Nepal
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Catherine Arsenault
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, USA.
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12
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Alhassan Y, Zaizay Z, Dean L, McCollum R, Watson V, Kollie K, Piotrowski H, Hastie O, Parker C, Dacombe R, Theobald S, Taegtmeyer M. Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics. BMC Health Serv Res 2023; 23:304. [PMID: 36991477 PMCID: PMC10057690 DOI: 10.1186/s12913-023-09162-8] [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: 10/13/2022] [Accepted: 02/08/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND COVID-19 has caused significant public health problems globally, with catastrophic impacts on health systems. This study explored the adaptations to health services in Liberia and Merseyside UK at the beginning of the COVID-19 pandemic (January-May 2020) and their perceived impact on routine service delivery. During this period, transmission routes and treatment pathways were as yet unknown, public fear and health care worker fear was high and death rates among vulnerable hospitalised patients were high. We aimed to identify cross-context lessons for building more resilient health systems during a pandemic response. METHODS The study employed a cross-sectional qualitative design with a collective case study approach involving simultaneous comparison of COVID-19 response experiences in Liberia and Merseyside. Between June and September 2020, we conducted semi-structured interviews with 66 health system actors purposively selected across different levels of the health system. Participants included national and county decision-makers in Liberia, frontline health workers and regional and hospital decision-makers in Merseyside UK. Data were analysed thematically in NVivo 12 software. RESULTS There were mixed impacts on routine services in both settings. Major adverse impacts included diminished availability and utilisation of critical health services for socially vulnerable populations, linked with reallocation of health service resources for COVID-19 care, and use of virtual medical consultation in Merseyside. Routine service delivery during the pandemic was hampered by a lack of clear communication, centralised planning, and limited local autonomy. Across both settings, cross-sectoral collaboration, community-based service delivery, virtual consultations, community engagement, culturally sensitive messaging, and local autonomy in response planning facilitated delivery of essential services. CONCLUSION Our findings can inform response planning to assure optimal delivery of essential routine health services during the early phases of public health emergencies. Pandemic responses should prioritise early preparedness, with investment in the health systems building blocks including staff training and PPE stocks, address both pre-existing and pandemic-related structural barriers to care, inclusive and participatory decision-making, strong community engagement, and effective and sensitive communication. Multisectoral collaboration and inclusive leadership are essential.
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Affiliation(s)
- Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | | | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Victoria Watson
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | | | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Paschoalotto MAC, Lazzari EA, Rocha R, Massuda A, Castro MC. Health systems resilience: is it time to revisit resilience after COVID-19? Soc Sci Med 2023; 320:115716. [PMID: 36702027 PMCID: PMC9851720 DOI: 10.1016/j.socscimed.2023.115716] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [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: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.
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Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil.
| | - Eduardo Alves Lazzari
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Rudi Rocha
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Adriano Massuda
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, Harvard University, USA
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14
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Arena L, Soloe C, Schlueter D, Ferriola-Bruckenstein K, DeGroff A, Tangka F, Hoover S, Melillo S, Subramanian S. Modifications in Primary Care Clinics to Continue Colorectal Cancer Screening Promotion During the COVID-19 Pandemic. J Community Health 2023; 48:113-126. [PMID: 36308666 PMCID: PMC9617236 DOI: 10.1007/s10900-022-01154-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/28/2022]
Abstract
COVID-19 caused significant declines in colorectal cancer (CRC) screening. Health systems and clinics, faced with a new rapidly spreading infectious disease, adapted to maintain patient safety and address the effects of the pandemic on healthcare delivery. This study aimed to understand how CDC-funded Colorectal Cancer Control Program recipients and their partner health systems and clinics may have modified evidence-based intervention (EBI) implementation to promote CRC screening during the COVID-19 pandemic; to identify barriers and facilitators to implementing modifications; and to extract lessons that can be applied to support CRC screening, chronic disease management, and clinic resilience in the face of future public health crises. Nine recipients were selected to reflect the diversity inherent among all CRCCP recipients. Recipient and clinic partner staff answered unique sets of pre-interview questions to inform tailoring of interview guides that were developed using constructs from the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and Consolidated Framework for Implementation Research (CFIR). The study team then interviewed recipient, health system, and clinic partner staff incorporating pre-interview responses to focus each conversation. We employed a rapid qualitative analysis approach then conducted virtual focus groups with recipient representatives to validate emergent themes. Three modifications that emerged from thematic analysis include: (1) offering mailed fecal immunochemical test (FIT) kits for CRC screening with mail or drop off return; (2) increasing the use of patient education and engagement strategies; and (3) increasing the use of or improving automated patient messaging systems. With improved tracking and automated reminder systems, mailed FIT kits paired with tailored patient education and clear instructions for completing the test could help primary care clinics catch up on the backlog of missed screenings during COVID-19. Future research can assess the effectiveness and cost-effectiveness of offering mailed FIT kits on maintaining or improving CRC screening, especially among people who are medically underserved.
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Affiliation(s)
- Laura Arena
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Cindy Soloe
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Dara Schlueter
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Florence Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sonja Hoover
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709 USA
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15
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Grimm PY, Wyss K. What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs. Global Health 2022; 18:55. [PMID: 35619166 PMCID: PMC9134130 DOI: 10.1186/s12992-022-00848-y] [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: 12/02/2021] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. The experiences and perspectives of Swiss NGOs in this article highlight the vital role NGOs may play in building resilient health systems in their partner countries. Specifically, strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and bear the responsibility to support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience. Resilience building will not only prepare countries for future shocks but bridge the disparate health and development agenda in order to better address the nexus between humanitarian aid and development cooperation. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00848-y.
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Affiliation(s)
- Pauline Yongeun Grimm
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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16
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Lal A, Lim C, Almeida G, Fitzgerald J. Minimizing COVID-19 disruption: Ensuring the supply of essential health products for health emergencies and routine health services. Lancet Reg Health Am 2022; 6:100129. [PMID: 34909753 PMCID: PMC8645973 DOI: 10.1016/j.lana.2021.100129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leveraging economies of scale and scope through multi-country pooled procurement enables countries to increase access to quality affordable essential medicines and supplies that meet priority health objectives as well as effectively respond to health emergencies. Strategic partnerships and tools can minimize supply chain disruptions and streamline procurement and deployment in health emergencies, thus mitigating stockouts and ensuring cost efficiencies across various therapeutic areas, including for public health programs at a time when countries may struggle to meet complex needs. As a means to better respond to health emergencies while maintaining priority public health programs, countries should optimize usage of pooled procurement mechanisms facilitated by multilateral technical cooperation and other regional mechanisms, such as the Pan American Health Organization's Strategic Fund. Because few analyses have assessed the role of such regional procurement mechanisms, this Health Policy paper evaluates the key areas of impact of the PAHO Strategic Fund and concludes with lessons learned to help prepare for future health crises while maintaining essential health services.
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Affiliation(s)
- Arush Lal
- Strategic Fund, Pan American Health Organization, Washington, DC, USA
| | - Christopher Lim
- Strategic Fund, Pan American Health Organization, Washington, DC, USA
| | - Gisele Almeida
- Department of Health Systems and Services, Pan American Health Organization, Washington, DC, USA
| | - James Fitzgerald
- Department of Health Systems and Services, Pan American Health Organization, Washington, DC, USA
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17
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Abstract
The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. While substantial effort has gone into the conceptualization of health system resilience, there has been no review of how the concept has been operationalized in empirical studies. We conducted an empirical review in three databases using systematic methods. Findings were synthesized using descriptive quantitative analysis and by mapping aims, findings, underlying concepts and measurement approaches according to the resilience definition by Blanchet et al. We identified 71 empirical studies on health system resilience from 2008 to 2019, with an increase in literature in recent years (62% of studies published since 2017). Most studies addressed a specific crisis or challenge (82%), most notably infectious disease outbreaks (20%), natural disasters (15%) and climate change (11%). A large proportion of studies focused on service delivery (48%), while other health system building blocks were side-lined. The studies differed in terms of their disciplinary tradition and conceptual background, which was reflected in the variety of concepts and measurement approaches used. Despite extensive theoretical work on the domains which constitute health system resilience, we found that most of the empirical literature only addressed particular aspects related to absorptive and adaptive capacities, with legitimacy of institutions and transformative resilience seldom addressed. Qualitative and mixed methods research captured a broader range of resilience domains than quantitative research. The review shows that the way in which resilience is currently applied in the empirical literature does not match its theoretical foundations. In order to do justice to the complexities of the resilience concept, knowledge from both quantitative and qualitative research traditions should be integrated in a comprehensive assessment framework. Only then will the theoretical ‘resilience idea’ be able to prove its usefulness for the research community.
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Affiliation(s)
- Louise Biddle
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany
| | - Katharina Wahedi
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany
| | - Kayvan Bozorgmehr
- Social Determinants, Equity and Migration Working Group, Department of General Practice & Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Turm West, Heidelberg 69120, Germany.,Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
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18
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Hamadeh RS, Kdouh O, Hammoud R, Leresche E, Leaning J. Working short and working long: can primary healthcare be protected as a public good in Lebanon today? Confl Health 2021; 15:23. [PMID: 33827637 PMCID: PMC8024932 DOI: 10.1186/s13031-021-00359-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/07/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
In this commentary we propose four questions to be addressed while building a meaningful public primary healthcare response in Lebanon today. These questions emerge from two imperatives: the necessity to consider both short- and longer-term struggles in a context of protracted conflict and the need to protect public health as a public good whilst the public Primary Healthcare Network (PHCN) is facing the Covid19 pandemic. In order to identify how these questions are related to the need to be working short and long, we look at the imprints left by past and present shocks. Profound shocks of the past include the Lebanese civil war and the Syrian refugee crisis. We analyse how these shocks have resulted in the PHCN developing resilience mechanisms in order to ensure a space for healthcare provision that stands public in Lebanon today. Then, we consider how two present shocks -- the economic breakdown and the blast of ammonium nitrate in Beirut port -- are affecting and threatening the progress made by the PHCN to ensure that primary healthcare remains a public good, a fragile space acquired with difficulty in the past half century. We identify what questions emerge from the combined consequences of such traumas, when the immediate constraints of the present meet the impediments of the past. We consider what such questions mean more broadly, for the people living in Lebanon today, and for the PHCN ability to respond to the Covid 19 pandemic in a relevant way. Our hypothesis is that in a protracted conflict, such as the one defining the circumstances of Lebanon now, public access to primary healthcare might persist for the people as one safeguard, in which social and moral continuity can be anchored to protect a sense of public good.
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Affiliation(s)
- Randa Sami Hamadeh
- Lebanese Ministry of Public Health, Beirut, Lebanon
- Global Health Team of Experts, Beirut, Lebanon
| | - Ola Kdouh
- Lebanese Ministry of Public Health, Beirut, Lebanon
- Global Health Team of Experts, Beirut, Lebanon
| | - Rawan Hammoud
- Lebanese Ministry of Public Health, Beirut, Lebanon
- Global Health Team of Experts, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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19
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Bouchard ME, Sheneman N, Hey MT, Hoemeke L, Abdullah F. Investments in surgical systems contribute to pandemic readiness and health system resilience. J Public Health Policy 2021; 42:493-500. [PMID: 34193939 PMCID: PMC8243617 DOI: 10.1057/s41271-021-00292-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/24/2021] [Indexed: 02/04/2023]
Abstract
Safe surgical care, including anesthesia, obstetrics, and trauma, is an essential component of a functional health system, yet five billion people lack access to high-quality, timely and affordable surgical care. As health decision makers are grappling with how to make appropriate investments for crisis readiness and resilience, investments in surgical care should be considered for their compounding benefits to meet a country's diverse health goals. National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) are developed through global partnerships and multi-stakeholder consensus and provide a dynamic framework for surgical scale-up that also improves the resilience of the larger health system. Our paper applies principles from the literature on health system resilience to surgical systems and examines the unique capabilities of the surgical workforce and infrastructure to be redeployed during times of crisis, using examples from the current pandemic.
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Affiliation(s)
- Megan E. Bouchard
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
| | | | - Matthew T. Hey
- The G4 Alliance, Chicago, IL USA ,grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Laura Hoemeke
- The G4 Alliance, Chicago, IL USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC USA
| | - Fizan Abdullah
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
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20
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Djalante R, Nurhidayah L, Van Minh H, Phuong NTN, Mahendradhata Y, Trias A, Lassa J, Miller MA. COVID-19 and ASEAN responses: Comparative policy analysis. Prog Disaster Sci 2020; 8:100129. [PMID: 34173447 PMCID: PMC7577870 DOI: 10.1016/j.pdisas.2020.100129] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 05/14/2023]
Abstract
Scholars and policy-makers agree that cross-border and multi-sector cooperation are essential components of coordinated efforts to contain the spread of COVID-19 infections. This paper examines the responses of ASEAN (Association of Southeast Asian Nation) member countries to the COVID-19 pandemic, including the limits of regional cooperation. ASEAN has pre-existing cooperative frameworks in place, including regional health security measures, which, at least theoretically, could assist the region's efforts to formulate cooperative responses to containing a global pandemic. With its overarching "One Vision, One Identity, One Community", ASEAN cooperation has extended to include region-wide disaster responses, framed as "One Asean, One Response". Using content analysis, this paper examines media statements and policies from ASEAN member states and the ASEAN Secretariat to assess the collective response to COVID-19 during the period from January to August 2020. By identifying gaps and opportunities in government responses to COVID-19 as the virus spread throughout Southeast Asia, this paper provides new insights as well as recommendations for the future.
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Affiliation(s)
- Riyanti Djalante
- United Nations University - Institute for the Advanced Study of Sustainability (UNU-IAS), Japan
| | | | - Hoang Van Minh
- Center for Population Health Sciences, Hanoi University of Public Health, Viet Nam
| | | | - Yodi Mahendradhata
- Faculty of Medicine, Public Health and Nursing, University of Gadjah Mada, Indonesia
| | - Angelo Trias
- S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University, Singapore
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21
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Nuzzo JB, Meyer D, Snyder M, Ravi SJ, Lapascu A, Souleles J, Andrada CI, Bishai D. What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review. BMC Public Health 2019; 19:1310. [PMID: 31623594 PMCID: PMC6798426 DOI: 10.1186/s12889-019-7707-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [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: 05/10/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
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Affiliation(s)
- Jennifer B Nuzzo
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Diane Meyer
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA.
| | - Michael Snyder
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Sanjana J Ravi
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Ana Lapascu
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jon Souleles
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carolina I Andrada
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan 2018; 32:iii91-iii94. [PMID: 29149319 DOI: 10.1093/heapol/czx118] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/12/2022] Open
Abstract
Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS.
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Affiliation(s)
- Edwine W Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Keith Cloete
- Western Cape Government, Health Department, 9 Wale street, Cape Town City Center, Cape Town 8000, South Africa
| | - Lucy Gilson
- School of Public Health and Family Medicine, University of Cape Town, Falmouth Rd, Observatory, Cape Town 7925, South Africa.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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Martineau FP. People-centred health systems: building more resilient health systems in the wake of the Ebola crisis. Int Health 2016; 8:307-9. [PMID: 27620922 PMCID: PMC5039820 DOI: 10.1093/inthealth/ihw029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/28/2016] [Accepted: 05/25/2016] [Indexed: 12/04/2022] Open
Abstract
The 2014–2016 West African Ebola outbreak demonstrated the extent to which local social and political dynamics shape health system responses to crises such as epidemics. Many post-Ebola health system strengthening programmes are framed around a notion of health system ‘resilience’ that focuses on global rather than local priorities and fails to account for key local social dynamics that shape crisis responses. Post-crisis health system strengthening efforts require a shift towards a more ‘people-centred’ understanding of resilience that attends to the people, relationships and local contexts that constitute health systems and the practices that produce crisis responses.
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Affiliation(s)
- Fred P Martineau
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Nabyonga-Orem J, Gebrikidane M, Mwisongo A. Assessing policy dialogues and the role of context: Liberian case study before and during the Ebola outbreak. BMC Health Serv Res 2016; 16 Suppl 4:219. [PMID: 27454117 PMCID: PMC4959377 DOI: 10.1186/s12913-016-1454-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/10/2022] Open
Abstract
Background In the last decade participatory approaches have gained prominence in policy-making, becoming the focus of good policy-making processes. Policy dialogue is recognised as an important aspect of policy-making among several interactive and innovative policy-making models applied in different contexts and sectors. Recently there has been emphasis on the quality of policy dialogue in terms of how it should be conducted to attain participation and inclusiveness. However, there is paucity of evidence on how the context influences policy dialogue, particularly participation of stakeholders. Liberia’s context, which is characterised as post-war, highly donor dependent and in recovery from the recent catastrophic Ebola outbreak, provides an opportunity to understand the influence of context on policy dialogue. Methods This was an exploratory study using qualitative methods. Key informant interviews were conducted using an interview guide. A total of 16 interviews were conducted, 12 at the national level and 4 at the sub national level. Data were analysed using inductive thematic content analysis. Results The respondents felt that the dialogues were a success and involved important stakeholders; however, there were concerns about the improper methodology and facilitation used to conduct them. Opinions among the respondents about the process of generating and selecting the themes for the dialogues were extremely divergent. Both before and during the Ebola outbreak, the context was instrumental in shaping the dialogues according to the issue of focus, requirements for participation and the decisions to be made. Policy dialogues have become a platform for policy discussions and decisions in Liberia. It is a process that is well recognised and appreciated and is highly attributed to the success of the negotiations during the Ebola outbreak. Conclusions To sustain and strengthen policy dialogues in future, there needs to be proper information sharing through diverse forums and avenues, stakeholders’ empowerment and competent facilitation. These will ensure that the process is credible and legitimate.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo.
| | - Mesfin Gebrikidane
- Health Systems and Services, World Health Organization Liberia Country Office, PO Box 316, Monrovia, Liberia
| | - Aziza Mwisongo
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo
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