Limitations of the Millennium Development Goals: a literature review

Coincidence of sustainable development indicators for the nekarood watershed with the United Nation's sustainable development goals

The present study evaluated sustainable development indicators of the Nekarood Watershed in Iran using global Sustainable Development Goals (SDGs) indicators. Identifying values and thresholds, justification of optimum values, ranking, and performance assessment of the associated SDGs' indicators were accordingly addressed. Moreover, due to a lack of complete information and ecological conditions, 77 indicators were selected based on compliance with the indicators of global SDGs. These indicators were used to evaluate the development situation of the study area. The indicators were then normalized, weighed, aggregated, and ranked into four categories from achieving to highly challenging. The results showed that among the SDGs, five goals performed above the mean of the global sustainable development goals. So, goals 3 and 1 had the highest performance of 69.82 and 57.97 %, respectively. Likewise, goals 7 and 16 showed the lowest performance beyond the global average of 51.08 and 54.62 %, respectively. SDG3-1-1, SDG3-1-2, SDG3-2-1, and SDG3-2-2 indicators with 100 % performance positively affected SDG3. SDG1-5-1 indicator with 100 % performance also had the most positive effect on SDG1. The performances of nine goals were also lower than the global mean. In this case, the lowest performance was assigned to goal 2, followed by goals 9, 17, 10, and 6, respectively, with 15.24, 19.71, 22.19, 24.98, and 45.78 %. SDG2-4-2, SDG2-4-1, and SDG2-3-1 indicators had the most negative effect on the performance of SDG2. SDG9-2-2 and SDG10-4-1 indicators also had the most negative effect on goals 9 and 10, respectively. The highest performance of the indicators was associated with the Ministry of Health and Medical Education, and the lowest was related to the Ministries of Agriculture Jihad and the Ministry of Industry, Mine, and Trade. The results of the present study verified an overall performance of 36.42 % for the Nekarood Watershed concerning the global SDGs, representing significantly challenging conditions.

Covalent Organic Frameworks: Cutting-Edge Materials for Carbon Dioxide Capture and Water Harvesting from Air

The implacable rise of carbon dioxide (CO2 ) concentration in the atmosphere and acute water stress are one of the central challenges of our time. Present-day chemistry is strongly inclined towards more sustainable solutions. Covalent organic frameworks (COFs), attributable to their structural designability with atomic precision, functionalizable chemical environment and robust extended architectures, have demonstrated promising performances in CO2 trapping and water harvesting from air. In this Review, we discuss the major developments in this field as well as sketch out the opportunities and shortcomings that remain over large-scale COF synthesis, device engineering, and long-term performance in real environments.

Advancing Universal Health Coverage in the WHO South-East Asia Region with a focus on Human Resources for Health

The identification in 2014 of Universal Health Coverage, including focus on human resources for health, as a flagship priority for the WHO South-East Asia Region marked critical departure from the prior period of the Millennium Development Goals. The last decade witnessed strong political commitment and action to advance UHC across the Region. At regional level, UHC service coverage index improved from 47 in 2010 to 62 in 2021. Improved availability of human resources for health has been an important contributor, with the regional average of doctors, nurses and midwives increasing by approximately a third between 2014 and 2020. Progress on financial protection has been mixed: proportion of population impoverished declined significantly but catastrophic expenditure did not reduce. Despite important gains, progress is insufficient to achieve UHC targets by 2030. Covid-19 pandemic and subsequent economic challenges have created further urgency to accelerate progress towards UHC, with attention to strengthening primary health care.

Retracing loss of momentum for primary health care: can renewed political interest in the context of COVID-19 be a turning point?

The COVID-19 pandemic has revealed major weaknesses in primary health care (PHC), and how such weaknesses pose a catastrophic threat to humanity. As a result, strengthening PHC has re-emerged as a global health priority and will take centre stage at the 2023 United Nations High Level Meeting (UNHLM) on Universal Health Coverage (UHC). In this analysis, we examine why, despite its fundamental importance and incredible promise, the momentum for PHC has been lost over the years. The portrayal of PHC itself (policy image) and the dominance of global interests has undermined the attractiveness of intended PHC reforms, leading to legacy historical policy choices (critical junctures) that have become extremely difficult to dismantle, even when it is clear that such choices were a mistake. PHC has been a subject of several political declarations, but post-declarative action has been weak. The COVID-19 provides a momentous opportunity under which the image of PHC has been reconstructed in the context of health security, breaking away from the dominant social justice paradigms. However, we posit that effective PHC investments are those that are done under calm conditions, particularly through political choices that prioritise the needs of the poor who continue to face a crisis even in non-pandemic situations. In the aftermath of the 2023 UNHLM on UHC, country commitment should be evaluated based on the technical and financial resources allocated to PHC and tangible deliverables as opposed to the formulation of documents or convening of a gathering that simply (re) endorses the concept.

A bibliometric analysis of sustainable development goals (SDGs): a review of progress, challenges, and opportunities

The Sustainable Development Goals (SDGs) are a global appeal to protect the environment, combat climate change, eradicate poverty, and ensure access to a high quality of life and prosperity for all. The next decade is crucial for determining the planet's direction in ensuring that populations can adapt to climate change. This study aims to investigate the progress, challenges, opportunities, trends, and prospects of the SDGs through a bibliometric analysis from 2015 to 2022, providing insight into the evolution and maturity of scientific research in the field. The Web of Science core collection citation database was used for the bibliometric analysis, which was conducted using VOSviewer and RStudio. We analyzed 12,176 articles written in English to evaluate the present state of progress, as well as the challenges and opportunities surrounding the SDGs. This study utilized a variety of methods to identify research hotspots, including analysis of keywords, productive researchers, and journals. In addition, we conducted a comprehensive literature review by utilizing the Web of Science database. The results show that 31% of SDG-related research productivity originates from the USA, China, and the UK, with an average citation per article of 15.06. A total of 45,345 authors around the world have contributed to the field of SDGs, and collaboration among authors is also quite high. The core research topics include SDGs, climate change, Agenda 2030, the circular economy, poverty, global health, governance, food security, sub-Saharan Africa, the Millennium Development Goals, universal health coverage, indicators, gender, and inequality. The insights gained from this analysis will be valuable for young researchers, practitioners, policymakers, and public officials as they seek to identify patterns and high-quality articles related to SDGs. By advancing our understanding of the subject, this research has the potential to inform and guide future efforts to promote sustainable development. The findings indicate a concentration of research and development on SDGs in developed countries rather than in developing and underdeveloped countries.

Graphical abstract

Pooled prevalence and determinants of antenatal care visits in countries with high maternal mortality: A multi-country analysis

Background

Complications during pregnancy and childbirth are the leading causes of maternal and child deaths and disabilities, particularly in low- and middle-income countries. Timely and frequent antenatal care prevents these burdens by promoting existing disease treatments, vaccination, iron supplementation, and HIV counseling and testing during pregnancy. Many factors could contribute to optimal ANC utilization remaining below targets in countries with high maternal mortality. This study aimed to assess the prevalence and determinants of optimal ANC utilization by using nationally representative surveys of countries with high maternal mortality.

Methods

Secondary data analysis was done using recent Demographic and Health Surveys (DHS) data of 27 countries with high maternal mortality. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from the individual record (IR) files of from each of the 27 countries. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) and p-value of ≤0.05 in the multivariable model were used to declare significant factors associated with optimal ANC utilization.

Result

The pooled prevalence of optimal ANC utilization in countries with high maternal mortality was 55.66% (95% CI: 47.48-63.85). Several determinants at the individual and community level were significantly associated with optimal ANC utilization. Mothers aged 25-34 years, mothers aged 35-49 years, mothers who had formal education, working mothers, women who are married, had media access, households of middle-wealth quintile, richest household, history of pregnancy termination, female household head, and high community education were positively associated with optimal ANC visits in countries with high maternal mortality, whereas being rural residents, unwanted pregnancy, having birth order 2-5, and birth order >5 were negatively associated.

Conclusion and recommendations

Optimal ANC utilization in countries with high maternal mortality was relatively low. Both individual-level factors and community-level factors were significantly associated with ANC utilization. Policymakers, stakeholders, and health professionals should give special attention and intervene by targeting rural residents, uneducated mothers, economically poor women, and other significant factors this study revealed.

When women win, we all win-Call for a gendered global NCD agenda

Gender is a social determinant of health, interacting with other factors such as income, education, and housing and affects health care access and health care outcomes. This paper reviews key literature and policies on health disparities and gender disparities within health. It examines noncommunicable disease (NCD) health outcomes through a gender lens and challenges existing prevailing measures of success for NCD outcomes that focus primarily on mortality. Chronic respiratory disease, one of the four leading contributors to NCD mortality, is highlighted as a case study to demonstrate the gender gap. Women have different risk factors and higher morbidity for chronic respiratory disease compared to men but morbidity is shadowed by a penultimate research focus on mortality, which results in less attention to the gap in women's NCD outcomes. This, in turn, affects how resources, programs, and interventions are implemented. It will likely slow progress in reducing overall NCD burden if we do not address risk factors in an equitable fashion. The article closes with recommendations to address these gender gaps in NCD outcomes. At the policy level, increasing representation and inclusion in global public health leadership, prioritizing NCDs among marginalized populations by global health societies and political organizations, aligning the gendered global NCD agenda with other well-established movements will each catalyze change for gender-based disparities in global NCDs specifically. Lastly, incorporating gender-based indicators and targets in major NCD-related goals and advancing gender-based NCD research will strengthen the evidence base for women's unique NCD risks and health outcomes.

Global perspectives on trends in health higher education

Today, changes in political and economic conditions, epidemiological and sociological developments, and the advancement of science and technology have necessitated the health and medical education systems to change. Therefore, we conducted a study entitled "Global perspectives on trends in higher education in healthcare," to improve the quality of healthcare so that it can be used as a model for predicting future events related to medical education. This futures study applied the social, technological, economical, ecological, political, values (STEEPV) model to identify and analyze the trends that affect medical education at different levels. To collect and analyze the data, a scoping review of the articles published from the year 2000 was conducted on the World Health Organization (WHO), Web of Science, Scopus, PubMed/MEDLINE, EMBASE, Science Direct, Google Scholar, EBSCO, and Cochrane databases. The review process was performed in five stages: 1- Determining the research question, 2- Identifying relevant studies, 3- Selecting the studies, 4- Charting the data, and 5- Analyzing data. The preferred reporting item for systematic review and meta-analysis (PRISMA) statement was used in the selection and screening of articles. A total of 213 articles were included in the study for qualitative synthesis. A total of 154 trends were identified using the STEEPV model at seven levels of health behaviors and patients, diseases and health problems, healthcare system, medical education system, medical education institutions, medical curricula, and teaching and learning. Considering the results of this study, it is possible to formulate proper and efficient future scenarios for the higher health education system. Also, it will be helpful for medical education policymaking.

Sustainable Local Development: Consolidated Framework for Cross-Sectoral Cooperation via a Systematic Approach

Cross-sectoral cooperation (CSC) has gained recognition as the key to achieving sustainable development goals within a locality. However, existing studies focused on sustainable local development (SLD) initiatives resulting from CSC remain sparse. This article aims to review the CSC–SLD literature, using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Research questions were constructed using the PICOC (population, intervention, comparison, outcomes, and context) structure. The identification of scientific works occurred through the search of relevant keywords, which resulted in a final set of 38 peer-reviewed manuscripts, from 1994 to 2021. First, the main driving forces for adopting CSC, to achieve SLD, which are dispersed at multiple levels, were captured and contextualised into the micro-, meso-, macro- and mega-framework. Second, salient aspects addressed in the literature for effective CSC implementation were identified and classified into approaches, governance, structure, key actors, psychological and social aspects, and experiences themes. This resulted in a consolidated guiding principles framework for implementing CSC, to pursue SLD. Additionally, the use of theories in different aspects of CSC–SLD initiatives was discussed. This study informs the practitioners, policy-makers, and researchers the fundamentals that need to be considered when planning, designing, and implementing effective CSC interventions for SLD.

Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals

Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically.

Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research.

Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors.

Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.

Women's dual centrality in food security solutions: The need for a stronger gender lens in food systems' transformation

Food insecurity remains a critical issue worldwide. The current COVID-19 crisis has exposed how vulnerable the global food systems are and that urgent measures need to be taken, especially in the Global South. Despite increased recognition that women are among the most food insecure yet major contributors to local and global food security over the recent years, there has not been a systemic change needed in the current food security paradigm. This paper argues that, in developing countries, a stronger gender lens ought to be at the center to the food systems' debate as women are critical to agriculture and food systems' sustainability and resilience. Women are central to food systems, both as primary food producers and as primary caretakers of the household. Three key recommendations are put forward in this article for establishing inclusive, sustainable and resilient food systems: One, ensuring a stronger gender lens in food systems and food security paradigms; by working with accurate sex-disaggregated data and beyond on individuals' level. Two, promoting and supporting alternative strategies to agriculture as a means of livelihood for women. Three, ensuring that women are central in food security solutions by not only listening to their concerns and needs, but also building on their resilience, knowledge, and practices.

Creating the Nightingale Initiative for Global Health: theoretical reflections to follow in Florence Nightingale's footsteps

OBJECTIVE

this paper articulates how three Nightingale scholars applied their theoretical reflections to Florence Nightingale's farreaching anticipation of the year 1999 and to her comprehensive definition of "Health" derived from her 1893 essay "Sick-nursing and Health-nursing."

METHOD

this is a historical narrative paper. With intentions to explore how Nightingale's insights might inform today's nursing culture and enhance nursing practice, these scholars joined a team of civil society activists to craft the Nightingale Declaration for A Healthy World as the founding credo of the Nightingale Initiative for Global Health. To follow in Nightingale's footsteps for more than two decades, these scholars since developed methods to increase public awareness of global health concerns and to engage today's nurses and concerned citizens in this public advocacy.

RESULTS

project demonstration results include specific advocacy for the United Nations Millennium Development Goals and Sustainable Development Goals - "Global Goals" targeted to achieve universal outcomes specific to "Health" and across the wider scope of social and environmental health determinants - all anticipated by Nightingale throughout her 40-year career.

CONCLUSION

given today's severe global health concerns, these scholars' theoretical reflections identify challenges to contemporary nursing culture - calling for methods developed to strengthen nursing's voice in the global public arena.

Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda

This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3's focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7's aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.

Growing physical rehabilitation needs in resource-poor world regions: secondary, cross-regional analysis with data from the global burden of disease 2017

PURPOSE

This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks.

MATERIALS AND METHODS

This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990-2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation.

RESULTS

All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990-2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values.

CONCLUSIONS

An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions.IMPLICATIONS FOR REHABILITATIONAsia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa.The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data.The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level.

Asserting disadvantaged communities' deliberative agency in a media-saturated society

This article investigates how communities experiencing poverty can exercise their deliberative agency in a media-saturated society. While empirical research on deliberative democracy tends to focus on the role of mini-publics in giving low-income households the opportunity in small-scale, carefully designed forums to characterise, justify, and reflect on their views, such conception of deliberative agency gets lost in the picture once deliberative theory begins thinking in systemic terms. This article proposes a remedy to this theoretical and analytical gap by characterising the hypermediated character of the deliberative system and identifying possibilities for communities experiencing poverty to maximise the affordances of digital media for them to make an appearance in the public sphere, speak in their own voice, and carry the embodied and storied character of their arguments. I present two illustrative cases drawing on the experiences of families with low income directly affected by the bloody war on drugs in the Philippines who utilise photojournalism and online music streaming to break in the public sphere and engage in systemic deliberations about the drug war. These examples demonstrate how communities experiencing poverty express their deliberative agency amidst fear, trauma and deprivation and democratise a media-saturated deliberative system under an increasingly authoritarian regime. Overall, this article hopes to strengthen the link between normative media studies and democratic theory and offering possibilities for reforming the public sphere that recognises the poor's deliberative agency.

Bleeding Bodies, Untrustworthy Bodies: A Social Constructionist Approach to Health and Wellbeing of Young People in Kenya

The Sustainable Development Goals provide a global development agenda that is meant to be inclusive of all people. However, the development needs for vulnerable populations such as youth are not reflected within the policy agenda of some developing countries. One of the reasons for this is that research that explores health and wellbeing concerns for young people are sparse in the region and where they exist, the focus has been on marginalized subgroups. To address this gap, this cross-sectional study explored the health and wellbeing of youth in Kenya. We conducted 10 focus group discussions and 14 in-depth interviews with youth ages 15 to 24 years. A thematic analysis of the data revealed that structural factors are important influencers of youth perceptions and their social constructions of health and wellbeing. Kenyan youth are concerned about the health status and healthcare services in their communities, as well as issues of community trust of youths and perceived risks of political misuse and emotional suffering. Our findings suggest that youth transitioning into adulthood in resource-constrained areas experience feelings of powerlessness and inability to take charge over their own life. This impacts how they perceive and socially construct health and wellbeing.

Keeping afloat: a case study tracing the emergence of drowning prevention as a health issue in Bangladesh 1999-2017

BACKGROUND

Drowning is a leading cause of child death in Bangladesh. The present study investigated the emergence of drowning reduction as a priority within Bangladesh and the position it currently holds on the national policy agenda.

METHODS

This case study documents the evolution of policy responses to drowning, reporting on data from semistructured interviews and a document analysis. To identify key factors that have facilitated the prioritisation of drowning prevention, data were synthesised using Shiffman and Smith's 2007 Policy Prioritisation Framework. Furthermore, an inductive approach was used to identify key themes unique to drowning prevention that were not embedded in the framework.

RESULTS

Four key phases of policy development for drowning prevention were distinguishable: (1) identification of issue and the emergence of actor support; (2) enhanced leadership and the accumulation of issue characteristics; (3) the formation of an internal frame and its impact on global support; and (4) enhanced national recognition and supportive global normative factors. Four additional themes unique to the case of drowning were also identified: competing health priorities, limited issue awareness, shift of disease burden to non-communicable diseases and the multisectoral nature of drowning.

CONCLUSION

This study demonstrates that the level of political prioritisation given to drowning prevention has evolved over the last decade and a half. A comprehensive understanding of factors that have elevated the issue onto the policy agenda will ensure future stakeholder engagement activities can be designed to foster deeper and more sustained commitment by key actors and organisations.

Does women's age matter in the SDGs era: coverage of demand for family planning satisfied with modern methods and institutional delivery in 91 low- and middle-income countries

BACKGROUND

The Sustainable Development Goals (SDGs) include specific targets for family planning (SDG 3.7) and birth attendance (SDG 3.1.2), and require analyses disaggregated by age and other dimensions of inequality (SDG 17.18). We aimed to describe coverage with demand for family planning satisfied with modern methods (DFPSm) and institutional delivery in low- and middle-income countries across the reproductive age spectrum. We attempted to identify a typology of patterns of coverage by age and compare their distribution according to geographic regions, World Bank income groups and intervention coverage levels.

METHODS

We used Demographic and Health Survey and Multiple Indicator Cluster Surveys. For DFPSm, we considered the woman's age at the time of the survey, whereas for institutional delivery we considered the woman's age at birth of the child. Both age variables were categorized into seven groups of 5 year-intervals, 15-19 up to 45-49. Five distinct patterns were identified: (a) increasing coverage with age; (b) similar coverage in all age groups; (c) U-shaped; (d) inverse U-shaped; and (e) declining coverage with age. The frequency of the five patterns was examined according to UNICEF regions, World Bank income groups, and coverage at national level of the given indicator.

RESULTS

We analyzed 91 countries. For DFPSm, the most frequent age patterns were inverse U-shaped (53%, 47 countries) and increasing coverage with age (41%, 36 countries). Inverse-U shaped patterns for DFPSm was the commonest pattern among lower-middle income countries, while low- and upper middle-income countries showed a more balanced distribution between increasing with age and U-shaped patterns. In the first and second tertiles of national coverage of DFPSm, inverse U-shaped was observed in more than half of countries. For institutional delivery, declining coverage with age was the prevailing pattern (44%, 39 countries), followed by similar coverage across age groups (39%, 35 countries). Most (79%) upper-middle income countries showed no variation by age group while most low-income countries showed declining coverage with age (71%).

CONCLUSION

Large inequalities in DFPSm and institutional delivery were identified by age, varying from one intervention to the other. Policy and programmatic approaches must be tailored to national patterns, and in most cases older women and adolescents will require special attention due to lower coverage and because they are at higher risk for maternal mortality and other poor obstetrical outcomes.

Prioritarian principles for digital health in low resource settings

This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need (of the marginalised), the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes.

Sustainable development goals for health promotion: a critical frame analysis

The Sustainable Development Goals (SDGs) lay the foundations for supporting global health and international development work for the next 15 years. Thirty years ago, the Ottawa Charter defined health promotion and outlined key principles for global action on health, including the importance of advocating, enabling and mediating for health equity. Advocacy underscores a human right to health and suggests political action to support its attainment. Enabling speaks to health promotion's focus on the empowerment of people and communities to take control over their health and aspirations. Mediation draws attention to the critical intersectoral partnerships required to address health and social inequities. Underpinned by this approach, the aim of this paper is to consider how key health promotion principles, namely, rights, empowerment and partnership feature (and are framed) within the SDGs and to consider how these framings may shape future directions for health promotion. To that end, a critical frame analysis of the Transforming Our World document was conducted. The analysis interrogated varying uses and meanings of partnerships, empowerment and rights (and their connections) within the SDGs. The analysis here presents three framings from the SDGs: (1) a moral code for global action on (in)equity; (2) a future orientation to address global issues yet devoid of history; and (3) a reductionist framing of health as the absence of disease. These framings raise important questions about the underpinning values of the SDGs and pathways to health equity - offering both challenges and opportunities for defining the nature and scope of health promotion.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

Towards Resilient Health Systems in Sub-Saharan Africa: A Systematic Review of the English Language Literature on Health Workforce, Surveillance, and Health Governance Issues for Health Systems Strengthening

Background:

Meeting health security capacity in sub-Saharan Africa will require strengthening existing health systems to prevent, detect, and respond to any threats to health. The purpose of this review was to examine the literature on health workforce, surveillance, and health governance issues for health systems strengthening.

Methods:

We searched PubMed, Science Direct, Cochrane library, CINAHL, Web of Science, EMBASE, EBSCO, Google scholar, and the WHO depository library databases for English-language publications between January 2007 and February 2017. Electronic searches for selected articles were supplemented by manual reference screening. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Results:

Out of 1,548 citations retrieved from the electronic searches, 31 articles were included in the review. Any country health system that trains a cadre of health professionals on the job, reduces health workforce attrition levels, and builds local capacity for health care workers to apply innovative mHealth technologies improves health sector performance. Building novel surveillance systems can improve clinical care and improve health system preparedness for health threats. Effective governance processes build strong partnerships for health and create accountability mechanisms for responding to health emergencies.

Conclusions:

Overall, policy shifts in African countries’ health systems that prioritize training a cadre of willing and able workforce, invest in robust and cost-effective surveillance capacity, and create financial accountability and good governance are vital in health strengthening efforts.

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r² = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r² = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.

Monitoring Transboundary Water Cooperation in SDG 6.5.2: How a Critical Hydropolitics Approach Can Spot Inequitable Outcomes

This article contributes to critical sustainability studies through an interrogation of the Sustainable Development Goals (SDGs) and their action towards improving access to water and sanitation. This is done through an analysis of ‘SDG 6: Ensure access to water and sanitation for all’, specifically focusing on Target 6.5: ‘By 2030, implement integrated water-resources management at all levels, including through transboundary cooperation as appropriate’, and its related Indicator 6.5.2, ‘Proportion of transboundary basin area with an operational arrangement for water cooperation’. While on paper Target 6.5 might seem relatively unproblematic, this article shows that its implementation could have some unintended practical implications for countries sharing transboundary waters. This article fine-tunes SDG 6.5.2 by suggesting two additional qualitative steps to improve the indicator. These qualitative dimensions are deemed extremely important for two reasons: the first one is the need to unfold and tackle inequitable water agreements; the second reason is to assess, recognize, and promote the role of civil society, NGOs, and technical and informal cooperation as a positive path toward the actual achievement of formal cooperation. The two steps that we propose are deemed essential if the United Nations (UN) is going to include SDG 6.5.2 as a proactive tool in the achievement of “implementing integrated water-resources management at all levels, including through transboundary cooperation as appropriate”, as declared in the 2030 agenda.

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim.

Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014.

Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries.

Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements.

Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

Evaluating Equity and Inclusion in Access to Water and Sanitation for Persons Living with HIV/AIDS in Wukro, Ethiopia

For more than a decade, foreign aid-supported water interventions focusing on an increase in household private connections have been implemented in the small urban center of Wukro. However, little has been investigated about the effectiveness of these interventions in achieving equitable and inclusive access to water and sanitation for all, including the most vulnerable. With this purpose, a cross-sectional comparative analysis of service provision between the HIV-infected population (n = 199) and non-infected population (n = 199) was undertaken. Findings suggest significant inequalities regarding the primary water source, monthly expenditure in water, water consumption, and time employed to fetch water, as well as the type of toilet facility, number of users, and the time employed to access it. Results also show a reported feeling of discrimination with regard to service provision within the HIV-positive population. This study provides evidence on local-scale interventions increasing the number of household water connections but overlooking the pursuit of equity and inclusion for the most vulnerable. The study also presents recommendations on how to specifically target the needs of persons living with HIV/AIDS in order to achieve equitable and inclusive access to water and sanitation for all.

A Meta-Data Manifesto: The Need for Global Health Meta-Data

Administrative health data recorded for individual health episodes (such as births, deaths, physician visits, and hospital stays) are being widely used to study policy-relevant scientific questions about population health, health services, and quality of care. An increasing number of international health comparisons are undertaken with these data. An essential pre-requisite to such international comparative work is a detailed characterization of existing international health data resources, so that they can be more readily used for comparisons across counties. A major challenge to such international comparative work is the variability across countries in the extent, content, and validity of existing administrative data holdings. Recognizing this, we have undertaken an international proof of concept pilot compiling detailed data about data – i.e., a “meta-data catalogue” – for existing international administrative health data holdings. We describe the methodological process for collecting these meta-data, along with some general descriptive results for selected countries included in the pilot.

PROGRESS AND PROSPECTS OF HEALTH-RELATED SUSTAINABLE DEVELOPMENT GOALS IN INDIA

The Sustainable Development Goals (SDGs) are increasingly being used to measure developmental progress among and within countries. Achieving the health-related SDGs remains a primary concern of many developing countries. This study measured the progress in selected health-related indicators of SDGs in the states of India by social and economic groups, and predicted their likely progress by 2030. The health indicators analysed included health outcomes, nutrition, health care utilization and determinants of health. Data from the Census of India, Sample Registration System (SRS), National Family and Health Surveys (NFHSs) and National Sample Survey Organization (NSSO) were used in the analysis. Annual rate of progress (ARP) and the required rate of progress (RRP) were computed for selected indicators over the period 2005-06 to 2015-16. A Composite Index of Health (CIH) was used to understand the state of health of populations. The ARP was higher than the RRP in maternal care and reduction of under-five mortality, while ARP was lower than the RRP in undernutrition and sanitation. The ARP for health-related indicators showed a mixed pattern across religion and caste groups. The ARP for medical assistance at birth and immunization was highest among Scheduled Castes and that for reduction of under-five mortality was highest among Scheduled Tribes. The CIH was lowest in Uttar Pradesh (0.26) and highest in Goa (0.81). The association between the CIH and the Human Development Index (HDI) was significant, suggesting interlinkage between health and development. Notable improvements were observed in maternal and child health and maternal health care utilization across social groups in India over the period 2005-06 to 2015-16, and if the trends continue the country can achieve the SDG target in maternal health by 2030. However, progress in nutrition and other health indicators has been slow and uneven.

How states exerted power to create the Millennium Development Goals and how this shaped the global health agenda: Lessons for the sustainable development goals and the future of global health

Since 2000, the eight Millennium Development Goals (MDGs) provided the framework for global development efforts transforming the field now known as global health. The MDGs both reflected and contributed to shaping a normative global health agenda. In the field of global health, the role of the state is largely considered to have diminished; however, this paper reasserts states as actors in the conceptualisation and institutionalisation of the MDGs, and illustrates how states exerted power and engaged in the MDG process. States not only sanctioned the MDGs through their heads of states endorsing the Millennium Declaration, but also acted more subtly behind the scenes supporting, enabling, and/or leveraging other actors, institutions and processes to conceptualise and legitimize the MDGs. Appreciating the MDGs' role in the conceptualisation of global health is particularly relevant as the world transitions to the MDGs' successor, the Sustainable Development Goals (SDGs). The SDGs' influence, impact and importance remains to be seen; however, to understand the future of global health and how actors, particularly states, can engage to shape the field, a deeper sense of the MDGs' legacy and how actors engaged in the past is helpful.

Neglected Tropical Disease Control - The Case for Adaptive, Location-specific Solutions

The world is experiencing environmental and social change at an unprecedented rate, with the effects being felt at local, regional, and international scales. This phenomenon may disrupt interventions against neglected tropical diseases (NTDs) that operate on the basis of linear scaling and 'one-size-fits-all'. Here we argue that investment in field-based data collection and building modelling capacity is required; that it is important to consider unintended consequences of interventions; that inferences can be drawn from wildlife ecology; and that interventions should become more location-specific. Collectively, these ideas underpin the development of adaptive decision-support tools that are sufficiently flexible to address emerging issues within the Anthropocene.

Health Consequences of Environmental Exposures in Early Life: Coping with a Changing World in the Post-MDG Era

Despite overall progress toward achieving the Millennium Development Goals, large health discrepancies persist between developed and developing countries. The world is rapidly changing and the influences of societal change and climate change will disproportionately affect the world's most vulnerable populations, thus exacerbating current inequities. Current development strategies do not adequately address these disproportionate impacts of environmental exposures. The aim of this study was to propose a new framework to address the health consequences of environmental exposures beyond 2015. This framework is transdisciplinary and precautionary. It is based on identifying social and economic determinants of health, strengthening primary health systems, and improving the health of vulnerable populations. It incorporates deliberate plans for assessment and control of avoidable environmental exposures. It sets specific, measurable targets for health and environmental improvement.

Tools and approaches to operationalize the commitment to equity, gender and human rights: towards leaving no one behind in the Sustainable Development Goals

The objective of this article is to present specific resources developed by the World Health Organization on equity, gender and human rights in order to support Member States in operationalizing their commitment to leave no one behind in the health Sustainable Development Goals (SDGs), and other health-related goals and targets. The resources cover: (i) health inequality monitoring; (ii) barrier analysis using mixed methods; (iii) human rights monitoring; (iv) leaving no one behind in national and subnational health sector planning; and (v) equity, gender and human rights in national health programme reviews. Examples of the application of the tools in a range of country contexts are provided for each resource.

Impact of male partner involvement on modern contraceptive use among married or partnered women in developing countries: a protocol for systematic review

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to explore the impact of male partner involvement on modern contraceptive use among married or partnered women of reproductive age in developing countries. Specifically, does male partner involvement.

Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: An observational study

BACKGROUND

Despite global health efforts to reduce maternal mortality, rates continue to be unacceptably high in large parts of the world. Feasible, acceptable, and accurate postmortem sampling methods could provide the necessary evidence to improve the understanding of the real causes of maternal mortality, guiding the design of interventions to reduce this burden.

METHODS AND FINDINGS

The validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in an observational study in 57 maternal deaths by comparing the results of the MIA with those of the gold standard (complete diagnostic autopsy [CDA], which includes any available clinical information). Concordance between the MIA and the gold standard diagnostic categories was assessed by the kappa statistic, and the sensitivity, specificity, positive and negative predictive values and their 95% confidence intervals (95% CI) to identify the categories of diagnoses were estimated. The main limitation of the study is that both the MIA and the CDA include some degree of subjective interpretation in the attribution of cause of death. A cause of death was identified in the CDA in 98% (56/57) of cases, with indirect obstetric conditions accounting for 32 (56%) deaths and direct obstetric complications for 24 (42%) deaths. Nonobstetric infectious diseases (22/32, 69%) and obstetric hemorrhage (13/24, 54%) were the most common causes of death among indirect and direct obstetric conditions, respectively. Thirty-six (63%) women were HIV positive, and HIV-related conditions accounted for 16 (28%) of all deaths. Cerebral malaria caused 4 (7%) deaths. The MIA identified a cause of death in 86% of women. The overall concordance of the MIA with the CDA was moderate (kappa = 0.48, 95% CI: 0.31-0.66). Both methods agreed in 68% of the diagnostic categories and the agreement was higher for indirect (91%) than for direct obstetric causes (38%). All HIV infections and cerebral malaria cases were identified in the MIA. The main limitation of the technique is its relatively low performance for identifying obstetric causes of death in the absence of clinical information.

CONCLUSIONS

The MIA procedure could be a valuable tool to determine the causes of maternal death, especially for indirect obstetric conditions, most of which are infectious diseases. The information provided by the MIA could help to prioritize interventions to reduce maternal mortality and to monitor progress towards achieving global health targets.

Analysis of the association between millennium development goals 4 & 5 and the physician workforce across international economic strata

BACKGROUND

The Millennium Development Goals (MDGs) are 8 international development goals voluntarily adopted by 189 nations. The goals included health related aims to reduce the under-five child mortality rate by two-thirds (MDG4), and to reduce the maternal mortality ratio by three-quarters (MDG5). To assess the relationship between the healthcare workforce and MDGs 4-5, we examined the physician workforces of countries around the globe, in terms of the Physician Density Level (PDL, or number of physicians per 1000 population), and compared this rate across a number of years to several indicator variables specified as markers of progress towards MDG4 and MDG5.

METHODS

Data for each variable of interest were obtained from the World Bank's Millennium Development Goals and World Development Indicators databases for 208 countries and territories from 2004 to 2014, representing a ten-year period for which the most information is available. We analyzed the relationships between MDG outcomes and PDL, controlling for national income levels and other covariates, using linear mixed model regression. Dependent variables were logarithmically transformed to meet assumptions necessary for multivariate analysis.

RESULTS

In unadjusted models, an increase of every one physician per 1000 population (one unit change in PDL) lowered the risk of not being vaccinated for measles-mumps-rubella (MMR) to 29.3% (p < 0.001, 95% CI: 22.2%-38.7%) and for not receiving diphtheria-tetanus-pertussis (DTaP) vaccination rate decreased to 38.5% (p < 0.001, 95% CI: 28.7% - 51.7%). Maternal mortality rate decreased to 76.6% (p < 0.001, 95% CI: 74.3% - 79.0%), neonatal mortality decreased to 58.8% (p < 0.001, 95% CI: 54.8% - 63.2%) and under-5 mortality rate decreased to 52.1% (p < 0.001, 95% CI: 48.0% - 56.4%), with every one-unit change in PDL. Adjusted models tended to reflect unadjusted risk assessments.

CONCLUSION

The maintenance and improvement of the health workforce is a vital consideration when assessing how to achieve global development goals related to health outcomes.

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

BACKGROUND

Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health.

METHODS

Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data.

RESULTS

On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension.

CONCLUSIONS

Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.

The importance of an integrating framework for achieving the Sustainable Development Goals: the example of health and well-being

The 2030 Agenda for Sustainable Development came into force in January 2016 as the central United Nations (UN) platform for achieving 'integrated and indivisible' goals and targets across the three characteristic dimensions of sustainable development: the social, environmental and economic. We argue that, despite the UN adoption of the Sustainable Development Goals (SDGs), a framework for operationalising them in an integrated fashion is lacking. This article puts forth a framework for integrating health and well-being across the SDGs as both preconditions and outcomes of sustainable development. We present a rationale for this approach, and identify the challenges and opportunities for implementing and monitoring such a framework through a series of examples. We encourage other sectors to develop similar integrating frameworks for supporting a more coordinated approach for operationalising the 2030 Agenda for Sustainable Development.

Seeking consensus on universal health coverage indicators in the sustainable development goals

There is optimism that the inclusion of universal health coverage in the Sustainable Development Goals advances its prominence in global and national health policy. However, formulating indicators for Target 3.8 through the Inter-Agency Expert Group on Sustainable Development Indicators has been challenging. Achieving consensus on the conceptual and methodological aspects of universal health coverage is likely to take some time in multi-stakeholder fora compared with national efforts to select indicators.

Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care

The current healthcare system in the United States (US) is characterized by high costs and poor patient outcomes. A value-based healthcare system, centered on providing the highest quality of care for the lowest cost, is the country's chosen solution for its healthcare crisis. As the US transitions to a value-based model, a new definition of health is necessary to clearly define what constitutes a healthy state. However, such a definition is impossible to develop without a proper understanding of what "health" actually means. To truly understand its meaning, one must have a thorough historical understanding of the changes in the concept of health and how it has evolved to reflect the beliefs and scientific understanding of each time period. Thus, this review summarizes the changes in the definition of health over time in order to provide a context for the definition needed today. We then propose a new definition of health that is specifically tailored to providers working in the era of value-based care.

Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care

The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge. Implementation and delivery of strategies and interventions are often impeded by existing grass root level challenges. Recognizing the importance of effective primary care, the review highlights the importance of implementing affordable, accessible, and comprehensive interventions, and delivering them at societal, a community and individual level. This simultaneously calls for strengthening of the primary care system through appropriate strategy and policy frameworks. Toward addressing India-specific needs in NCD prevention and management, concerted efforts on development of robust surveillance mechanisms, intersectoral and interdepartmental collaborations, integration of national programs, enhanced role of education and awareness should be made, to ensure effectivity, scale-up, and outreach of services in primary care.

The importance of an integrating framework for achieving the Sustainable Development Goals: the example of health and well-being

The 2030 Agenda for Sustainable Development came into force in January 2016 as the central United Nations (UN) platform for achieving 'integrated and indivisible' goals and targets across the three characteristic dimensions of sustainable development: the social, environmental and economic. We argue that, despite the UN adoption of the Sustainable Development Goals (SDGs), a framework for operationalising them in an integrated fashion is lacking. This article puts forth a framework for integrating health and well-being across the SDGs as both preconditions and outcomes of sustainable development. We present a rationale for this approach, and identify the challenges and opportunities for implementing and monitoring such a framework through a series of examples. We encourage other sectors to develop similar integrating frameworks for supporting a more coordinated approach for operationalising the 2030 Agenda for Sustainable Development.

Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania

Background

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff.

Methods

An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed.

Results

For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011–2013, with a quality score <75 % classed as ‘unsatisfactory’. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3–7 % in mean score, with the most pronounced improvements in staff motivation and job expectations.

Conclusions

Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1809-4) contains supplementary material, which is available to authorized users.

Sustainable Development Goals for Monitoring Action to Improve Global Health

Women and children compose the largest segment of the more than 1 billion people worldwide who are unable to access needed health care services. To address this and other global health issues, the United Nations brought together world leaders to address growing health inequities, first by establishing the Millennium Development Goals in 2000 and more recently establishing Sustainable Development Goals, which are an intergovernmental set of 17 goals consisting of 169 targets with 304 indicators to measure compliance; they were designed to be applicable to all countries. Goal number 3, "Good Health and Well-Being: Ensure Heathy Lives and Promote Well-Being for All at All Ages," includes targets to improve the health of women and newborns.

Discourse, ideas and power in global health policy networks: political attention for maternal and child health in the millennium development goal era

BACKGROUND

Maternal and child health issues have gained global political attention and resources in the past 10 years, due in part to their prominence on the Millennium Development Goal agenda and the use of evidence-based advocacy by policy networks. This paper identifies key factors for this achievement, and raises questions about prospective challenges for sustaining attention in the transition to the post-2015 Sustainable Development Goals, far broader in scope than the Millennium Development Goals.

METHODS

This paper relies on participant observation methods and document analysis to develop a case study of the behaviours of global maternal and child health advocacy networks during 2005-2015.

RESULTS

The development of coordinated networks of heterogeneous actors facilitated the rise in attention to maternal and child health during the past 10 years. The strategic use of epidemiological and economic evidence by these networks enabled policy attention and promoted network cohesion. The time-bound opportunity of reaching the 2015 Millennium Development Goals created a window of opportunity for joint action. As the new post-2015 goals emerge, networks seek to sustain attention by repositioning their framing of issues, network structures, and external alliances, including with networks that lay both inside and outside of the health domain.

CONCLUSIONS

Issues rise on global policy agendas because of how ideas are constructed, portrayed and positioned by actors within given contexts. Policy networks play a critical role by uniting stakeholders to promote persuasive ideas about policy problems and solutions. The behaviours of networks in issue-framing, member-alignment, and strategic outreach can force open windows of opportunity for political attention -- or prevent them from closing.