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Wilf-Miron R, Avni S, Valinsky L, Myers V, Ziv A, Peretz G, Luxenburg O, Saban M, Feder-Bubis P. Developing a National Set of Health Equity Indicators Using a Consensus Building Process. Int J Health Policy Manag 2022; 11:1522-1532. [PMID: 34273926 PMCID: PMC9808363 DOI: 10.34172/ijhpm.2021.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators. METHODS The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors. RESULTS Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75. CONCLUSION A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.
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Affiliation(s)
- Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Avni
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Liora Valinsky
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Gidi Peretz
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences & Guildford Glazer Faculty of Business and management, Ben Gurion University of the Negev, Beersheba, Israel
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Phuong J, Riches NO, Madlock‐Brown C, Duran D, Calzoni L, Espinoza JC, Datta G, Kavuluru R, Weiskopf NG, Ward‐Caviness CK, Lin AY. Social Determinants of Health Factors for Gene-Environment COVID-19 Research: Challenges and Opportunities. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100056. [PMID: 35574521 PMCID: PMC9087427 DOI: 10.1002/ggn2.202100056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Indexed: 01/25/2023]
Abstract
The characteristics of a person's health status are often guided by how they live, grow, learn, their genetics, as well as their access to health care. Yet, all too often, studies examining the relationship between social determinants of health (behavioral, sociocultural, and physical environmental factors), the role of demographics, and health outcomes poorly represent these relationships, leading to misinterpretations, limited study reproducibility, and datasets with limited representativeness and secondary research use capacity. This is a profound hurdle in what questions can or cannot be rigorously studied about COVID-19. In practice, gene-environment interactions studies have paved the way for including these factors into research. Similarly, our understanding of social determinants of health continues to expand with diverse data collection modalities as health systems, patients, and community health engagement aim to fill the knowledge gaps toward promoting health and wellness. Here, a conceptual framework is proposed, adapted from the population health framework, socioecological model, and causal modeling in gene-environment interaction studies to integrate the core constructs from each domain with practical considerations needed for multidisciplinary science.
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Affiliation(s)
- Jimmy Phuong
- Division of Biomedical and Health InformaticsUniversity of WashingtonSeattleWA98195USA
- Harborview Injury Prevention Research CenterUniversity of WashingtonSeattleWA98104USA
| | - Naomi O. Riches
- Department of Biomedical InformaticsUniversity of Utah School of MedicineSalt Lake CityUT84108‐3514USA
| | - Charisse Madlock‐Brown
- Health Informatics and Information ManagementUniversity of Tennessee Health Science CenterMemphisTN38163USA
| | - Deborah Duran
- National Institute on Minority Health and Health Disparities (NIMHD)National Institutes of HealthBethesdaMD20892‐5465USA
| | - Luca Calzoni
- National Institute on Minority Health and Health Disparities (NIMHD)National Institutes of HealthBethesdaMD20892‐5465USA
- Department of Biomedical InformaticsUniversity of PittsburghPittsburghPA15206USA
| | - Juan C. Espinoza
- Department of PediatricsChildren's Hospital Los AngelesLos AngelesCA90015USA
| | - Gora Datta
- Department of Civil and Environmental EngineeringUniversity of California at BerkeleyBerkeleyCA94720USA
| | - Ramakanth Kavuluru
- Division of Biomedical InformaticsDepartment of Internal MedicineUniversity of KentuckyLexingtonKY40506USA
| | - Nicole G. Weiskopf
- Department of Medical Informatics & Clinical EpidemiologyOregon Health & Science UniversityPortlandOR97239USA
| | - Cavin K. Ward‐Caviness
- Center for Public Health and Environmental AssessmentUS Environmental Protection AgencyChapel HillNC27514USA
| | - Asiyah Yu Lin
- National Human Genome Research Institute (NHGRI)National Institutes of HealthBethesdaMD20892‐2152USA
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3
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Strengthening health policy development and management systems in low- and middle- income countries: South Africa's approach. HEALTH POLICY OPEN 2020. [DOI: 10.1016/j.hpopen.2020.100010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Mothupi MC, Knight L, Tabana H. Improving the validity, relevance and feasibility of the continuum of care framework for maternal health in South Africa: a thematic analysis of experts' perspectives. Health Res Policy Syst 2020; 18:28. [PMID: 32102672 PMCID: PMC7045428 DOI: 10.1186/s12961-020-0537-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The continuum of care is a key strategy for ensuring comprehensive service delivery for maternal health, while acknowledging the role of the social determinants of health. However, there is little research on the operationalisation of the framework by decision-makers and implementers to address maternal health challenges. The framework should be measurable and feasible for implementation in low- and middle-income country contexts. In this study, we explore experts' perspective on monitoring indicators for continuum of care and key issues related to their use in the South African context. METHODS We conducted key informant interviews with a range of experts in decision-making and programme implementation roles in the health system and relevant sectors. Key informants provided their perspectives on systematically selected, nationally representative monitoring indicators in terms of validity, relevance and feasibility. We interviewed 13 key informants and conducted a thematic analysis of their responses using multi-stage coding techniques in Atlas.ti 8.4. RESULTS Experts believed that the continuum of care framework and monitoring indicators offer a multisectoral perspective for maternal health intervention missing in current programmes. To improve validity of monitoring indicators, experts suggested reflection on the use of proxy indicators and improvement of data to allow for equity analysis. In terms of relevance and feasibility, experts believe there was potential to foster co-accountability using continuum of care indicators. However, as experts stated, new indicators should be integrated that directly measure intersectoral collaboration for maternal health. In addition, experts recommended that the framework and indicators should evolve over time to reflect evolving policy priorities and public health challenges. CONCLUSION Experts, as decision-makers and implementers, helped identify key issues in the application of the continuum of care framework and its indicators. The use of local indicators can bring the continuum of care framework from an under-utilised strategy to a useful tool for action and decision-making in maternal health. Our findings point to measurement issues and systematic changes needed to improve comprehensive monitoring of maternal health interventions in South Africa. Our methods can be applied to other low- and middle-income countries using the continuum of care framework and locally available indicators.
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Affiliation(s)
| | - Lucia Knight
- University of the Western Cape, School of Public Health, Cape Town, South Africa
| | - Hanani Tabana
- University of the Western Cape, School of Public Health, Cape Town, South Africa
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Stawicki S, Le N, Garg M, Izurieta R, Garg S, Papadimos T, Arquilla B, Miller A, Khan A, Worlton T, Firstenberg M, Galwankar S, Raina S, Anderson H, Jeanmonod R, Kaufmann K, Jeanmonod D, De Wulf A, McCallister D, Bloem C, Opara I, Martin N, Asensio J. What's new in Academic International Medicine? International health security agenda – Expanded and re-defined. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2020. [DOI: 10.4103/ijam.ijam_113_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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6
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Byskov J, Maluka S, Marchal B, Shayo EH, Blystad A, Bukachi S, Zulu JM, Michelo C, Hurtig AK, Bloch P. A systems perspective on the importance of global health strategy developments for accomplishing today's Sustainable Development Goals. Health Policy Plan 2019; 34:635-645. [PMID: 31363736 PMCID: PMC6880334 DOI: 10.1093/heapol/czz042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 12/01/2022] Open
Abstract
Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.
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Affiliation(s)
- Jens Byskov
- Research and Health Systems Advisor, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Stephen Maluka
- Institute of Development Studies, University of Dar Es Salaam, Tanzania
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, B Antwerpen, Belgium
| | - Elizabeth H Shayo
- National Institute for Medical Research (NIMR), Dar Es Salaam, Tanzania
| | - Astrid Blystad
- Department of Global Health and Primary Care, University of Bergen, Norway
| | - Salome Bukachi
- Institute of Anthropology, Gender and African Studies University of Nairobi, Nairobi, Kenya
| | - Joseph M Zulu
- School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, SE, Umea, Sweden
| | - Paul Bloch
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK Gentofte, Denmark
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Joarder T, Chaudhury TZ, Mannan I. Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions. PSYCHE; A JOURNAL OF ENTOMOLOGY 2019; 2019:4954095. [PMID: 33281233 PMCID: PMC7691757 DOI: 10.1155/2019/4954095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/20/2019] [Indexed: 12/17/2022]
Abstract
Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three sub districts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector's implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.
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Affiliation(s)
| | | | - Ishtiaq Mannan
- Bangladesh Country Office, Save the Children, Dhaka 1212, Bangladesh
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8
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Hosseinpoor AR, Bergen N, Schlotheuber A, Boerma T. National health inequality monitoring: current challenges and opportunities. Glob Health Action 2018; 11:1392216. [PMID: 29460696 PMCID: PMC5827767 DOI: 10.1080/16549716.2017.1392216] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities.
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Affiliation(s)
- Ahmad Reza Hosseinpoor
- a Department of Information, Evidence and Research , World Health Organization , Geneva , Switzerland
| | - Nicole Bergen
- b Faculty of Health Sciences , University of Ottawa , Ottawa , Canada
| | - Anne Schlotheuber
- a Department of Information, Evidence and Research , World Health Organization , Geneva , Switzerland
| | - Ties Boerma
- c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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9
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Knoblauch AM, Divall MJ, Owuor M, Musunka G, Pascall A, Nduna K, Ng'uni H, Utzinger J, Winkler MS. Selected indicators and determinants of women's health in the vicinity of a copper mine development in northwestern Zambia. BMC WOMENS HEALTH 2018; 18:62. [PMID: 29716578 PMCID: PMC5930803 DOI: 10.1186/s12905-018-0547-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/03/2018] [Indexed: 11/14/2022]
Abstract
Background Large projects in the extractive industry sector can affect people’s health and wellbeing. In low- and middle-income countries (LMICs), women’s health is of particular concern in such contexts due to potential educational and economic disadvantages, vulnerability to transactional sex and unsafe sex practices. At the same time, community health interventions and development initiatives present opportunities for women's and maternal health. Methods Within the frame of the health impact assessment (HIA) of the Trident copper mining project in Zambia, two health surveys were conducted (baseline in 2011 and follow-up in 2015) in order to monitor health and health-related indicators. Emphasis was placed on women residing in the mining area and, for comparison, in settings not impacted by the project. Results All measured indicators improved over time, regardless of whether communities were affected by the project or not. Additionally, the percentage of mothers giving birth in a health facility, the percentage of women who acknowledge that HIV cannot be transmitted by witchcraft or other supernatural means and the percentage of women having ever tested for HIV showed a significant increase in the impacted sites but not in the comparison communities. In 2015, better health, behavioural and knowledge outcomes in women were associated with employment by the project (or a sub-contractor thereof), migration background, increased wealth and higher educational attainment. Conclusions Our study reveals that natural resource development projects can positively impact women’s health, particularly if health risks are adequately anticipated and managed. Hence, the conduct of a comprehensive HIA should be a requirement at the feasibility stage of any large infrastructure project, particularly in LMICs. Continued monitoring of health outcomes and wider determinants of health after the initial assessment is crucial to judge the project’s influence on health and for reducing inequalities over time. Electronic supplementary material The online version of this article (10.1186/s12905-018-0547-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Astrid M Knoblauch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Mark J Divall
- SHAPE Consulting Ltd, St Peter Port, Guernsey, Channel Islands, Guernsey
| | - Milka Owuor
- SHAPE Consulting Ltd, St Peter Port, Guernsey, Channel Islands, Guernsey
| | | | | | - Kennedy Nduna
- Solwezi District Health Management Team, Solwezi, Zambia
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Mirko S Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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10
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Bossuyt P, Pouillon L, Bonnaud G, Danese S, Peyrin-Biroulet L. E-health in inflammatory bowel diseases: More challenges than opportunities? Dig Liver Dis 2017; 49:1320-1326. [PMID: 28899622 DOI: 10.1016/j.dld.2017.08.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 02/09/2023]
Abstract
Patients with inflammatory bowel disease need close monitoring for an optimal disease management. For this, e-health technologies are promising tools. But the current evidence for the implementation of e-health in inflammatory bowel disease is weak. For this a critical evaluation of the existing evidence is presented. Furthermore some essential conditions need to be full-filled. We need a robust digital infrastructure that is workable for the patient and the healthcare provider. Important legal issues need to be solved to protect the patient. And the e-health technologies will have to proof their durability, feasibility and acceptance for the patient on the long term.
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Affiliation(s)
- Peter Bossuyt
- Imelda GI clinical research centre, Imelda General Hospital Bonheiden, Bonheiden, Belgium.
| | - Lieven Pouillon
- Department of Hepato-Gastroenterology, University Hospitals Gasthuisberg Leuven, Leuven, Belgium
| | - Guillaume Bonnaud
- Department of Hepato-Gastroenterology, Ambroise Paré Clinic, Toulouse, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
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Nabyonga-Orem J, Tumusiime P, Nyoni J, Kwamie A. Harmonisation and standardisation of health sector and programme reviews and evaluations - how can they better inform health policy dialogue? Health Res Policy Syst 2016; 14:87. [PMID: 27986084 PMCID: PMC5162096 DOI: 10.1186/s12961-016-0161-9;14(87)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/01/2016] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Health sector and programme performance assessments provide a rich source of contextual data directly linked to implementation of programmes and can inform health policy dialogue, planning and resource allocation. In seeking to maximise this opportunity, there are challenges to overcome. A meeting convened by the World Health Organization African Region discussed the strengths, weaknesses and challenges to harmonising and standardising health sector and programme performance assessments, as well as use of evidence from such processes in decision making. This article synthesises the deliberations which emerged from the meeting. Discussing these in light of other literature we propose practical options to standardising health sector and programme performance assessment and improve realisation of using evidence in decision making. DISCUSSION Use of evidence generated from health sector and programme performance assessments into regular country processes of sectoral monitoring, dialogue and policy modification is crucial. However, this process faces several challenges. Identified challenges were categorised under several themes, namely the weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms; desynchronised planning timeframes between programme and overall health sector strategies; inadequate time to undertake comprehensive and good quality performance assessment; weak mechanisms for following up on implementation of recommendations; lack of effective stakeholder participation; and divergent political aspirations. CONCLUSION The question of what performance assessment is for in a country must be asked and answered clearly if the utility of these processes is to be realised. Standardising programme and sector reviews offers numerable opportunities that need to be maximised. Identified challenges need to be overcome through strengthened Ministry of Health leadership, effective stakeholder engagement and institutionalising follow-up mechanisms for agreed recommendations. In addition, health sector performance assessments need to be institutionalised as part of the accountability mechanism, and they must be planned for and funding secured within annual budget and medium term expenditure frameworks.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Health Systems and Services Cluster, Health Systems Governance, World Health Organization, Inter-Country Support Team for Eastern & Southern Africa, P.O. Box CY 348, Causeway, Harare, Zimbabwe
| | - Prosper Tumusiime
- Health Systems and Services cluster, World Health Organization Regional office for Africa, BP 06, Cite de Djoue, Brazzaville, Congo
| | - Jennifer Nyoni
- Health Systems and Services cluster, World Health Organization Regional office for Africa, BP 06, Cite de Djoue, Brazzaville, Congo
| | - Aku Kwamie
- Ghana Health Service, Research and Development Division, PMB M9, Ministries, Accra, Ghana
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12
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Nabyonga-Orem J, Tumusiime P, Nyoni J, Kwamie A. Harmonisation and standardisation of health sector and programme reviews and evaluations - how can they better inform health policy dialogue? Health Res Policy Syst 2016; 14:87. [PMID: 27986084 PMCID: PMC5162096 DOI: 10.1186/s12961-016-0161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health sector and programme performance assessments provide a rich source of contextual data directly linked to implementation of programmes and can inform health policy dialogue, planning and resource allocation. In seeking to maximise this opportunity, there are challenges to overcome. A meeting convened by the World Health Organization African Region discussed the strengths, weaknesses and challenges to harmonising and standardising health sector and programme performance assessments, as well as use of evidence from such processes in decision making. This article synthesises the deliberations which emerged from the meeting. Discussing these in light of other literature we propose practical options to standardising health sector and programme performance assessment and improve realisation of using evidence in decision making. DISCUSSION Use of evidence generated from health sector and programme performance assessments into regular country processes of sectoral monitoring, dialogue and policy modification is crucial. However, this process faces several challenges. Identified challenges were categorised under several themes, namely the weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms; desynchronised planning timeframes between programme and overall health sector strategies; inadequate time to undertake comprehensive and good quality performance assessment; weak mechanisms for following up on implementation of recommendations; lack of effective stakeholder participation; and divergent political aspirations. CONCLUSION The question of what performance assessment is for in a country must be asked and answered clearly if the utility of these processes is to be realised. Standardising programme and sector reviews offers numerable opportunities that need to be maximised. Identified challenges need to be overcome through strengthened Ministry of Health leadership, effective stakeholder engagement and institutionalising follow-up mechanisms for agreed recommendations. In addition, health sector performance assessments need to be institutionalised as part of the accountability mechanism, and they must be planned for and funding secured within annual budget and medium term expenditure frameworks.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Health Systems and Services Cluster, Health Systems Governance, World Health Organization, Inter-Country Support Team for Eastern & Southern Africa, P.O. Box CY 348, Causeway, Harare, Zimbabwe
| | - Prosper Tumusiime
- Health Systems and Services cluster, World Health Organization Regional office for Africa, BP 06, Cite de Djoue, Brazzaville, Congo
| | - Jennifer Nyoni
- Health Systems and Services cluster, World Health Organization Regional office for Africa, BP 06, Cite de Djoue, Brazzaville, Congo
| | - Aku Kwamie
- Ghana Health Service, Research and Development Division, PMB M9, Ministries, Accra, Ghana
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Valentine NB, Koller TS, Hosseinpoor AR. Monitoring health determinants with an equity focus: a key role in addressing social determinants, universal health coverage, and advancing the 2030 sustainable development agenda. Glob Health Action 2016; 9:34247. [PMID: 27989275 PMCID: PMC5165053 DOI: 10.3402/gha.v9.34247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Nicole B Valentine
- Department of Public Health, Environmental and Social Determinants of Health, WHO, Geneva;
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14
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Huda TM, Tahsina T, El Arifeen S, Dibley MJ. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh. Glob Health Action 2016; 9:29741. [PMID: 26880153 PMCID: PMC4754013 DOI: 10.3402/gha.v9.29741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. OBJECTIVES This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). DESIGN We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. RESULTS The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. CONCLUSION The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; ;
| | - Tazeen Tahsina
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Rasella D, Machado DB, Castellanos MEP, Paim J, Szwarcwald CL, Lima D, Magno L, Pedrana L, Medina MG, Penna GO, Barreto ML. Assessing the relevance of indicators in tracking social determinants and progress toward equitable population health in Brazil. Glob Health Action 2016; 9:29042. [PMID: 26853898 PMCID: PMC4744865 DOI: 10.3402/gha.v9.29042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The importance of the social determinants of health (SDH) and barriers to the access and utilization of healthcare have been widely recognized but not previously studied in the context of universal healthcare coverage (UHC) in Brazil and other developing countries. OBJECTIVE To evaluate a set of proposed indicators of SDH and barriers to the access and utilization of healthcare - proposed by the SDH unit of the World Health Organization - with respect to their relevance in tracking progress in moving toward equitable population health and UHC in Brazil. DESIGN This study had a mixed methodology, combining a quantitative analysis of secondary data from governmental sources with a qualitative study comprising two focus group discussions and six key informant interviews. The set of indicators tested covered a broad range of dimensions classified by three different domains: environment quality; accountability and inclusion; and livelihood and skills. Indicators were stratified according to income quintiles, urbanization, race, and geographical region. RESULTS Overall, the indicators were adequate for tracking progress in terms of the SDH, equity, gender, and human rights in Brazil. Stratifications showed inequalities. The qualitative analysis revealed that many of the indicators were well known and already used by policymakers and health sector managers, whereas others were considered less useful in the Brazilian context. CONCLUSIONS Monitoring and evaluation practices have been developed in Brazil, and the set of indicators assessed in this study could further improve these practices, especially from a health equity perspective. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in relation to addressing the SDH.
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Affiliation(s)
- Davide Rasella
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil;
- Fundação Oswaldo Cruz (Fiocruz), Brasilia, Brazil
| | | | | | - Jairnilson Paim
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | | | - Diana Lima
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Leo Pedrana
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | | | - Gerson Oliveira Penna
- Fundação Oswaldo Cruz (Fiocruz), Brasilia, Brazil
- Núcleo de Medicina Tropical, University of Brasilia, Brasilia, Brazil
| | - Mauricio Lima Barreto
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
- Centro de Pesquisas Gonçalo Muniz, Fundação Oswaldo Cruz (Fiocruz), Salvador, Brazil
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Pedrana L, Pamponet M, Walker R, Costa F, Rasella D. Scoping review: national monitoring frameworks for social determinants of health and health equity. Glob Health Action 2016; 9:28831. [PMID: 26853896 PMCID: PMC4744868 DOI: 10.3402/gha.v9.28831] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/25/2015] [Accepted: 10/31/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity. OBJECTIVES This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH. DESIGN We conducted a scoping review of published SDH studies in the PubMed(®) database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish. RESULTS The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in the WHO EQuAL framework were not common in the studies in this review due to their intersectoral and interdisciplinary nature. CONCLUSIONS Our review illustrates that the attention to SDH monitoring has grown in terms of its importance and complexity within the scientific health literature. We identified a need to make indicators more wide-ranging in order to include a broader range of social conditions. The WHO EQuAL framework can provide intersectoral and interdisciplinary means of building a more comprehensive standardised approach to monitoring the SDH and improving equity in health.
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Affiliation(s)
- Leo Pedrana
- ISC Instituto de Saúde Coletiva, UFBA - Universidade Federal da Bahia, Salvador, Brazil;
| | - Marina Pamponet
- ISC Instituto de Saúde Coletiva, UFBA - Universidade Federal da Bahia, Salvador, Brazil
| | - Ruth Walker
- Department of Evolution, Ecology and Behaviour, University of Liverpool, Liverpool, UK
| | - Federico Costa
- ISC Instituto de Saúde Coletiva, UFBA - Universidade Federal da Bahia, Salvador, Brazil
| | - Davide Rasella
- ISC Instituto de Saúde Coletiva, UFBA - Universidade Federal da Bahia, Salvador, Brazil
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Van Minh H, Giang KB, Hoat LN, Chung LH, Huong TTG, Phuong NTK, Valentine NB. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam. Glob Health Action 2016; 9:28836. [PMID: 26850052 PMCID: PMC4744327 DOI: 10.3402/gha.v9.28836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'. METHODS Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. RESULTS In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14-0.55; OR=0.19, 95% CI: 0.05-0.80) and a higher risk of having had a child death in the previous two years (OR=1.71, 95% CI: 1.28-2.30; OR=1.59, 95% CI: 1.20-2.10). CONCLUSIONS Our study shows the need for accelerating education and infrastructure investments for ethnic minority communities living in rural areas so as to be able to contribute to equity-oriented progress toward UHC.
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Affiliation(s)
| | - Kim Bao Giang
- Department of Health Education, Hanoi Medical University, Hanoi, Vietnam
| | - Luu Ngoc Hoat
- Department of Biostatistics, Hanoi Medical University, Hanoi, Vietnam
| | - Le Hong Chung
- Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Nicole B Valentine
- Social Determinants of Health (SDH), Public Health, Environmental and Social Determinants of Health Department (PHE), World Health Organization, Geneva, Switzerland
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