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Huang A, Zhao Y, Cao C, Lyu M, Tang K. Development assistance, donor-recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank-UK and Global Fund in China. Glob Health Res Policy 2024; 9:7. [PMID: 38310321 PMCID: PMC10838425 DOI: 10.1186/s41256-024-00344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor-recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability. METHODS We conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998-2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010-2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson's health policy analysis model and the World Health Organization's health system building blocks. We used process tracing for analysis. RESULTS According to the collected data, our case study identified three reemergent, interrelated aspects of donor-recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases. CONCLUSIONS Given the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor-recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international-domestic expert partnerships to identify and respond to contextual enablers and barriers.
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Affiliation(s)
- Aidan Huang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Institute for International and Area Studies, Tsinghua University, Beijing, China
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Department of Medicine, University of Oxford, Nuffield Oxford, UK
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing, 100084, China.
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Pakkiyaretnam M, Francis VR, Francis GR, Raheem S, Sanjeev R, Rajavarman R, Ramesh R. Demographic Characteristics and Disease Pattern Among Non-COVID-19 Patients Admitted to Medical Units of a Tertiary Care Hospital in Sri Lanka During Lockdown of the COVID-19 Pandemic: A Comparison During and Before Lockdown. Cureus 2023; 15:e45248. [PMID: 37842446 PMCID: PMC10576610 DOI: 10.7759/cureus.45248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease. Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. METHODS This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). RESULTS Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%). Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.
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Affiliation(s)
- Mayurathan Pakkiyaretnam
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Vaithehi R Francis
- Department of Pathophysiology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Microbiology, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - George Rajeevan Francis
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Cardiology, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Sanooz Raheem
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
| | - Rajavarthani Sanjeev
- Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
| | - Rajeswaran Rajavarman
- Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
- Emergency Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Ramanathan Ramesh
- General Internal Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
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Herron LM, Phillips G, Brolan CE, Mitchell R, O'Reilly G, Sharma D, Körver S, Kendino M, Poloniati P, Kafoa B, Cox M. "When all else fails you have to come to the emergency department": Overarching lessons about emergency care resilience from frontline clinicians in Pacific Island countries and territories during the COVID-19 pandemic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 25:100519. [PMID: 35822061 PMCID: PMC9262465 DOI: 10.1016/j.lanwpc.2022.100519] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic continues to test health systems resilience worldwide. Low- and middle-income country (LMIC) health care systems have considerable experience in disasters and disease outbreaks. Lessons from the preparedness and responses to COVID-19 in LMICs may be valuable to other countries.This policy paper synthesises findings from a multiphase qualitative research project, conducted during the pandemic to document experiences of Pacific Island Country and Territory (PICT) frontline clinicians and emergency care (EC) stakeholders. Thematic analysis and synthesis of enablers related to each of the Pacific EC systems building blocks identified key factors contributing to strengthened EC systems.Effective health system responses to the COVID-19 pandemic occurred when frontline clinicians and 'decision makers' collaborated with respect and open communication, overcoming healthcare workers' fear and discontent. PICT EC clinicians demonstrated natural leadership and strengthened local EC systems, supporting essential healthcare. Despite resource limitations, PICT cultural strengths of relational connection and innovation ensured health system resilience. COVID-19 significantly disrupted services, with long-tail impacts on non-communicable disease and other health burdens.Lessons learned in responding to COVID-19 can be applied to ongoing health system strengthening initiatives. Optimal systems improvement and sustainability requires EC leaders' involvement in current decision-making as well as future planning. Search strategy and selection criteria Search strategy and selection criteria We searched PubMed, Google Scholar, Ovid, WHO resources, Pacific and grey literature using search terms 'emergency care', 'acute/critical care', 'health care workers', 'emergency care systems/health systems', 'health system building blocks', 'COVID-19', 'pandemic/surge event/disease outbreaks' 'Low- and Middle-Income Countries', 'Pacific Islands/region' and related terms. Only English-language articles were included. Funding Phases 1 and 2A of this study were part of an Epidemic Ethics/World Health Organization (WHO) initiative, supported by Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Copyright of the original work on which this publication is based belongs to WHO. The authors have been given permission to publish this manuscript. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of WHO. Co-funding for this research was received from the Australasian College for Emergency Medicine Foundation via an International Development Fund Grant. RM is supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship and a Monash Graduate Excellence Scholarship. GOR is supported by a NHMRC Early Career Research Fellowship. CEB is supported by a University of Queensland Development Research Fellowship. None of these funders played any role in study design, results analysis or manuscript preparation.
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Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Claire E. Brolan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Policy Futures, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Australia
| | - Rob Mitchell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Health, Australia
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Global Programs, Emergency & Trauma Centre, Alfred Health, Australia
| | - Deepak Sharma
- Emergency Department, Colonial War Memorial Hospital, Suva, Fiji
| | - Sarah Körver
- Australasian College for Emergency Medicine, Melbourne, Australia
| | | | | | - Berlin Kafoa
- Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Megan Cox
- Faculty of Medicine and Health, The University of Sydney, Australia
- The Sutherland Hospital, NSW, Australia
- State Retrieval Consultant, NSW Ambulance, Sydney, Australia
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Zheng H, Peng C. The impact of public health emergency governance based on artificial intelligence. JOURNAL OF INTELLIGENT SYSTEMS 2022. [DOI: 10.1515/jisys-2022-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
To optimize the data clustering effect of public health emergencies, an application research on social governance ability under public health emergencies based on artificial intelligence is proposed. First, the firefly optimization algorithm is used to collect the information data of the social governance ability of public health emergencies, establish a unified format, and save it. Then, artificial intelligence technology is used to mine the correlation of clustering data, and on this basis, a learning model integrating global structure information and local structure information is established. Finally, the social governance model under public health emergencies is established. The experimental results show that the design method has high clustering accuracy, regularization cross index, and adjusted rand index (ARI) index. This shows that the design method can improve the social governance ability of data fusion clustering and improve the social governance ability.
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Affiliation(s)
- Hao Zheng
- School of Humanities and Social Science , Heilongjiang Bayi Agricultural University , Daqing 163000 , China
| | - Chuanyuan Peng
- Daqing Children’s Rescue and Protection Center , Daqing 163000 , China
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Kohler IV, Sudharsanan N, Bandawe C, Kohler HP. Aging and hypertension among the global poor-Panel data evidence from Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000600. [PMID: 36962748 PMCID: PMC10022104 DOI: 10.1371/journal.pgph.0000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/19/2022] [Indexed: 05/28/2023]
Abstract
Hypertension is a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. We find that high blood pressure is very common among mature adults aged 45+, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013-17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Overall, our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups-including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45-55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a "generalized epidemic" than in high-income countries where cardiovascular risk has strong socioeconomic gradients.
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Affiliation(s)
- Iliana V. Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nikkil Sudharsanan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Chiwoza Bandawe
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States of America
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