1
|
Lai Y, Liang D, Bobogare A, Yadamsuren B, Yam E, Yi S, Bugoro H, Huang J. Synergising universal health coverage and global health security in the Western Pacific Region. J Glob Health 2025; 15:04037. [PMID: 39946553 PMCID: PMC11827627 DOI: 10.7189/jogh.15.04037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2025] Open
Abstract
Background Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy. Methods We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence. Results Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs. Conclusions The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.
Collapse
Affiliation(s)
- Yuhua Lai
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Di Liang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| | - Albino Bobogare
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | | | - Esabelle Yam
- College of Health and Medicine, Australian National University, Canberra, Australia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- KHANA Centre for Population Health Research, Phnom Penh, Cambodia
- Centre for Global Health Research, Public Health Program, Touro University California, Vallejo, California, USA
| | - Hugo Bugoro
- Solomon Islands National University, Solomon Islands
| | - Jiayan Huang
- School of Public Health, Global Health Institute, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Ssegujja E, Andipatin M. Translating lessons to reinforce national stillbirth response; multi-stakeholder perspectives regarding priorities and opportunities to deliver quality evidence-based interventions within a limited-resource context in Uganda. BMC Health Serv Res 2024; 24:715. [PMID: 38858756 PMCID: PMC11165756 DOI: 10.1186/s12913-024-11180-z] [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: 11/02/2023] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND There is noted increase in attention towards implementation of evidence-based interventions in response to the stillbirth burden in low- and middle-income countries including Uganda. Recent results reporting some of the strategies adopted have tended to focus much attention towards their overall effect on the stillbirth burden. More is needed regarding stakeholder reflections on priorities and opportunities for delivering quality services within a limited resource setting like Uganda. This paper bridges this knowledge gap. METHODS Data collection occurred between March and June 2019 at the national level. Qualitative interviews were analysed using a thematic analysis technique. RESULTS Identified priorities included; a focus on supportive functions such as the referral system, attention to the demand side component of maternal health services, and improvements in the support supervision particularly focusing on empowering subnational level actors. The need to strengthen the learning for better implementation of strategies which are compatible with context was also reported. A comprehensive and favourable policy environment with the potential to direct implementation of strategies, harnessing the private sector contribution as well as the role of national level champions and patient advocates to amplify national stillbirth reduction efforts for continued visibility and impact were recommended. CONCLUSION Great potential exists within the current strategies to address the national stillbirth burden. However, priorities such as improving the supportive functions of MCH service delivery and attention to the demand side need to be pursued more for better service delivery with opportunities including a favourable policy environment primed to better serve the current strategies. This calls for dedicated efforts targeted at addressing gaps within the existing priorities and opportunities for better delivery of national strategies to address the stillbirth burden in Uganda.
Collapse
Affiliation(s)
- Eric Ssegujja
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7076, Kampala, Uganda.
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Republic of South Africa.
| | - Michelle Andipatin
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
3
|
Kamara ABS, Fatoma P, Moseray A. The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone. Risk Manag Healthc Policy 2024; 17:1127-1149. [PMID: 38737418 PMCID: PMC11088388 DOI: 10.2147/rmhp.s455254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Background Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality. Methods A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact. Results The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever. Conclusion Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.
Collapse
Affiliation(s)
- Abu-Bakarr Steven Kamara
- Department of Public Health, School of Community Health Sciences, Njala University Bo Campus, Bo City, Sierra Leone
| | - Patrick Fatoma
- Department of Public Health, School of Community Health Sciences, Njala University Bo Campus, Bo City, Sierra Leone
| | - Andrew Moseray
- Department of Public Health, School of Community Health Sciences, Njala University Bo Campus, Bo City, Sierra Leone
| |
Collapse
|
4
|
Mahmoodi H, Bolbanabad AM, Shaghaghi A, Zokaie M, Gheshlagh RG, Afkhamzadeh A. Barriers to implementing health programs based on community participation: the Q method derived perspectives of healthcare professional. BMC Public Health 2023; 23:2019. [PMID: 37848872 PMCID: PMC10580595 DOI: 10.1186/s12889-023-16961-5] [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: 02/12/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Community participation in implementing health programs leads to positive organizational, social and individual consequences. This study aimed to investigate the prospects of a sample of Iranian healthcare professionals about their perceived barriers to implementing health programs based on community participation. METHODS This was a cross-sectional study that employed a Q-methodology approach. Twenty health professional sorted the 47 statements into a 9-column Q-sort diagram ranging from - 4 as not important to + 4 as very important. The data were analyzed with PQMethod 2.35 software. The centroid factor analysis and varimax rotation were used for data analysis. Factors identified were interpreted and described in terms of the participants perspectives on the phenomenon. RESULTS Analysis of the study participants' viewpoints (the Q-sorts) resulted in a five factor solution (accounted for 57% of the total variance) to endorse the main barriers to the implementation of health programs based on community participation in Iran. Barriers related to government, health programs, lack of necessary skills amongst health professionals and weak coordination between departments, barriers related to community, lack of understanding of goals, benefits and transparency of roles and responsibilities were among the important emanated factors to implementing health programs based community participation. CONCLUSION Health policymakers and managers should consider the five mentioned identified barriers based on the community when planning and implementing the health program participation and try to empower the community to implement the programs in Iran.
Collapse
Affiliation(s)
- Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Vice Chancellor for Health Affairs, Health Education and Promotion Group, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Abdolreza Shaghaghi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Zokaie
- Department of Vice Chancellor for Health Affairs, Population, Family and School Health Group, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Ghanei Gheshlagh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abdorrahim Afkhamzadeh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
5
|
van Niekerk L, Fosiko N, Likaka A, Blauveldt CP, Msiska B, Manderson L. From idea to systems solution: enhancing access to primary care in Malawi. BMC Health Serv Res 2023; 23:547. [PMID: 37231399 DOI: 10.1186/s12913-023-09349-z] [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: 08/04/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
Malawi, like many other countries, faces challenges in providing accessible, affordable, and quality health services to all people. The Malawian policy framework recognizes the value of communities and citizens, as co-creators of health and leaders of localized and innovative initiatives, such as social innovations.Social innovations involve and include communities and citizens, as well as bring about changes in the institutions responsible for care delivery. In this article, we describe the institutionalization process of a citizen-initiated primary care social innovation, named Chipatala Cha Pa Foni, focused on extending access to health information and appropriate service-seeking behavior.An interdisciplinary multi-method qualitative case study design was adopted, drawing on data collected from key informant interviews, observations, and documents over an 18-month period. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis. Institutional-level changes were analyzed in five key dimensions as well as the role of actors, operating as institutional entrepreneurs, in this process.A subset of actors matched the definition of operating as Institutional Entrepreneurs. They worked in close collaboration to bring about changes in five institutional dimensions: roles, resource flows, authority flows, social identities and meanings. We highlight the changing role of nurses; redistribution and decentralization of health information; shared decision-making, and greater integration of different technical service areas.From this study, the social innovation brought about key institutional and socio-cultural changes in the Malawi health system. These changes supported strengthening the system's integrity for achieving Universal Health Coverage by unlocking and cultivating dormant human-based resources. As a fully institutionalized social innovation, Chipatala Cha Pa Foni has enhanced access to primary care and especially as part of the Covid-19 response.
Collapse
Affiliation(s)
- L van Niekerk
- London School of Hygiene and Tropical Medicine, London, UK.
- Chembe Collaborative, Los Angeles, USA.
| | - N Fosiko
- The Malawi Ministry of Health, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - A Likaka
- The Malawi Ministry of Health, Lilongwe, Malawi
| | | | - B Msiska
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - L Manderson
- University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Kiendrébéogo JA, Thoumi A, Mangam K, Touré C, Mbaye S, Odero P, Owino E, Jones C, Kiwanuka GS, Audi Z, Bloom D, Kinter A, Gamble Kelley A. Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda. BMJ Glob Health 2021; 6:bmjgh-2020-004273. [PMID: 33608321 PMCID: PMC7898844 DOI: 10.1136/bmjgh-2020-004273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/10/2022] Open
Abstract
Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project. The ACS project stems from the premise that the global health community can more effectively support UHC processes in countries if development partners change three long-standing paradigms: (1) time-limited projects to enhancing long-lasting processes, (2) fly-in/fly-out development support to leveraging and strengthening local and regional expertise and (3) static knowledge creation to supporting practical and co-developed resources that enhance learning and capture implementation experience. We assume that development partners can facilitate progress towards UHC if interventions follow five action steps, including (1) align to country demand, (2) provide evidence-based and tailored health financing technical support, (3) respond to knowledge and learnings throughout activity design and implementation, (4) foster multi-stakeholder collaboration and ownership and (5) strengthen accountability mechanisms. Since 2017, the ACS project has applied these five action steps in its implementing countries, including Benin, Namibia and Uganda. This article shares with the global health community preliminary achievements of implementing a unique, challenging but promising experience.
Collapse
Affiliation(s)
- Joël Arthur Kiendrébéogo
- Public Health, University of Ouagadougou Health Sciences Training and Research Unit, Ouagadougou, Kadiogo, Burkina Faso
| | - Andrea Thoumi
- Duke-Margolis Center for Health Policy, Duke University, Washington DC, North Carolina, USA
| | - Keith Mangam
- Results for Development Institute, Washington DC, North Carolina, USA
| | - Cheickna Touré
- Results for Development Institute, Washington DC, North Carolina, USA
| | - Seyni Mbaye
- Results for Development Institute, Washington DC, North Carolina, USA
| | - Patricia Odero
- Global Health Innovation Center, Duke University, Durham, North Carolina, USA
| | - Edward Owino
- Results for Development Institute, Washington DC, North Carolina, USA
| | | | | | - Zilper Audi
- Global Health Innovation Center, Duke University, Durham, North Carolina, USA.,Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Danielle Bloom
- Results for Development Institute, Washington DC, North Carolina, USA
| | - Amelia Kinter
- Results for Development Institute, Washington DC, North Carolina, USA
| | | |
Collapse
|
7
|
May SY, Clara N, Khin OK, Mar WW, Han AN, Maw SS. Challenges faced by community health nurses to achieve universal health coverage in Myanmar: A mixed methods study. Int J Nurs Sci 2021; 8:271-278. [PMID: 34307775 PMCID: PMC8283707 DOI: 10.1016/j.ijnss.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to identify the challenges of community health nurses (CHNs) in delivering effective community health care to achieve universal health coverage (UHC) in Myanmar. Methods A total of 30 CHNs from township health centers in the northeastern, southern, and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews. Quantitative data were processed using Microsoft Excel software, and qualitative data were analyzed using thematic analysis. This study is registered with researchregistry6201. Results Around the country, 30 CHNs uncovered their hardships in implementing primary health care to achieve UHC. Over 90% of the participants agreed to the problem of inadequate health infrastructure, while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion. Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services. Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidence-based practices. Insecure work and living conditions, unsupportive community relationships, and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC. Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs. Conclusion Myanmar's CHNs face many challenges in achieving UHC. These challenges are not confined to the health sector. Some situations, such as geographical barriers and transportation problems, remain persistent challenges for healthcare providers. This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure. Meanwhile, public empowerment plays a critical role in promoting health development.
Collapse
|
8
|
Otu A, Effa E, Umoh V, Maxwell N, Ekpenyong A. Private sector initiatives to tackle the burden of COVID-19: experiences from the Nigerian frontline. Pan Afr Med J 2021; 38:233. [PMID: 34046138 PMCID: PMC8140726 DOI: 10.11604/pamj.2021.38.233.24634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 02/05/2021] [Indexed: 11/16/2022] Open
Abstract
Across Africa, there is some evidence of COVID-19 private sector activities to tackle COVID-19 which include the development of rapid diagnostic kits, deployment of e-health platforms for bespoke health workforce training, disease surveillance, reporting, auto-screening and advisories. Inequities in living and access to care by disadvantaged populations in the rural areas have been ameliorated by multi-pronged responses such as that mounted by the Joseph Ukpo Hospitals and Research Institute (JUHRI) in Nigeria. The provision, production and donation of personal protective equipment (PPE), the production of hand sanitizers and the engagement of the local community in the process represents an effective strategy to contain COVID-19, protect health workers and provide pathways for economic support for people whose sources of income have been upended during the pandemic. The JUHRI experience underpinned by Catholic medical ethics provides concrete evidence of the value of private sector participation in dealing with public health emergencies.
Collapse
Affiliation(s)
- Akaninyene Otu
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.,Joseph Ukpo Hospitals and Research Institutes (JUHRI), Afua Site, Ibiono Ibom, Nigeria.,Foundation for Healthcare Innovation and Development (FHIND), Cross River State, Nigeria.,Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Emmanuel Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria.,Joseph Ukpo Hospitals and Research Institutes (JUHRI), Afua Site, Ibiono Ibom, Nigeria.,Foundation for Healthcare Innovation and Development (FHIND), Cross River State, Nigeria
| | - Victor Umoh
- Joseph Ukpo Hospitals and Research Institutes (JUHRI), Afua Site, Ibiono Ibom, Nigeria.,Foundation for Healthcare Innovation and Development (FHIND), Cross River State, Nigeria.,Department of Internal Medicine, Faculty of Medicine, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Nicholas Maxwell
- Joseph Ukpo Hospitals and Research Institutes (JUHRI), Afua Site, Ibiono Ibom, Nigeria.,University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Andrew Ekpenyong
- Joseph Ukpo Hospitals and Research Institutes (JUHRI), Afua Site, Ibiono Ibom, Nigeria.,Department of Physics, Creighton University, NE, 68178, Nebraska, United States of America
| |
Collapse
|
9
|
Olu O, Drameh-Avognon P, Asamoah-Odei E, Kasolo F, Valdez T, Kabaniha G, Karamagi H, Good S, O'Malley H, Yoti Z, Razakazoa N, Minkoulou E, Dangou JM, Mbassi SM, Castellon MS, Cabore J, Moeti M. Correction to: Community participation and private sector engagement are fundamental to achieving universal health coverage and health security in Africa: reflections from the second Africa health forum. BMC Proc 2019; 13:11. [PMID: 31827602 PMCID: PMC6889179 DOI: 10.1186/s12919-019-0182-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Olushayo Olu
- WHO Country Office, Juba, Republic of South Sudan
| | | | - Emil Asamoah-Odei
- 3Consultant, Regional Director's Office, WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Francis Kasolo
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Grace Kabaniha
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Suvajee Good
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Helena O'Malley
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Zabulon Yoti
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Nirina Razakazoa
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | | | | | | | - Joseph Cabore
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Matshidiso Moeti
- 2WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| |
Collapse
|