Monitoring and evaluation practices and operational research during public health emergencies in southeast Asia region (2012-2022) - a systematic review

This systematic review aimed to explore the monitoring and evaluation (M&E) and operational research (OR) practices during public health emergencies (PHE) in the southeast Asian region (SEAR) over the last decade. We searched electronic databases and grey literature sources for studies published between 2012 and 2022. The studies written in English were included, and a narrative synthesis was undertaken. A total of 29 studies were included in this review. Among these 25 studies documented M&E and four studies documented OR practices. The majority of the studies were from India and Bangladesh, with no evidence found from Sri Lanka, Bhutan, Myanmar, and Timor-Leste. M&E of surveillance programs were identified among which PHE due to COVID-19 was most prevalent. M&E was conducted in response to COVID-19, cholera, Nipah, Ebola, Candida auris, and hepatitis A. OR practice was minimal and reported from India and Indonesia. India conducted OR on COVID-19 and malaria, whereas Indonesia focused on COVID-19 and influenza. While most SEAR countries have mechanisms for conducting M&E, there is a noticeable limitation in OR practices. There is a compelling need to develop a standard framework for M&E. Additionally, enhancing private sector engagement is crucial for strengthening preparedness against PHE. Furthermore, there is a necessity to increase awareness about the importance of conducting M&E and OR during PHE.

Community-based interventions to prevent stroke in low-income and middle-income countries: a protocol for a systematic review and meta-analysis

INTRODUCTION

Stroke is the second leading cause of death and morbidity across the globe. In low-income and middle-income countries (LMICs), it has become an overwhelming burden over the past few decades. This burden is escalating at a much greater pace compared with that of high-income countries. It is considered the most frequent cause of adult disability that affects the quality of life. 'Prevention' is one of the key components to combating stroke. In this regard, community-based interventions can play a vital role in improving population-level health and well-being. Considering the escalating trend of stroke in LMICs, this systematic review aims to map the available community-based interventions in preventing stroke and to conduct further analysis regarding the effectiveness of the identified interventions.

METHODS AND ANALYSIS

We have searched Medline, Web of Science and Scopus using a comprehensive search strategy in October 2021. Two reviewers will independently perform screening, data extraction and risk of bias (ROB) assessment. The ROB assessment and applicability of results of eligible studies will be performed using the Cochrane ROB tool for assessing randomised controlled trials and the ROBANS (Risk Of Bias Assessment tool for Non-randomised Studies) to assess non-randomised studies. A random-effect model meta-analysis will be used to calculate pooled results and to obtain weighted OR and risk ratio of incidence of stroke along with corresponding 95% CI.

ETHICS AND DISSEMINATION

The results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant national and international conferences. Ethical approval is not required as this is a systematic review of publicly available data.

PROSPERO REGISTRATION NUMBER

CRD42021283670.

Challenges of performing essential public health functions by the physicians at leadership positions in peripheral level government health system in Bangladesh: A qualitative exploratory study

Introduction

Identifying and ensuring the Essential Public Health Functions (EPHFs) is one of the core agendas of the World Health Organization to strengthen the health system of a country. The definition of EPHFs varies widely, considering country needs. In Bangladesh, the physician cadres are in the leadership position to oversee the EPHFs at the district and sub-district levels. However, there is a dearth of contextual information regarding the purview of essential EPHFs in the country. The purpose of this study was to document the perception of key stakeholders on what constitute the EPHFs at district and sub-district level and identify the challenges they face in providing the services.

Methods

We carried out a qualitative exploratory study consisting of document review and Key Informant Interviews (KIIs). The desk review included the organograms of the government district and sub-district level health facilities and the job description of Civil Surgeons (CSs) and Upazila Health and Family Planning Officers (UHFPOs). In addition, 15 KIIs with relevant professionals and stakeholders from the Directorate of General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW) were conducted. Collected data were analyzed thematically.

Results

Three major categories of EPHFs were identified: i) population-oriented preventive functions, ii) clinical preventive functions, and iii) administrative/management functions. The CSs and UHFPOs need to ensure these wide range of EPHFs at the district level and below. However, at peripheral level, the leadership positions’ clinical and public health roles often get amalgamated. Therefore, ensuring public health functions are hampered. Besides, these positions need training and adequate support staff to perform the EPHFs effectively.

Conclusion

Recognizing the EPHFs in the Bangladesh context is crucial. Revisiting the job descriptions and strengthening appropriate public health services at different tiers in the country health system should be prioritized to achieve health-related Sustainable Development Goals.

Service coverage and health workforce allocation strategies for geriatric and palliative care in low- and middle-income countries: A protocol for a systematic review and meta-analysis

BACKGROUND

Advances in medical science coupled with increased people's income results an elevated average of life expectancy even in the resource poor countries. The growing number of aged population, however, has drawn little attention in health system discourse of low- and Middle-Income Countries (LMICs). Nevertheless, ensuring availability of appropriate service and properly trained and skilled health workforce is an absolute necessity for a functional geriatric and palliative healthcare. Given the lack of specialist geriatricians in LMICs contexts, there are other health workforce strategies that might be effective in building a proper health system response to this growing demand. Therefore, we aimed to identify and synthesize evidence on the existing health workforce-related strategies taken to provide geriatric and palliative care in LMICs.

METHODS

We will follow the recommendations provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Following the PRISMA guidelines, we will search the Medline/PubMed, Scopus, Web of Science and Cochrane database from January 2011 to December 2021 using a comprehensive search strategy. Two independent reviewers will screen the title and abstracts text using the specified inclusion and exclusion criteria. For the finally included articles, full manuscripts will be retrieved, and reviewers will appraise and extract data using standardized form independently. The third reviewer will resolve any disagreements appear in the process. The findings of the review be synthesized using the narrative synthesis approach to analyse descriptive quantitative and qualitative data. Furthermore, meta-analysis will be done provided that the data meet certain requirement as per Cochrane guideline. Rayyan software will be used to manage and synthesize data. Revman software will be used to do meta-analysis, if data support.

RESULTS

Findings of this review will be published in a peer-reviewed journal.

CONCLUSION

This systematic review will identify the existing effective strategies taken to provide geriatric and palliative care, in LMICs.

Implementing a digital human resources management tool in the government health sector in Bangladesh: a policy content analysis

INTRODUCTION

In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh.

METHODS

We conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings.

RESULTS

Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders' engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened.

DISCUSSION

Findings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.

Primary healthcare policy and governance in low-income and middle-income countries: an evidence gap map

Introduction

Governance is one of the most important aspects for strong primary healthcare (PHC) service delivery. To achieve the targets for the Sustainable Development Goals, good governance may play a prime role in low-income and middle-income countries (LMICs). This evidence gap map (EGM) explored the available evidence in LMICs to identify the knowledge gap concerning PHC policy and governance in these settings.

Methods

We followed the standard 3ie EGM protocol, finalising the scope of the EGM through a stakeholder workshop. We searched a total of 32 bibliographic databases, systematic review databases, impact evaluation databases, and donor and bilateral agency databases using a comprehensive search strategy. Two reviewers screened retrieved studies, extracted data and performed quality assessment. We plotted the interventions and outcomes derived from the included studies in a dynamic platform to build the interactive EGM and conducted a stakeholder consultation with nominal group technique methods to prioritise the identified gaps.

Results

The EGM included 24 systematic reviews and 7 impact evaluations focusing on PHC policy and governance in LMICs. Most of the sources emphasised workforce management and supervision. There were noticeable evidence gaps regarding accountability and social responsibility. The most highly prioritised themes were the role of accountability, the role of public–private partnerships and the role of user–provider communication in PHC governance.

Conclusions

This EGM identified some important aspects of PHC policy and governance such as accountability, social responsibility, public–private partnership, user–provider communication through the methodological approaches of evidence synthesis and stakeholder consultation. Identified gaps will provide directions for an implementation research plan to improve the governance of PHC in LMICs.