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Giorgio L, Morandi F, Cicchetti A. Maintaining health service during COVID-19: A study on regional health services. Health Serv Manage Res 2024:9514848241254931. [PMID: 38873755 DOI: 10.1177/09514848241254931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock.
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Affiliation(s)
| | | | - Americo Cicchetti
- General Director of Health Planning, Ministry of Health, Rome, Italy
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2
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Buabeng-Baidoo B, Olivier J. Public-Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study. Health Policy Plan 2024; 39:469-485. [PMID: 38498334 PMCID: PMC11095267 DOI: 10.1093/heapol/czae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG's non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG's ability to provide quality, affordable care. This study underscores private providers' pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.
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Affiliation(s)
| | - Jill Olivier
- School of Public Health, University of Cape Town, Rondebosch 7701, South Africa
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3
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Amberbir A, Huda FA, VanderZanden A, Mathewos K, Ntawukuriryayo JT, Binagwaho A, Hirschhorn LR. Mitigating the impact of COVID-19 on primary healthcare interventions for the reduction of under-5 mortality in Bangladesh: Lessons learned through implementation research. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002997. [PMID: 38446832 PMCID: PMC10917255 DOI: 10.1371/journal.pgph.0002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality (U5M) in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic. We utilized a mixed methods implementation science approach, with data from: 1) desk review of available literature; 2) existing District Health Information System 2 (DHIS2) in Bangladesh; and 3) key informant interviews (KIIs), exploring evidence on changes in coverage, implementation strategies, and contextual factors influencing primary healthcare EBI coverage during March-December 2020. We used interrupted time series analysis (timeframe January 2019 to December 2020) using a Poisson regression model to estimate the impact of COVID-19 on DHIS2 indicators. We audio recorded, transcribed, and translated the qualitative data from KIIs. We used thematic analysis of coded interviews to identify emerging patterns and themes using the implementation research framework. Bangladesh had an initial drop in U5M-oriented EBIs during the early phase of the pandemic, which began recovering in June 2020. Barriers such as lockdown and movement restrictions, difficulties accessing medical care, and redirection of the health system's focus to the COVID-19 pandemic, resulted in reduced health-seeking behavior and service utilization. Strategies to prevent and respond to disruptions included data use for decision-making, use of digital platforms, and leveraging community-based healthcare delivery. Transferable lessons included collaboration and coordination of activities and community and civil society engagement, and investing in health system quality. Countries working to increase EBI implementation can learn from the barriers, strategies, and transferable lessons identified in this work in an effort to reduce and respond to health system disruptions in anticipation of future health system shocks.
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Affiliation(s)
| | - Fauzia A. Huda
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | - Lisa R. Hirschhorn
- University of Global Health Equity, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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4
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Saulnier DD, Topp SM. We need to talk about 'bad' resilience. BMJ Glob Health 2024; 9:e014041. [PMID: 38320804 PMCID: PMC10859976 DOI: 10.1136/bmjgh-2023-014041] [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: 09/22/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
In this analysis, we argue against seeing health system resilience as an inherently positive concept. The rise in the popularity of health system resilience has led to its increasingly normative framing. We question this widely accepted perspective by examining the underlying assumptions associated with this normative framing of 'good' resilience. Our focus is on the risks of accepting the assumption, which can lead us to ignore the social nature of health systems and overlook the consequences of change if resilience is seen as a positive, achievable objective. Finally, we suggest that seeing resilience as a normative concept can be detrimental to health system policy and research, and encourage a critical rethinking of these assumptions so that we can maintain resilience's usefulness for health systems.
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Affiliation(s)
- Dell D Saulnier
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- The University of Melbourne Nossal Institute for Global Health, Melbourne, Victoria, Australia
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Truppa C, Yaacoub S, Valente M, Celentano G, Ragazzoni L, Saulnier D. Health systems resilience in fragile and conflict-affected settings: a systematic scoping review. Confl Health 2024; 18:2. [PMID: 38172918 PMCID: PMC10763433 DOI: 10.1186/s13031-023-00560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Health systems resilience (HSR) research is a rapidly expanding field, in which key concepts are discussed and theoretical frameworks are emerging with vibrant debate. Fragile and conflict-affected settings (FCAS) are contexts exposed to compounding stressors, for which resilience is an important characteristic. However, only limited evidence has been generated in such settings. We conducted a scoping review to: (a) identify the conceptual frameworks of HSR used in the analysis of shocks and stressors in FCAS; (b) describe the representation of different actors involved in health care governance and service provision in these settings; and (c) identify health systems operations as they relate to absorption, adaptation, and transformation in FCAS. METHODS We used standard, extensive search methods. The search captured studies published between 2006 and January 2022. We included all peer reviewed and grey literature that adopted a HSR lens in the analysis of health responses to crises. Thematic analysis using both inductive and deductive approaches was conducted, adopting frameworks related to resilience characteristics identified by Kruk et al., and the resilience capacities described by Blanchet et al. RESULTS: Thirty-seven studies met our inclusion criteria. The governance-centred, capacity-oriented framework for HSR emerged as the most frequently used lens of analysis to describe the health responses to conflict and chronic violence specifically. Most studies focused on public health systems' resilience analysis, while the private health sector is only examined in complementarity with the former. Communities are minimally represented, despite their widely acknowledged role in supporting HSR. The documentation of operations enacting HSR in FCAS is focused on absorption and adaptation, while transformation is seldom described. Absorptive, adaptive, and transformative interventions are described across seven different domains: safety and security, society, health system governance, stocks and supplies, built environment, health care workforce, and health care services. CONCLUSIONS Our review findings suggest that the governance-centred framework can be useful to better understand HSR in FCAS. Future HSR research should document adaptive and transformative strategies that advance HSR, particularly in relation to actions intended to promote the safety and security of health systems, the built environment for health, and the adoption of a social justice lens.
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Affiliation(s)
- Claudia Truppa
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy.
- International Committee of the Red Cross, Geneva, Switzerland.
| | - Sally Yaacoub
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Giulia Celentano
- ETH Zürich, Institut Für Bau- Und Infrastrukturmanagement, Chair of Sustainable Construction, Zurich, Schweiz
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, 13100, Vercelli, Italy
| | - Dell Saulnier
- Division of Social Medicine and Global Health/Department of Clinical Sciences, Lund University, Malmö, Sweden
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Copeland S, Hinrichs-Krapels S, Fecondo F, Santizo ER, Bal R, Comes T. A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Serv Res 2023; 23:1297. [PMID: 38001460 PMCID: PMC10675888 DOI: 10.1186/s12913-023-10022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature. METHODS We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation. RESULTS The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature. CONCLUSIONS Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.
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Affiliation(s)
- Samantha Copeland
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Saba Hinrichs-Krapels
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands.
| | - Federica Fecondo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Esteban Ralon Santizo
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burg. Oudlaan 50, Rotterdam, The Netherlands
| | - Tina Comes
- Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628 BX, Delft, The Netherlands
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Neill R, Peters MA, Bello S, Dairo MD, Azais V, Samuel Jegede A, Adebowale AS, Nzelu C, Azodo N, Adoghe A, Wang W, Bartlein R, Liu A, Ogunlayi M, Yaradua SU, Shapira G, Hansen PM, Fawole OI, Ahmed T. What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria. BMJ Glob Health 2023; 8:e012700. [PMID: 37984895 PMCID: PMC10660915 DOI: 10.1136/bmjgh-2023-012700] [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: 04/27/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience. METHODS Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework. RESULTS A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps. CONCLUSION Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.
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Affiliation(s)
- Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Michael A Peters
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ngozi Azodo
- Nigeria Federal Ministry of Health, Abuja, Nigeria
| | | | - William Wang
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Rebecca Bartlein
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Anne Liu
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Saudatu Umma Yaradua
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Gil Shapira
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Peter M Hansen
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
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Reid M, Agbassi YJP, Arinaminpathy N, Bercasio A, Bhargava A, Bhargava M, Bloom A, Cattamanchi A, Chaisson R, Chin D, Churchyard G, Cox H, Denkinger CM, Ditiu L, Dowdy D, Dybul M, Fauci A, Fedaku E, Gidado M, Harrington M, Hauser J, Heitkamp P, Herbert N, Herna Sari A, Hopewell P, Kendall E, Khan A, Kim A, Koek I, Kondratyuk S, Krishnan N, Ku CC, Lessem E, McConnell EV, Nahid P, Oliver M, Pai M, Raviglione M, Ryckman T, Schäferhoff M, Silva S, Small P, Stallworthy G, Temesgen Z, van Weezenbeek K, Vassall A, Velásquez GE, Venkatesan N, Yamey G, Zimmerman A, Jamison D, Swaminathan S, Goosby E. Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis. Lancet 2023; 402:1473-1498. [PMID: 37716363 DOI: 10.1016/s0140-6736(23)01379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Michael Reid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Yvan Jean Patrick Agbassi
- Global TB Community Advisory Board, Abidjan, Côte d'Ivoire, Yenepoya Medical College, Mangalore, India
| | | | - Alyssa Bercasio
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Anurag Bhargava
- Department of General Medicine, Yenepoya Medical College, Mangalore, India
| | - Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, India
| | - Amy Bloom
- Division of Tuberculosis, Bureau of Global Health, USAID, Washington, DC, USA
| | | | - Richard Chaisson
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Chin
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - Helen Cox
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Claudia M Denkinger
- Heidelberg University Hospital, German Center of Infection Research, Heidelberg, Germany
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Department of Medicine, Center for Global Health Practice and Impact, Georgetown University, Washington, DC, USA
| | - Anthony Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Petra Heitkamp
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Nick Herbert
- Global TB Caucus, Houses of Parliament, London, UK
| | | | - Philip Hopewell
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Emily Kendall
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aamir Khan
- Interactive Research & Development, Karachi, Pakistan
| | - Andrew Kim
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Nalini Krishnan
- Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India
| | - Chu-Chang Ku
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Erica Lessem
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Payam Nahid
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Mario Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Theresa Ryckman
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sachin Silva
- Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | | | | | | | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Gustavo E Velásquez
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Dean Jamison
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Eric Goosby
- University of California San Francisco Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
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9
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Witter S, Thomas S, Topp SM, Barasa E, Chopra M, Cobos D, Blanchet K, Teddy G, Atun R, Ager A. Health system resilience: a critical review and reconceptualisation. Lancet Glob Health 2023; 11:e1454-e1458. [PMID: 37591591 DOI: 10.1016/s2214-109x(23)00279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/19/2023]
Abstract
This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and-as amply shown during the COVID-19 pandemic-relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities-what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK; ReBUILD for Resilience, Queen Margaret University, Edinburgh, UK.
| | - Steve Thomas
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stephanie M Topp
- Centre for Health Policy & Management, James Cook University, Townsville, QLD, Australia
| | - Edwine Barasa
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Daniel Cobos
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Geneva, Switzerland
| | - Gina Teddy
- Ghana Institute of Management and Public Affairs, Accra, Ghana
| | - Rifat Atun
- Harvard School of Public Health, Boston, MA, USA
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Nzinga J, Oliwa J, Oluoch D, Jepkosgei J, Mbuthia D, Boga M, Musitia P, Ogola M, Muinga N, Muraya K, Hinga A, Kamuya D, Kelley M, Molyneux S. The hidden emotional labour behind ensuring the social value of research: Experiences of frontline health policy and systems researchers based in Kenya during COVID-19. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002116. [PMID: 37643165 PMCID: PMC10464993 DOI: 10.1371/journal.pgph.0002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/23/2023] [Indexed: 08/31/2023]
Abstract
Health policy and systems research (HPSR) is a multi-disciplinary, largely applied field of research aimed at understanding and strengthening the performance of health systems, often with an emphasis on power, policy and equity. The value of embedded and participatory HPSR specifically in facilitating the collection of rich data that is relevant to addressing real-world challenges is increasingly recognised. However, the potential contributions and challenges of HPSR in the context of shocks and crises are not well documented, with a particular gap in the literature being the experiences and coping strategies of the HPSR researchers who are embedded in health systems in resource constrained settings. In this paper, we draw on two sets of group discussions held among a group of approximately 15 HPSR researchers based in Nairobi, Kenya, who were conducting a range of embedded HPSR studies throughout the COVID-19 pandemic. The researchers, including many of the authors, were employed by the KEMRI-Wellcome Trust Research Programme (KWTRP), which is a long-standing multi-disciplinary partnership between the Kenya Medical Research Institute and the Wellcome Trust with a central goal of contributing to national and international health policy and practice. We share our findings in relation to three inter-related themes: 1) Ensuring the continued social value of our HPSR work in the face of changing priorities; 2) Responding to shifting ethical procedures and processes at institutional and national levels; and 3) Protecting our own and front-line colleagues' well-being, including clinical colleagues. Our experiences highlight that in navigating research work and responsibilities to colleagues, patients and participants through the pandemic, many embedded HPSR staff faced difficult emotional and ethical challenges, including heightened forms of moral distress, which may have been better prevented and supported. We draw on our findings and the wider literature to discuss considerations for funders and research leads with an eye to strengthening support for embedded HPSR staff, not only in crises such as the on-going COVID-19 pandemic, but also more generally.
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Affiliation(s)
- Jacinta Nzinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacquie Oliwa
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorothy Oluoch
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joyline Jepkosgei
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Daniel Mbuthia
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mwanamvua Boga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peris Musitia
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Muthoni Ogola
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Naomi Muinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Alex Hinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorcas Kamuya
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Nuffield Department of Population Health, Wellcome Centre for Ethics & Humanities, University of Oxford, Oxford, United Kingdom
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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11
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Yaacoub S, Zmeter C, Abou Abbas L, Leresche E, Kdouh O, Hammoud R, Leaning J, Hamadeh R, Truppa C. Has the COVID-19 pandemic changed the utilization and provision of essential health care services from 2019 to 2020 in the primary health care network in Lebanon? Results from a nationwide representative cross-sectional survey. PLoS One 2023; 18:e0288387. [PMID: 37440540 DOI: 10.1371/journal.pone.0288387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
There is limited research soliciting the patient and staff perspectives on the overall effects of COVID-19 on the utilization and provision of primary care in Lebanon. The present study was part of a larger study on the overall effect of COVID-19 on both utilization and provision of essential health care services within the Lebanese primary health care network (PHCN). Here, we present the patient and staff perspectives on continuity of service provision, adherence to infection prevention and control measures, and the role of the PHCN in epidemic preparedness and response. We conducted a cross-sectional survey between June and July 2021 among patients who had received a health care service in 2019 or 2020 from registered primary healthcare centers (PHCs) in the network and among the respective PHC staff working during the same period. A total of 763 patients and 198 staff completed the surveys. Services were reported as interrupted by 15% of the total patients who used services either in 2020 only or in both 2019 and 2020. Access to chronic (67%) and acute medications (40%) were reported as the main interrupted services. Immunization also emerged as a foregone service in 2020. Among the staff, one third (33%) reported interruptions in the provision of services. Financial barriers rather than fear of COVID-19 were reported as main reasons for interruption. Both groups considered that the facilities implemented adequate infection prevention and control measures. They perceived that the PHCN maintained some essential healthcare services and that it should have played a bigger role in the response to the pandemic. There was a continuity in utilization and provision of services in the PHCN that was higher than expected, with non-communicable diseases and immunizations suffering more than other services.
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Affiliation(s)
- Sally Yaacoub
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - Carla Zmeter
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
| | - Linda Abou Abbas
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
| | - Enrica Leresche
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Ola Kdouh
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Rawan Hammoud
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Jennifer Leaning
- Harvard FXB Center for Health and Human Rights, Boston, MA, United States of America
| | - Randa Hamadeh
- Global Health Team of Experts, Ministry of Public Health Lebanon, Baabda, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross, Lebanon Delegation, Beirut, Lebanon
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
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12
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Gold AW, Bozorgmehr K, Biddle L, Perplies C, Rast E, Jahn R. [Early crisis response to the COVID-19 pandemic in collective accommodation facilities for refugees : Analysis of cross-actor working arrangements from the perspective of the reception authorities in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03745-w. [PMID: 37418026 PMCID: PMC10371912 DOI: 10.1007/s00103-023-03745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Refugees in collective accommodation facilities are at increased risk of COVID-19-infections due to high occupancy density and shared spaces. It is unclear which (organisational) actors the reception authorities were working with in their crisis response and how. The aim of this paper is to examine the working arrangements between reception authorities and other actors involved in accommodation and (health) care during the first wave of the COVID-19 pandemic and to derive recommendations for future crisis responses. METHODS The analysis was based on qualitative interviews with representatives responsible for the reception and accommodation of refugees (N = 46) conducted from May to July 2020. Cross-actor networks were visualised, and a qualitative analysis of the data material was carried out using the framework method. RESULTS The reception authorities worked with a multitude of other (organisational) actors. Health authorities, social workers and security personnel were mentioned most frequently. The crisis response was found to be highly heterogeneous due to its dependence on the commitment, knowledge and attitude of the individuals and organisations involved. In the absence of a coordinating actor, there may also be delays due to a "wait-and-see" attitude of the actors involved. CONCLUSION Crisis response in collective accommodation facilities for refugees would benefit from a clear allocation of the coordinating role to an appropriate actor. Instead of improvised ad hoc solutions, sustainable improvements in terms of transformative resilience are needed to reduce structural vulnerabilities.
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Affiliation(s)
- Andreas W Gold
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120
- AG Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Kayvan Bozorgmehr
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120
- AG Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Louise Biddle
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120
- AG Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Clara Perplies
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120
| | - Eilin Rast
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120
| | - Rosa Jahn
- Sektion Health Equity Studies und Migration, Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland, Im Neuenheimer Feld 130.3, 69120.
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Clausin M, Rieckhoff A, Tediosi F, Morel CM, Kaspiarovich Y, Levrat N, Wernli D. Multisystemic resilience to shocks: a temporal analysis of health, fundamental rights and freedoms, and economic resilience during the first wave of the COVID-19 pandemic in 22 European countries. BMJ Open 2023; 13:e065445. [PMID: 37419631 PMCID: PMC10335565 DOI: 10.1136/bmjopen-2022-065445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Research on resilience to the COVID-19 pandemic has primarily focused on health system resilience. The purpose of this paper is to: (1) develop a broader understanding of societal resilience to shocks by evaluating resilience in three systems: health, economic and fundamental rights and freedoms and (2) to further operationalise resilience in terms of robustness, resistance and recovery. SETTINGS 22 European countries were selected based on the availability of data in the health, fundamental rights and freedoms, and economic systems during the first wave of the COVID-19 pandemic in early 2020. DESIGN This study uses time series data to assess resilience in health, fundamental rights and freedoms, and economic systems. An overall resilience was estimated, as well as three of its components: robustness, resistance and recovery. RESULTS Six countries exhibited an outlier excess mortality peak compared with the prepandemic period (2015-2019). All countries experienced economic repercussions and implemented diverse measures affecting individual rights and freedoms. Three main groups of countries were identified: (1) high health and high or moderate economic and/or fundamental rights and freedoms resilience, (2) moderate health and fundamental rights and freedoms resilience and (3) low resilience in all three systems. CONCLUSIONS The classification of countries into three groups provides valuable insights into the multifaceted nature of multisystemic resilience during the first wave of the COVID-19 pandemic. Our study highlights the importance of considering both health and economic factors when assessing resilience to shocks, as well as the necessity of safeguarding individual rights and freedoms during times of crisis. Such insights can inform policy decisions and aid in the development of targeted strategies to enhance resilience in the face of future challenges.
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Affiliation(s)
- Mia Clausin
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Alicia Rieckhoff
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | | | - Chantal M Morel
- Global Studies Institute, University of Geneva, Geneva, Switzerland
| | | | - Nicolas Levrat
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Faculty of Law, University of Geneva, Geneva, Switzerland
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
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14
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Biadgilign S, Hailu A, Gebremichael B, Letebo M, Berhanesilassie E, Shumetie A. The role of universal health coverage and global health security nexus and interplay on SARS-CoV-2 infection and case-fatality rates in Africa : a structural equation modeling approach. Global Health 2023; 19:46. [PMID: 37415196 DOI: 10.1186/s12992-023-00949-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The Coronavirus Disease (COVID-19) caused by SARS-CoV-2 infections remains a significant health challenge worldwide. There is paucity of evidence on the influence of the universal health coverage (UHC) and global health security (GHS) nexus on SARS-CoV-2 infection risk and outcomes. This study aimed to investigate the effects of UHC and GHS nexus and interplay on SARS-CoV-2 infection rate and case-fatality rates (CFR) in Africa. METHODS The study employed descriptive methods to analyze the data drawn from multiple sources as well used structural equation modeling (SEM) with maximum likelihood estimation to model and assess the relationships between independent and dependent variables by performing path analysis. RESULTS In Africa, 100% and 18% of the effects of GHS on SARS-CoV-2 infection and RT-PCR CFR, respectively were direct. Increased SARS-CoV-2 CFR was associated with median age of the national population (β = -0.1244, [95% CI: -0.24, -0.01], P = 0.031 ); COVID-19 infection rate (β = -0.370, [95% CI: -0.66, -0.08], P = 0.012 ); and prevalence of obesity among adults aged 18 + years (β = 0.128, [95% CI: 0.06,0.20], P = 0.0001) were statistically significant. SARS-CoV-2 infection rates were strongly linked to median age of the national population (β = 0.118, [95% CI: 0.02,0.22 ], P = 0.024); population density per square kilometer, (β = -0.003, [95% CI: -0.0058, -0.00059], P = 0.016 ) and UHC for service coverage index (β = 0.089, [95% CI: 0.04,0.14, P = 0.001 ) in which their relationship was statistically significant. CONCLUSIONS The study shade a light that UHC for service coverage, and median age of the national population, population density have significant effect on COVID-19 infection rate while COVID-19 infection rate, median age of the national population and prevalence of obesity among adults aged 18 + years were associated with COVID-19 case-fatality rate. Both, UHC and GHS do not emerge to protect against COVID-19-related case fatality rate.
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Affiliation(s)
- Sibhatu Biadgilign
- Independent Public Health Analyst and Research Consultant, P.O.BOX 24414, Addis Ababa, Ethiopia.
| | - Alemayehu Hailu
- Department of Global Public Health and Primary Care Medicine, Bergen Center for Ethics and Priority Setting, The University of Bergen, Bergen, Norway
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, United States of America
| | | | - Mekitew Letebo
- Independent Public Health Analyst and Research Consultant, P.O.BOX 24414, Addis Ababa, Ethiopia
| | - Etsub Berhanesilassie
- Independent Public Health Analyst and Research Consultant, P.O.BOX 24414, Addis Ababa, Ethiopia
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15
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Sagan A, Thomas S, Kennedy E, Webb E, McKee M. Assessing resilience of a health system is difficult but necessary to prepare for the next crisis. BMJ 2023; 382:e073721. [PMID: 37402509 DOI: 10.1136/bmj-2022-073721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Anna Sagan
- European Observatory on Health Systems and Policies, London, UK
- London School of Economics and Political Science, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Erin Webb
- European Observatory on Health Systems and Policies, London, UK
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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16
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David PM, Gabet M, Duhoux A, Traverson L, Ridde V, Zinszer K, Gautier L. Adapting Hospital Work During COVID-19 in Quebec (Canada). Health Syst Reform 2023; 9:2200566. [PMID: 37071844 DOI: 10.1080/23288604.2023.2200566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Among hospital responses to the COVID19 pandemic worldwide, service reorganization and staff reassignment have been some of the most prominent ways of adapting hospital work to the expected influx of patients. In this article, we examine work reorganization induced by the pandemic by identifying the operational strategies implemented by two hospitals and their staff to contend with the crisis and then analyzing the implications of those strategies. We base our description and analysis on two hospital case studies in Quebec. We used a multiple case study approach, wherein each hospital is considered a unique case. In both cases, work adaptation through staff reassignment was one of the critical measures undertaken to ensure absorption of the influx of patients into the hospitals. Our results showed that this general strategy was designed and applied differently in the two cases. More specifically, the reassignment strategies revealed numerous healthcare resource disparities not only between health territories, but also between different types of facilities within those territories. Comparing the two hospitals' adaptation strategies showed that past reforms in Quebec determined what these reorganizations could achieve, as well as how they would affect workers and the meaning they gave to their work.
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Affiliation(s)
| | - Morgane Gabet
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Lara Gautier
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
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de Araújo Oliveira SR, Cazarin G, Soares Sampaio A, Ribeiro de Vasconcelos AL, Furtado B, Gomes de Medeiros S, Correia Paes Zacarias A, Reis Andrade AC, Paz de Sousa KM, Zinszer K, Ridde V. Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study. Health Syst Reform 2023; 9:2177242. [PMID: 37036130 DOI: 10.1080/23288604.2023.2177242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.
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Affiliation(s)
| | - Gisele Cazarin
- Public Health Department, Instituto Aggeu Magalhães, Fiocruz, Pernambuco, Brazil
| | | | | | - Betise Furtado
- Public Health Department, University of Pernambuco, Nossa Senhora das Graças Nursing School, FENSG/UPE, FOP/UPE, Pernambuco, Brazil
| | | | | | | | | | - Kate Zinszer
- Public Health Department, University of Montreal, Montreal, Quebec, Canada
| | - Valéry Ridde
- Public Health Department, Université Paris Cité, IRD, Inserm, Ceped, Paris, France
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Ridde V, Traverson L, Zinszer K. Hospital Resilience to the COVID-19 Pandemic in Five Countries: A Multiple Case Study. Health Syst Reform 2023; 9:2242112. [PMID: 37652669 DOI: 10.1080/23288604.2023.2242112] [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: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Since the beginning of the pandemic, hospitals have been central to the COVID-19 response, often experiencing severe financial, material, and human constraints. In this special issue, we present some of the findings of the HoSPiCOVID research project. One of its main objectives was to compare hospital responses to the first and second waves of the COVID-19 pandemic in Brazil, Canada, France, Japan, and Mali. Studying and comparing how nine different hospitals coped with the pandemic in terms of preparedness and response allowed us to: 1) identify strengths and weaknesses of their responses, including challenges for hospital professionals; and 2) produce lessons learned, using a systematic approach to reflect and analyze their potential of resilience to the crisis. In the five countries, research teams conducted in-depth qualitative studies focused on nine large hospitals, using observation sessions, semistructured interviews with hospital professionals, and lessons learned workshops. The empirical work was supported by an original analytical framework on hospital resilience and a heuristic tool focused on configurations. The studies demonstrate that the hospitals were able to absorb and/or adapt to the crisis by deploying different coping mechanisms, which often required extensive involvement of hospital professionals. More extended study periods would be needed to assess the sustainability of these coping mechanisms and discern whether they have transformative potential. These international comparisons of hospital resilience, based on studies of contrasting contexts and epidemiological situations, allowed researchers to identify lessons learned to support hospital decision-makers in thinking more deeply about managing future health crises.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Kate Zinszer
- School of Public Health (ESPUM), Université de Montréal, Montreal, Quebec, Canada
- Public Health Research Centre (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Honda A, de Araujo Oliveira SR, Ridde V, Zinszer K, Gautier L. Attributes and Organizational Factors that Enabled Innovation in Health Care Service Delivery during the COVID-19 Pandemic - Case Studies from Brazil, Canada and Japan. Health Syst Reform 2023; 9:2176022. [PMID: 37023218 DOI: 10.1080/23288604.2023.2176022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Innovation by health service organizations can enable adaptation to and transformation of challenges caused by health shocks. Drawing on results from case studies in Brazil, Canada, and Japan, this study looked at innovations the study hospitals introduced in response to challenges caused by COVID-19 to identify: 1) attributes of the innovations that make them conducive to adoption; and 2) organizational factors that facilitate the creation and implementation of innovative health care approaches during health system shocks. Qualitative information was gathered using key informant interviews, participatory observations at the study hospitals and a review of relevant documentation. A thematic approach was used for analysis, and a cross-country comparison framework was prepared to synthesize findings from the case studies in the three countries. In response to the disruptions caused by COVID-19, the study hospitals undertook innovative changes in services, processes, organizational structures, and operational policy. The driving force behind the innovations was the need and urgency generated by the unprecedented nature of the pandemic. With COVID-19, if an innovation met the perceived needs of hospitals and provided an operational advantage, some level of complexity in the implementation appeared to be acceptable. The study findings suggest that for hospitals to create and implement innovations in response to health shocks, they need to: have adaptive and flexible organizational structures; build and maintain functioning communication systems; have committed leadership; ensure all staff share an understanding of hospital organizational and professional missions; and establish social networks that facilitate the creation and implementation of new ideas.
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Affiliation(s)
- Ayako Honda
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- École de Santé Publique, Université de Montréal, Montreal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Lara Gautier
- École de Santé Publique, Université de Montréal, Montreal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Peters MA, Ahmed T, Azais V, Amor Fernandez P, Baral P, Drouard S, Neill R, Bachir K, Bassounda P, Dube Q, Flora S, Montufar E, Nzelu C, Tassembedo M, Sanford Wesseh C, Alam B, Rusatira JDD, Hashemi T, Karibwami AD, Moscosco V, Ogunlayi M, Ortiz de Zunigalo T, Ruel-Bergeron J, Sieleunou I, Hansen PM, Shapira G. Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight low- and middle-income countries. Health Policy Plan 2023:7187082. [PMID: 37256762 DOI: 10.1093/heapol/czad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/17/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Responsive primary health-care facilities are the foundation of resilient health systems, yet little is known about facility-level processes that contribute to the continuity of essential services during a crisis. This paper describes the aspects of primary health-care facility resilience to coronavirus disease 2019 (COVID-19) in eight countries. Rapid-cycle phone surveys were conducted with health facility managers in Bangladesh, Burkina Faso, Chad, Guatemala, Guinea, Liberia, Malawi and Nigeria between August 2020 and December 2021. Responses were mapped to a validated health facility resilience framework and coded as binary variables for whether a facility demonstrated capacity in eight areas: removing barriers to accessing services, infection control, workforce, surge capacity, financing, critical infrastructure, risk communications, and medical supplies and equipment. These self-reported capacities were summarized nationally and validated with the ministries of health. The analysis of service volume data determined the outcome: maintenance of essential health services. Of primary health-care facilities, 1,453 were surveyed. Facilities maintained between 84% and 97% of the expected outpatient services, except for Bangladesh, where 69% of the expected outpatient consultations were conducted between March 2020 and December 2021. For Burkina Faso, Chad, Guatemala, Guinea and Nigeria, critical infrastructure was the largest constraint in resilience capabilities (47%, 14%, 51%, 9% and 29% of facilities demonstrated capacity, respectively). Medical supplies and equipment were the largest constraints for Liberia and Malawi (15% and 48% of facilities demonstrating capacity, respectively). In Bangladesh, the largest constraint was workforce and staffing, where 44% of facilities experienced moderate to severe challenges with human resources during the pandemic. The largest constraints in facility resilience during COVID-19 were related to health systems building blocks. These challenges likely existed before the pandemic, suggesting the need for strategic investments and reforms in core capacities of comprehensive primary health-care systems to improve resilience to future shocks.
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Affiliation(s)
- Michael A Peters
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Pablo Amor Fernandez
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Prativa Baral
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Salomé Drouard
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Kante Bachir
- Ministère de la Sante de la Guinea, Blvd de Commerce, Conakry, Guinea
| | | | - Queen Dube
- Ministry of Health of Malawi, Capital Hill Circle, Lilongwe, Malawi
| | - Sabrina Flora
- Government of Bangladesh Ministry of Health and Family Welfare, Abdul Gani Road, Dhaka 1000, Bangladesh
| | - Edwin Montufar
- Ministerio de Salud Pública y Asistencia Social de Guatemala, Avenida 3-45, Cdad. de Guatemala, Guatemala
| | - Charles Nzelu
- Federal Ministry of Health of Nigeria, Federal Secretariat Complex, Phase III, Shehu Shagari Way, Central Business District, Abuja, Nigeria
| | - Mahamadi Tassembedo
- Ministère de la Santé et de l'Hygiène Publique du Burkina Faso, Ave du Burkina, Koulouba, Ouagadougou, Burkina Faso
| | | | - Bushra Alam
- The World Bank, 1818 H St NW, Washington, DC 20433, USA
| | - Jean de Dieu Rusatira
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tawab Hashemi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Alain-Desire Karibwami
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Virginia Moscosco
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Tania Ortiz de Zunigalo
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Julie Ruel-Bergeron
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Isidore Sieleunou
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Peter M Hansen
- The Global Financing Facility for Women, Children, and Adolescents, 1818 H St NW, Washington, DC 20433, USA
| | - Gil Shapira
- The World Bank, 1818 H St NW, Washington, DC 20433, USA
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Marchal B, Michielsen J, Simon S, Verdonck K, Accoe K, Tonga C, Polman K, Tawaytibhongs O, Cornu T, Dens S, Sy H, Nieto-Sanchez C, Van Belle S. Making 'resilience' useful again: recognising health system resilience as an effective boundary object. BMJ Glob Health 2023; 8:bmjgh-2023-012064. [PMID: 37247871 DOI: 10.1136/bmjgh-2023-012064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sara Simon
- Department of Conflict Resolution, University of Massachusetts, Boston, Massachusetts, USA
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Tom Cornu
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Family Medicine and Population Health Department, University of Antwerp, Antwerpen, Belgium
| | - Stefanie Dens
- Research Group for Urban Development, University of Antwerp, Antwerpen, Belgium
- Department of Public Health, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium
| | - Houssynatou Sy
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Pitayarangsarit S, Bhagaman N, Yodmai K, Thangsirikul N, Tipayamongkholgul M. The resiliency of noncommunicable diseases services during the public health crisis: a lesson from Bangkok, Thailand. BMC Health Serv Res 2023; 23:409. [PMID: 37101168 PMCID: PMC10132400 DOI: 10.1186/s12913-023-09400-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. METHODS Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. RESULTS The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. CONCLUSION During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.
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Affiliation(s)
- Siriwan Pitayarangsarit
- Division of Non-communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Nanapas Bhagaman
- Department of Epidemiology, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Korravarn Yodmai
- Department of Family Health, Faculty of Public Health, Korravarn Yodmai, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Nattaya Thangsirikul
- Division of Non-communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Mathuros Tipayamongkholgul
- Department of Epidemiology, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
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23
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Ignatowicz A, Tarrant C, Mannion R, El-Sawy D, Conroy S, Lasserson D. Organizational resilience in healthcare: a review and descriptive narrative synthesis of approaches to resilience measurement and assessment in empirical studies. BMC Health Serv Res 2023; 23:376. [PMID: 37076882 PMCID: PMC10113996 DOI: 10.1186/s12913-023-09242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/03/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The coronavirus pandemic has had a profound impact on organization and delivery of care. The challenges faced by healthcare organizations in dealing with the pandemic have intensified interest in the concept of resilience. While effort has gone into conceptualising resilience, there has been relatively little work on how to evaluate organizational resilience. This paper reports on an extensive review of approaches to resilience measurement and assessment in empirical healthcare studies, and examines their usefulness for researchers, policymakers and healthcare managers. METHODS Various databases (MEDLINE, EMBASE, PsycINFO, CINAHL (EBSCO host), Cochrane CENTRAL (Wiley), CDSR, Science Citation Index, and Social Science Citation Index) were searched from January 2000 to September 2021. We included quantitative, qualitative and modelling studies that focused on measuring or qualitatively assessing organizational resilience in a healthcare context. All studies were screened based on titles, abstracts and full text. For each approach, information on the format of measurement or assessment, method of data collection and analysis, and other relevant information were extracted. We classified the approaches to organizational resilience into five thematic areas of contrast: (1) type of shock; (2) stage of resilience; (3) included characteristics or indicators; (4) nature of output; and (5) purpose. The approaches were summarised narratively within these thematic areas. RESULTS Thirty-five studies met the inclusion criteria. We identified a lack of consensus on how to evaluate organizational resilience in healthcare, what should be measured or assessed and when, and using what resilience characteristic and indicators. The measurement and assessment approaches varied in scope, format, content and purpose. Approaches varied in terms of whether they were prospective (resilience pre-shock) or retrospective (during or post-shock), and the extent to which they addressed a pre-defined and shock-specific set of characteristics and indicators. CONCLUSION A range of approaches with differing characteristics and indicators has been developed to evaluate organizational resilience in healthcare, and may be of value to researchers, policymakers and healthcare managers. The choice of an approach to use in practice should be determined by the type of shock, the purpose of the evaluation, the intended use of results, and the availability of data and resources.
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Affiliation(s)
- Agnieszka Ignatowicz
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Russell Mannion
- Russell Mannion, Health Services and Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Dena El-Sawy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Paschoalotto MAC, Lazzari EA, Rocha R, Massuda A, Castro MC. Health systems resilience: is it time to revisit resilience after COVID-19? Soc Sci Med 2023; 320:115716. [PMID: 36702027 PMCID: PMC9851720 DOI: 10.1016/j.socscimed.2023.115716] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.
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Affiliation(s)
- Marco Antonio Catussi Paschoalotto
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil.
| | - Eduardo Alves Lazzari
- David Rockefeller Center for Latin American Studies, Harvard University, USA; Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Rudi Rocha
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Adriano Massuda
- Sao Paulo School of Business Administration, Fundação Getúlio Vargas, Brazil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public Health, Harvard University, USA
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25
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Topp SM. Health System Resilience as the Basis for Explanation Versus Evaluation Comment on "The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic". Int J Health Policy Manag 2023; 12:7481. [PMID: 37579433 PMCID: PMC10125067 DOI: 10.34172/ijhpm.2023.7481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/18/2023] [Indexed: 08/16/2023] Open
Abstract
The onset and impacts of COVID-19 have prompted attention to national health system preparedness for, and capacity to adapt in response to, public health emergencies and other shocks. This preparedness and adaptive capacity are often framed as 'health system resilience' a concept previously associated more with assessments of health systems in conflict-affected and fragile states. Yet health system resilience remains a slippery concept, defined and applied in multiple ways. Reflecting on the Hodgins and colleagues' study "the COVID-19 system shock framework: capturing health system innovation during the COVID-19 pandemic," this article restates the limitations of health systems resilience as a concept capable of anchoring evaluative assessments of health system performance but stresses its value in the context of explanatory research investigating how and why health systems adapt, with due attention to the power of actors' whose choices inform the nature and direction of change.
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Affiliation(s)
- Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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26
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Durand F, Ridde V, Touré L, Coulibaly A. The moderating role of support for innovation in sub-Saharan African healthcare teams: a multilevel perspective. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Chabrol F, David PM. How resilience affected public health research during COVID-19 and why we should abandon it. Glob Public Health 2023; 18:2212750. [PMID: 37196668 DOI: 10.1080/17441692.2023.2212750] [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: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Resilience has accompanied the COVID-19 pandemic as a rallying motto, with calls by governments for a resilient society, resilient families and schools, and, of course, resilient healthcare systems in the face of this unprecedented pandemic shock. Resilience had already gained traction as an analytical concept in public health research for approximately a decade. It became a key concept despite the recognition of its lack of conceptual consistency. The COVID-19 pandemic presented itself as a perfect test-case and encouraged a multiplicity of studies on resilience and health care systems. In this commentary, we add to the existing critiques of resilience in the social sciences by reflecting on the effects of resilience when used to frame empirical inquiries and to draw lessons from the crisis. Resilience as a concept is unable to address crucial structural issues that health systems already faced throughout the world, and it remains a non-neutral political notion. We argue that we need to resist a generalised view of resilience and work with alternative imaginaries.
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Affiliation(s)
- Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
- Institute for Humanities in Africa (HUMA), University of Cape Town, Cape Town, South Africa
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28
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Ridde V, Kane B, Mbow NB, Senghor I, Faye A. The resilience of two departmental health insurance units during the COVID-19 pandemic in Senegal. BMJ Glob Health 2022; 7:bmjgh-2022-010062. [PMID: 36526299 PMCID: PMC9764624 DOI: 10.1136/bmjgh-2022-010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In its pursuit of solutions for universal health coverage (UHC), Senegal has set up two departmental health insurance units (UDAMs) since 2014. Few studies on the resilience of health systems in Africa have examined health insurance organisations. This article aims to understand how these two UDAMs have been resilient during the COVID-19 pandemic and the restrictive measures imposed by the State to maintain services to their members and reimbursements to healthcare providers. METHODS This study was a multicase study with multiple levels of analysis using a conceptual framework of resilience and analysis of organisational configurations. Empirical data are derived from document analysis, observations for 6 months and 17 qualitative in-depth interviews. RESULTS The results identified three main configurations concerning (1) safety and hygiene, (2) organisation and planning and (3) communication for sustainable payment. The UDAM faced the pandemic with resilience processes to absorb the shock and maintain service to their members. The UDAM learnt positive lessons from crisis management, such as remote work or the ability to support members in their care in hospitals away from their headquarters. They have innovated (transformative resilience) with the organisation of electronic payment and the use of social networks to raise funds and communicate with members. Strengthening their effectiveness after the shock of the departure of the donors in 2017 contributed to the adaptation and even transformation from the pandemic shock of 2020 and 2021. The study shows that leadership, team dynamics and adaptation to contexts are drivers of resilience processes. CONCLUSION Both UDAMs adapted to the shocks of the pandemic and government measures to maintain the services of their members and their organisational routine. This resilience confirms that UDAMs are one of the possible solutions for UHC in the Sahel.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France,Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Babacar Kane
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
| | - Ndeye Bineta Mbow
- Foundiougne, Sénégal, Departmental Health Insurance Unit, Foundiougne, Senegal
| | - Ibrahima Senghor
- Koungheul, Sénégal, Departmental Health Insurance Unit, Koungheul, Senegal
| | - Adama Faye
- Université Cheikh Anta Diop, Institut de santé et developpement, Dakar, Senegal
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Gooding K, Bertone MP, Loffreda G, Witter S. How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks. BMC Health Serv Res 2022; 22:1441. [PMID: 36447261 PMCID: PMC9706990 DOI: 10.1186/s12913-022-08859-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Discussions of health system resilience and emergency management often highlight the importance of coordination and partnership across government and with other stakeholders. However, both coordination and partnership have been identified as areas requiring further research. This paper identifies characteristics and enablers of effective coordination for emergency preparedness and response, drawing on experience from different countries with a range of shocks, including floods, drought, and COVID-19. METHODS The paper synthesises evidence from a set of reports related to research, evaluation and technical assistance projects, bringing together evidence from 11 countries in sub-Saharan Africa and South Asia. Methods for the original reports included primary data collection through interviews, focus groups and workshop discussions, analysis of secondary data, and document review. Reports were synthesised using a coding framework, and quality of evidence was considered for reliability of the findings. RESULTS The reports highlighted the role played by coordination and partnership in preparedness and response, and identified four key areas that characterise and enable effective coordination. First, coordination needs to be inclusive, bringing together different government sectors and levels, and stakeholders such as development agencies, universities, the private sector, local leaders and civil society, with equitable gender representation. Second, structural aspects of coordination bodies are important, including availability of coordination structures and regular meeting fora; clear roles, mandates and sufficient authority; the value of building on existing coordination mechanisms; and ongoing functioning of coordination bodies, before and after crises. Third, organisations responsible for coordination require sufficient capacity, including staff, funding, communication infrastructure and other resources, and learning from previous emergencies. Fourth, effective coordination is supported by high-level political leadership and incentives for collaboration. Country experience also highlighted interactions between these components, and with the wider health system and governance architecture, pointing to the need to consider coordination as part of a complex adaptive system. CONCLUSION COVID-19 and other shocks have highlighted the importance of effective coordination and partnership across government and with other stakeholders. Using country experience, the paper identifies a set of recommendations to strengthen coordination for health system resilience and emergency management.
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Affiliation(s)
- Kate Gooding
- grid.479394.40000 0000 8881 3751ReBUILD for Resilience and Oxford Policy Management, Clarendon House, Level 3, 52 Cornmarket Street, Oxford, OX1 3HJ UK
| | - Maria Paola Bertone
- grid.104846.fReBUILD for Resilience & Institute for Global Health and Development – Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Giulia Loffreda
- grid.104846.fReBUILD for Resilience & Institute for Global Health and Development – Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Sophie Witter
- grid.104846.fReBUILD for Resilience & Institute for Global Health and Development – Queen Margaret University, Edinburgh, EH21 6UU UK
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Rajapaksha RMNU, Khatri RB, Abeysena C, Wijesinghe MSD, Endalamaw A, Thomas TK, Perera N, Rambukwella R, De Silva G, Fernando M, Alemu YA. Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol. BMJ Open 2022; 12:e067829. [PMID: 36410836 PMCID: PMC9680175 DOI: 10.1136/bmjopen-2022-067829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic. METHODS The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar ETHICS AND DISSEMINATION: Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review's findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics. PROSPERO REGISTRATION NUMBER CRD42022352612; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612.
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Affiliation(s)
- R M Nayani Umesha Rajapaksha
- Ministry of Health, Colombo, Western Province, Sri Lanka
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Chrishantha Abeysena
- Department of Community Medicine, University of Kelaniya, Ragama, Western Province, Sri Lanka
| | | | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Pediatrics and Child Health Nursing, Bahir Dar University, Ethiopia Bahir Dar, University of Gondar, Gondar, Ethiopia
| | - Toms K Thomas
- Department of Public Health, SRM University Sikkim, Sikkim, India
| | - Nadeeka Perera
- Ministry of Health, Colombo, Western Province, Sri Lanka
- Community Medicine, Postgraduate Institute of Medicine University of Colombo, Colombo, Western Province, Sri Lanka
| | - Roshan Rambukwella
- Ministry of Health, Colombo, Western Province, Sri Lanka
- Community Medicine, Postgraduate Institute of Medicine University of Colombo, Colombo, Western Province, Sri Lanka
| | - Gayani De Silva
- Ministry of Health, Colombo, Western Province, Sri Lanka
- Community Medicine, Postgraduate Institute of Medicine University of Colombo, Colombo, Western Province, Sri Lanka
| | - Mekala Fernando
- Ministry of Health, Colombo, Western Province, Sri Lanka
- Community Medicine, Postgraduate Institute of Medicine University of Colombo, Colombo, Western Province, Sri Lanka
| | - Yibeltal Assefa Alemu
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Khalil M, Ravaghi H, Samhouri D, Abo J, Ali A, Sakr H, Camacho A. What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation. Front Public Health 2022; 10:1009400. [PMID: 36311596 PMCID: PMC9614418 DOI: 10.3389/fpubh.2022.1009400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level. Aim This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature. Methods Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction. Findings and discussion In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings. Conclusion Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.
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Affiliation(s)
- Merette Khalil
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil
| | - Hamid Ravaghi
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dalia Samhouri
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Abo
- Asian Disaster Preparedness Center, Bangkok, Thailand
| | - Ahmed Ali
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hala Sakr
- Department of Healthier Populations, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Alex Camacho
- Health Emergencies Programme, World Health Organization, Regional Office for the Americas, Washington, DC, United States
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Trump BD, Linkov I. Resilience and lessons learned from COVID-19 emergency response. ENVIRONMENT SYSTEMS AND DECISIONS 2022; 42:325-327. [PMID: 36061514 PMCID: PMC9425814 DOI: 10.1007/s10669-022-09877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
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Stengel S, Roth C, Breckner A, Cordes L, Weber S, Ullrich C, Peters-Klimm F, Wensing M. Resilience of the primary health care system - German primary care practitioners' perspectives during the early COVID-19 pandemic. BMC PRIMARY CARE 2022; 23:203. [PMID: 35948965 PMCID: PMC9365682 DOI: 10.1186/s12875-022-01786-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 07/05/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective. METHODS Shortly after the first COVID-19 wave (July-October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience. RESULTS Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews. CONCLUSIONS The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.
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Affiliation(s)
- Sandra Stengel
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Lara Cordes
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophia Weber
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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McCollum R, Zaizay Z, Dean L, Watson V, Frith L, Alhassan Y, Kollie K, Piotrowski H, Bates I, Anderson de Cuevas R, Harris R, Chowdhury S, Berrian H, Smith JS, Tate WS, El Hajj T, Ozano K, Hastie O, Parker C, Kollie J, Zawolo G, Ding Y, Dacombe R, Taegtmeyer M, Theobald S. Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19. BMJ Open 2022; 12:e058626. [PMID: 35914910 PMCID: PMC9344595 DOI: 10.1136/bmjopen-2021-058626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION COVID-19 has tested the resilience of health systems globally and exposed existing strengths and weaknesses. We sought to understand health systems COVID-19 adaptations and decision making in Liberia and Merseyside, UK. METHODS We used a people-centred approach to carry out qualitative interviews with 24 health decision-makers at national and county level in Liberia and 42 actors at county and hospital level in the UK (Merseyside). We explored health systems' decision-making processes and capacity to adapt and continue essential service delivery in response to COVID-19 in both contexts. RESULTS Study respondents in Liberia and Merseyside had similar experiences in responding to COVID-19, despite significant differences in health systems context, and there is an opportunity for multidirectional learning between the global south and north. The need for early preparedness; strong community engagement; clear communication within the health system and health service delivery adaptations for essential health services emerged strongly in both settings. We found the Foreign, Commonwealth and Development Office (FCDO) principles to have value as a framework for reviewing health systems changes, across settings, in response to a shock such as a pandemic. In addition to the eight original principles, we expanded to include two additional principles: (1) the need for functional structures and mechanisms for preparation and (2) adaptable governance and leadership structures to facilitate timely decision making and response coordination. We find the use of a people-centred approach also has value to prompt policy-makers to consider the acceptance of service adaptations by patients and health workers, and to continue the provision of 'routine services' for individuals during health systems shocks. CONCLUSION Our study highlights the importance of a people-centred approach, placing the person at the centre of the health system, and value in applying and adapting the FCDO principles across diverse settings.
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Affiliation(s)
- Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victoria Watson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucy Frith
- Centre for Social Ethics & Policy, School of Law, The University of Manchester, Manchester, UK
| | - Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Monrovia, Liberia
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Imelda Bates
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Rebecca Harris
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hannah Berrian
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - John Solunta Smith
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Wede Seekey Tate
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Taghreed El Hajj
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olivia Hastie
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Colleen Parker
- Department of Planning, Policy and M&E, Ministry of Health, Monrovia, Liberia
| | - Jerry Kollie
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia, Liberia
| | - Yan Ding
- Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Institute, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Juárez-Ramírez C, Reyes-Morales H, Gutiérrez-Alba G, Reartes-Peñafiel DL, Flores-Hernández S, Muños-Hernández JA, Escalante-Castañón A, Malo M. Local Health Systems Resilience in Managing the COVID-19 Pandemic: Lessons from Mexico. Health Policy Plan 2022; 37:1278-1294. [PMID: 35799347 PMCID: PMC9278258 DOI: 10.1093/heapol/czac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
The concept of resilience was applied to the public health field to investigate the way health systems are impacted by health crises, what conditions allow them to mitigate the blow, and how they reorganize once the crisis is over. In 2020, the COVID-19 pandemic caused by the SARS-CoV-2 virus represented a global challenge demanding immediate response to an unprecedented health crisis. Various voices drew attention to the intensity of the crisis in countries with greater inequalities, where the pandemic converged with other social emergencies. We documented the experiences of health personnel who faced the pandemic at the primary care level while simultaneously maintaining the functioning of other areas of medical care. Our results derived from a qualitative study comprising 103 participants from five states of Mexico. We aimed to show through inferential analysis their perspective on what we call “the resilience of local health systems.” We observed three stages of experience during the crisis: (a) Preparation (official guidelines received to organize care, training, and planning of epidemiological surveillance); (b) Adaptation (performance of community-based prevention activities, infrastructure modifications, telehealth); (c) Learning (participatory governance with city councils, business sector, and organized population). The study suggests that the local health systems analyzed benefited from the initiatives of health personnel that in some cases positively exceeded their duties. In terms of the resilience analysis, they were able to handle the impact of the crisis and cope with it. Their transformative capacity came from the strategies implemented to adapt health services by managing institutional resources. Their experience represents a lesson on the strengthening of the essential functions of health systems and shows a way to address successfully the increasingly complex health challenges of the present and future times.
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Affiliation(s)
- Clara Juárez-Ramírez
- Center for Health Systems Research, National Institute of Public Health, 7a privada de Fray Pedro de Gante, Sección XVI, Tlalpan 14000, CDMX, México
| | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Mor. CP 62100
| | - Gaudencio Gutiérrez-Alba
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Luis Castelazo Ayala s/n, Col. Industrial Animas, C.P.91190, Xalapa, Veracruz, México
| | | | - Sergio Flores-Hernández
- Dirección de Estadística CIEE. Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 62100, México
| | - José Alberto Muños-Hernández
- Instituto de Ciencias de la Salud, Universidad Veracruzana, Luis Castelazo Ayala s/n, Col. Industrial Animas, C.P. 91190, Xalapa, Veracruz, México
| | - André Escalante-Castañón
- Independent Consultor, Av. Venustiano Carranza 1115, C.P. 78230, Tequisquiapan, San Luis Potosí, México
| | - Miguel Malo
- Pan American Health Organization, Montes Urales 440, Lomas Virreyes. C.P. 11000, Ciudad de México, México
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Grimm PY, Wyss K. What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs. Global Health 2022; 18:55. [PMID: 35619166 PMCID: PMC9134130 DOI: 10.1186/s12992-022-00848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. The experiences and perspectives of Swiss NGOs in this article highlight the vital role NGOs may play in building resilient health systems in their partner countries. Specifically, strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and bear the responsibility to support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience. Resilience building will not only prepare countries for future shocks but bridge the disparate health and development agenda in order to better address the nexus between humanitarian aid and development cooperation. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00848-y.
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Affiliation(s)
- Pauline Yongeun Grimm
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Ismail SA, Bell S, Chalabi Z, Fouad FM, Mechler R, Tomoaia-Cotisel A, Blanchet K, Borghi J. Conceptualising and assessing health system resilience to shocks: a cross-disciplinary view. Wellcome Open Res 2022; 7:151. [PMID: 38826487 PMCID: PMC11140310 DOI: 10.12688/wellcomeopenres.17834.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 06/04/2024] Open
Abstract
Health systems worldwide face major challenges in anticipating, planning for and responding to shocks from infectious disease epidemics, armed conflict, climatic and other crises. Although the literature on health system resilience has grown substantially in recent years, major uncertainties remain concerning approaches to resilience conceptualisation and measurement. This narrative review revisits literatures from a range of fields outside health to identify lessons relevant to health systems. Four key insights emerge. Firstly, shocks can only be understood by clarifying how, where and over what timescale they interact with a system of interest, and the dynamic effects they produce within it. Shock effects are contingent on historical path-dependencies, and on the presence of factors or system pathways (e.g. financing models, health workforce capabilities or supply chain designs) that may amplify or dampen impact in unexpected ways. Secondly, shocks often produce cascading effects across multiple scales, whereas the focus of much of the health resilience literature has been on macro-level, national systems. In reality, health systems bring together interconnected sub-systems across sectors and geographies, with different components, behaviours and sometimes even objectives - all influencing how a system responds to a shock. Thirdly, transformability is an integral feature of resilient social systems: cross-scale interactions help explain how systems can show both resilience and transformational capability at the same time. We illustrate these first three findings by extending the socioecological concept of adaptive cycles in social systems to health, using the example of maternal and child health service delivery. Finally, we argue that dynamic modelling approaches, under-utilised in research on health system resilience to date, have significant promise for identification of shock-moderating or shock-amplifying pathways, for understanding effects at multiple levels and ultimately for building resilience.
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Affiliation(s)
- Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Sadie Bell
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Zaid Chalabi
- Institute for Environmental Design and Engineering, University College London, London, WC1E 6BT, UK
| | - Fouad M. Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Reinhard Mechler
- Advanced Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg, A-2361, Austria
| | - Andrada Tomoaia-Cotisel
- RAND Corporation, Santa Monica, 90401-3208, USA
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, 1211, Switzerland
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
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Chapman E, Illanes E, Reveiz L, Saenz C. Mapeo de protocolos de investigación, publicaciones y colaboraciones sobre la COVID-19 en América Latina y el Caribe. Rev Panam Salud Publica 2022; 46:e42. [PMID: 35520021 PMCID: PMC9065933 DOI: 10.26633/rpsp.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Objetivo. Mapear protocolos de investigación, publicaciones y colaboraciones sobre la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) desarrollados en América Latina y el Caribe (ALC). Métodos. Se incluyeron protocolos registrados en plataformas internacionales y publicaciones de investigaciones que consideraron población, datos y autores de ALC. La fuente de información para los protocolos fue principalmente la Plataforma Internacional de Registro de Ensayos Clínicos (ICTRP, por su sigla en inglés) de la Organización Mundial de la Salud; para las publicaciones se utilizaron bases electrónicas y repositorios específicos sobre la COVID-19. Se realizaron búsquedas de las publicaciones hasta el 11 de noviembre y de los protocolos hasta el día 30 de noviembre de 2020, inclusive. La información de los protocolos se extrajo según variables estandarizadas de la plataforma ICTRP y la de las publicaciones, según criterios preestablecidos. Resultados. De los protocolos, 63,0% fueron estudios sobre terapias, 10% de prevención y 45% fueron colaborativos. Con respecto al financiamiento, 64% de los protocolos no provino de la industria. En cuanto a las publicaciones, 23% fueron sin revisión de pares y 23% fueron colaborativas. Los diseños más frecuentes fueron las revisiones sistemáticas y estudios de corte transversal; 47,1% fueron realizados en servicios de salud y 22% en el ámbito comunitario; 38,0% se enfocaron en el diagnóstico y 27,9% en el pronóstico. Se realizó una síntesis cualitativa según la línea de cuidado y las estrategias de abordaje. Conclusiones. Se observó un aumento del número de investigaciones colaborativas en comparación con estudios anteriores y de protocolos no financiados por la industria. La agenda de investigación propuesta se cubrió en gran parte conforme al avance de la pandemia.
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Affiliation(s)
| | | | - Ludovic Reveiz
- Organización Panamericana de la Salud. Washington, D.C., Estados Unidos de
| | - Carla Saenz
- Organización Panamericana de la Salud. Washington, D.C., Estados Unidos de
- Carla Saenz,
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Clech L, Meister S, Belloiseau M, Benmarhnia T, Bonnet E, Casseus A, Cloos P, Dagenais C, De Allegri M, du Loû AD, Franceschin L, Goudet JM, Henrys D, Mathon D, Matin M, Queuille L, Sarker M, Turenne CP, Ridde V. Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol. BMC Health Serv Res 2022; 22:340. [PMID: 35291985 PMCID: PMC8921708 DOI: 10.1186/s12913-021-07294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. Methods The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. Discussion This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07294-3.
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Affiliation(s)
- Lucie Clech
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.
| | - Sofia Meister
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Maeva Belloiseau
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health & Scripps Institution of Oceanography University of California, San Diego, CA, USA
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, 5, cours des Humanités, Cedex, F-93 322, Aubervilliers, France
| | - Alain Casseus
- Zanmi Lasante, Cange, Haiti.,École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti
| | - Patrick Cloos
- Département de médecine sociale et préventive, École de santé publique, École de travail social, Centre de recherche en santé publique (CRESP), Université de Montréal, Québec, Canada
| | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Annabel Desgrées du Loû
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.,fellow of the French Collaborative Insitute on Migration, Paris, France
| | - Lucas Franceschin
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Jean-Marc Goudet
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Daniel Henrys
- École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti
| | - Dominique Mathon
- École supérieure d'infotronique d'Haïti, Port-au-Prince, Haiti.,Université du Québec, Montréal, Québec, Canada
| | - Mowtushi Matin
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Malabika Sarker
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, University of Heidelberg, Heidelberg, Germany.,BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Charlotte Paillard Turenne
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France
| | - Valéry Ridde
- Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.,fellow of the French Collaborative Insitute on Migration, Paris, France
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Hanson C, Luedtke S, Spicer N, Stilhoff Sörensen J, Mayhew S, Mounier-Jack S. National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020. BMJ Glob Health 2021; 6:bmjgh-2021-006691. [PMID: 34872972 PMCID: PMC8764706 DOI: 10.1136/bmjgh-2021-006691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 response of Germany, Sweden and the UK in 2020. We mapped legitimacy, interdependence, knowledge generation and the capacity to deal with uncertainty. Our analysis revealed stark differences which were linked to pre-existing governing structures, the traditional role of academia, experience of crisis management and the communication of uncertainty—all of which impacted on how much people trusted their government. Germany leveraged diversity and inclusiveness, a ‘patchwork quilt’, for which it was heavily criticised during the second wave. The Swedish approach avoided plurality and largely excluded academia, while in the UK’s academia played an important role in knowledge generation and in forcing the government to review its strategies. However, the vivant debate left the public with confusing and rapidly changing public health messages. Uncertainty and the lack of evidence on how best to manage the COVID-19 pandemic—the main feature during the first wave—was only communicated explicitly in Germany. All country governments lost trust of their populations during the epidemic due to a mix of communication and transparency failures, and increased questioning of government legitimacy and technical capacity by the public.
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Affiliation(s)
- Claudia Hanson
- Global Public Health, Karolinska Institutet, Stockholm, Sweden .,Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Susanne Luedtke
- Institute for risk and disaster reduction, University College London, London, UK.,Gesundheitsamt Nuremberg, Nuremberg, Germany
| | - Neil Spicer
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Susannah Mayhew
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sandra Mounier-Jack
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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