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Whiffin CJ, Smith BG, Esene IN, Karekezi C, Bashford T, Mukhtar Khan M, Hutchinson PJ, Kolias AG, Fontoura Solla DJ, Paiva WS, Figaji A. Neurosurgeons' experiences of conducting and disseminating clinical research in low-income and middle-income countries: a reflexive thematic analysis. BMJ Open 2021; 11:e051806. [PMID: 34551952 PMCID: PMC8461280 DOI: 10.1136/bmjopen-2021-051806] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Low-income and-middle-income countries (LMICs) are increasing investment in research and development, yet there remains a paucity of neurotrauma research published by those in LMICs. The aim of this study was to understand neurosurgeons' experiences of, aspirations for, and ability to conduct and disseminate clinical research in LMICs. DESIGN This was a two-stage inductive qualitative study situated within the naturalistic paradigm. This study committed to an interpretivist way of knowing (epistemology), and considered reality subjective and multiple (ontology). Data collection used online methods and included a web-based survey tool for demographic data, an asynchronous online focus group and follow-up semistructured interviews. Data were analysed using Braun and Clarke's Reflexive Thematic Analysis supported by NVivo V.12. SETTING LMICs. PARTICIPANTS In April-July 2020, 26 neurosurgeons from 11 LMICs participated in this study (n=24 in the focus groups, n=20 in follow-up interviews). RESULTS The analysis gave rise to five themes: The local landscape; creating capacity; reach and impact; collaborative inquiry; growth and sustainability. Each theme contained an inhibitor and stimulus to neurosurgeons conducting and disseminating clinical research, interpreted as 'the neurosurgical research potential in LMICs'. Mentorship, education, infrastructure, impact and engagement were identified as specific accelerators. Whereas lack of generalisability, absence of dissemination and dissemination without peer review may desensitise the impact of research conducted by neurosurgeons. CONCLUSION The geographical, political and population complexities make research endeavour challenging for neurosurgeons in LMICs. Yet in spite of, and because of, these complexities LMICs provide rich opportunities to advance global neurosurgery. More studies are required to evaluate the specific effects of accelerators of research conducted by neurosurgeons and to understand the effects of desensitisers on high-quality, high-impact clinical research.
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Affiliation(s)
- Charlotte Jane Whiffin
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- College of Health Psychology and Social Care, University of Derby, Derby, UK
| | - Brandon George Smith
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ignatius N Esene
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, NW Region, Cameroon
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Kigali City, Rwanda
- Young Neurosurgeons Committee, World Federation of Neurosurgical Societies, Nyon, Switzerland
| | - Tom Bashford
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Muhammad Mukhtar Khan
- Young Neurosurgeons Committee, World Federation of Neurosurgical Societies, Nyon, Switzerland
- Neurosurgery, Northwest School of Medicine, Northwest General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Peter John Hutchinson
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Angelos G Kolias
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | | | - Wellingson S Paiva
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Department of Neurology, Division of Neurosurgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Anthony Figaji
- University of Cambridge, NIHR Global Health Research Group on Neurotrauma, Cambridge, UK
- Division of Neurosurgery, Red Cross Children's Hospital & University of Cape Town, Cape Town, South Africa
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Walsh CM, Mwase T, De Allegri M. How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II. Int J Health Plann Manage 2020; 35:1571-1592. [PMID: 33030271 DOI: 10.1002/hpm.3055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022] Open
Abstract
Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.
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Affiliation(s)
- Caitlin M Walsh
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Takondwa Mwase
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Manuela De Allegri
- Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany
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Merry L, Turcotte-Tremblay AM, Alam N, D’souza N, Fillion M, Fregonese F, Gautier L, Kadio K. The Global Health Research Capacity Strengthening (GHR-CAPS) Program: trainees’ experiences and perspectives. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Dorjbal D, Zanini C, Tsegmid N, Stucki G, Rubinelli S. Toward an optimization of rehabilitation services for persons with spinal cord injury in Mongolia: the perspective of medical doctors. Disabil Rehabil 2019; 43:2200-2212. [PMID: 31790290 DOI: 10.1080/09638288.2019.1696415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To explore medical doctors' views on what are barriers in providing rehabilitation services for persons with SCI in Mongolia. METHODS A qualitative study with semi-structured interviews was conducted with 12 medical doctors. Participants were purposely sampled. The World Health Organization (WHO)'s report International Perspectives on Spinal Cord Injury was chosen as a guide to structure the interviews. The study used inductive thematic analysis. RESULTS Five barriers in the provision of rehabilitation services were identified: low awareness and limited knowledge regarding SCI and rehabilitation issues, inadequate rehabilitation policies, deficiencies in infrastructure, deficiencies in equipment and medication, and a shortage of well-prepared rehabilitation workforce. CONCLUSIONS Based on WHO recommendations "Rehabilitation in health systems", this study provides suggestions on how to strengthen rehabilitation services in Mongolia to better respond to the needs of the SCI population. Our findings highlight that a core issue is the lack of awareness among policymakers regarding rehabilitation and its benefits at the micro, meso and macro levels of the health system. Actions are needed at the level of health policies to ensure, for instance, adequate financing and access to the services. Also, synergies between the Ministries of Education and Health can improve the training of the workforce.Implications for rehabilitationEvidence that rehabilitation services contribute to improving health outcomes and cost-effectiveness could raise awareness among Mongolian policymakers and inform their decisions on funding schemes.Health policies in Mongolia should be reformed to remove barriers in the provision of rehabilitation services for persons with complex and chronic health conditions.Rehabilitation services need to be included into the Mongolian health insurance scheme in order to improve the quality and accessibility of rehabilitation services.Synergies between the Ministry of Education and the Ministry of Health in Mongolia are needed to develop training standards for rehabilitation professionals.
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Affiliation(s)
- Delgerjargal Dorjbal
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Claudia Zanini
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Narantsetseg Tsegmid
- Department of Rehabilitation Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Sriram V, George A, Baru R, Bennett S. Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India. Int J Equity Health 2018; 17:142. [PMID: 30244680 PMCID: PMC6151935 DOI: 10.1186/s12939-018-0824-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India. METHODS This analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6). RESULTS From the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care. CONCLUSIONS This analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India.
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Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, MC 1005, Suite M200, Chicago, IL USA
| | - Asha George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
| | - Rama Baru
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Mehrauli Road, Munirka, New Delhi, 110067 India
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
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Méndez CA. Global health politics: neither solidarity nor policy: Comment on "Globalization and the diffusion of ideas: why we should acknowledge the roots of mainstream ideas in global health". Int J Health Policy Manag 2014; 3:103-5. [PMID: 25114949 DOI: 10.15171/ijhpm.2014.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/22/2014] [Indexed: 11/09/2022] Open
Abstract
The global health agenda has been dominating the current global health policy debate. Furthermore, it has compelled countries to embrace strategies for tackling health inequalities in a wide range of public health areas. The article by Robert and colleagues highlights that although globalization has increased opportunities to share and spread ideas, there is still great asymmetry of power according to the countries' economic and political development. It also emphasizes how policy diffusion from High Income Countries (HICs) to Low- and Middle-Income Countries (LMICs) have had flaws at understanding their political, economic, and cultural backgrounds while they are pursuing knowledge translation. Achieving a fair global health policy diffusion of ideas would imply a call for a renewal on political elites worldwide at coping global health politics. Accordingly, moving towards fairness in disseminating global health ideas should be driven by politics not only as one of the social determinants of health, but the main determinant of health and well-being among-and within-societies.
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Affiliation(s)
- Claudio A Méndez
- Instituto de Salud Pública, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile. ; Programa de Salud Global, Instituto de Salud Poblacional, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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