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Müller SA, Isaaka L, Mumm R, Scheidt-Nave C, Heldt K, Schuster A, Abdulaziz M, El-Bcheraoui C, Hanefeld J, Agweyu A. Latent viral infections as neglected risk factors for long COVID - Authors' reply. Lancet Glob Health 2024; 12:e198. [PMID: 38245110 DOI: 10.1016/s2214-109x(23)00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin 13353, Germany.
| | - Lynda Isaaka
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebekka Mumm
- Epidemiology and Health Monitoring, Robert Koch Institute, Berlin 13353, Germany
| | - Christa Scheidt-Nave
- Epidemiology and Health Monitoring, Robert Koch Institute, Berlin 13353, Germany
| | - Katharina Heldt
- Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin 13353, Germany
| | - Angela Schuster
- Centre for International Health Protection, Robert Koch Institute, Berlin 13353, Germany; Institute of General Practice and Family Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mohammed Abdulaziz
- Division of Disease Control and Prevention, Africa CDC, Addis Ababa, Ethiopia
| | - Charbel El-Bcheraoui
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin 13353, Germany
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; London School of Hygiene and Tropical Medicine, London, UK
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Fischer HT, Müller K, Wenham C, Hanefeld J. Policy responses to the COVID-19 pandemic in West Africa: a scoping review protocol. BMJ Open 2023; 13:e079810. [PMID: 38072480 PMCID: PMC10728961 DOI: 10.1136/bmjopen-2023-079810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Four years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face masks among others. In the absence of widely available vaccinations, NPIs were the only known means to try to slow the spread of COVID-19. While numerous studies have assessed the effectiveness of these NPIs in high-income countries, less is known about the processes that lead to the adoption of policies and the factors that influence their implementation and adherence in low-income and middle-income countries. The objective of this scoping review is to understand the extent and type of evidence in relation to the policy formulation, decision-making and implementation stages of NPIs in West Africa. METHODS AND ANALYSIS A scoping review will be undertaken following the guidance developed by Arskey and O'Malley, the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA guidelines for Scoping Reviews. Both peer-reviewed and grey literature will be searched using Web of Science, Embase, Scopus, APA PsycInfo, WHO Institutional Repository for Information Sharing, JSTOR and Google Advanced Search, and by searching the websites of the WHO, and the West African Health Organisation. Screening will be conducted by two reviewers based on inclusion and exclusion criteria, and data will be extracted, coded and narratively synthesised. ETHICS AND DISSEMINATION We started this scoping review in May 2023, and anticipate finishing by April 2024. Ethics approval is not required since we are not collecting primary data. This protocol was registered at Open Science Framework (https://osf.io/gvek2/). We plan to disseminate this research through publications, conference presentations and upcoming West African policy dialogues on pandemic preparedness and response.
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Affiliation(s)
| | | | - Clare Wenham
- The London School of Economics and Political Science, London, UK
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Gotsche CI, Meierkord A, Baruch J, Körner-Nahodilová L, Weishaar H, Hanefeld J. Approaches, challenges, and opportunities to strengthen the epidemic intelligence workforce: a scoping review. Public Health 2023; 225:353-359. [PMID: 37979312 DOI: 10.1016/j.puhe.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Weak surveillance systems have limited countries' ability to adequately respond to public health emergencies. Strengthening the human workforce in this field is considered an important opportunity to ensure the future response to infectious diseases outbreaks globally. A scoping review of the academic literature and relevant documents was conducted to identify approaches, challenges, and opportunities to strengthen the epidemic intelligence (EI) workforce. METHODS Five peer-reviewed databases were systematically searched, as well as Google as a grey literature source. English language articles and documents published between 2014 and 2022 were included. No geographical restrictions were set. RESULTS 37 articles and 20 documents were included in the review. Professional training, the acknowledgement of including a broad variety of disciplines into the workforce, the inclusion of communities, the pursuit of a One Health approach and the use of digital tools were identified as impeding and/or facilitating the EI workforce. The review shows that the field epidemiology training programme is a prominent approach for strengthening the EI workforce and that little evidence exists on how non-traditional disciplines (e.g., disciplines besides medicine, laboratory science, or epidemiology) contributing to surveillance may support the future EI workforce. CONCLUSION The identification of approaches, challenges, and opportunities of EI can inform future policy and practice on strengthening the EI workforce. The conduct of more high-quality studies is needed to guide this process. The potential benefits of integrating a wider range of disciplines than currently found in the surveillance workforce and of involving communities in disease surveillance needs to be further researched.
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Affiliation(s)
- C I Gotsche
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
| | - A Meierkord
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité Center for Global Health, Institute of International Health, Berlin, 13353, Germany
| | - J Baruch
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - L Körner-Nahodilová
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - H Weishaar
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany
| | - J Hanefeld
- Robert Koch Institute, Centre for International Health Protection, Nordufer 20, Berlin, 13353, Germany; London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
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Müller SA, Isaaka L, Mumm R, Scheidt-Nave C, Heldt K, Schuster A, Abdulaziz M, El Bcheraoui C, Hanefeld J, Agweyu A. Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: a systematic review. Lancet Glob Health 2023; 11:e1713-e1724. [PMID: 37858583 DOI: 10.1016/s2214-109x(23)00384-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic or sociocultural determinants of reporting long COVID. METHODS We conducted a systematic review, searching PubMed, the Living OVerview of Evidence platform, and grey literature sources for publications from Dec 1, 2019, to Nov 23, 2022. We included articles published in English, French, Spanish, or Portuguese that reported on any study type in Africa with participants of any age who had symptoms for 4 weeks or more after an acute SARS-CoV-2 infection. We excluded secondary research, comments, and correspondence. Screening and data extraction were performed by two reviewers. Summary estimates were extracted, including sociodemographic factors, medical history, prevalence of persistent symptoms, and symptoms and associated factors. Results were analysed descriptively. The study was registered on the Open Science Framework platform. FINDINGS Our search yielded 294 articles, of which 24 peer-reviewed manuscripts were included, reporting on 9712 patients from eight African countries. Only one study exclusively recruited children, and one other study included children as part of their study population. Studies indicated moderate to low risk of bias. Prevalence of long COVID varied widely, from 2% in Ghana to 86% in Egypt. Long COVID was positively associated with female sex, older age, non-Black ethnicity, low level of education, and the severity of acute infection and underlying comorbidity. HIV and tuberculosis were not identified as risk factors. Factors influencing reporting included absence of awareness, inadequate clinical data and diagnostics, and little access to health-care services. INTERPRETATION In Africa, research on long COVID is scarce, particularly among children, who represent the majority of the population. However, existing studies show a substantial prevalence across settings, emphasising the importance of vaccination and other prevention strategies to avert the effects of long COVID on individual wellbeing, the increased strain on health systems, and the potential negative effects on economically vulnerable populations. At a global level, including African countries, tools for research on long COVID need to be harmonised to maximise the usefulness of the data collected. FUNDING None.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
| | - Lynda Isaaka
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebekka Mumm
- Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Katharina Heldt
- Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin, Germany
| | - Angela Schuster
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany; Institute of General Practice and Family Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mohammed Abdulaziz
- Division of Disease Control and Prevention, Africa CDC, Addis Ababa, Ethiopia
| | - Charbel El Bcheraoui
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; London School of Hygiene and Tropical Medicine, London, UK
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Wieler LH, Antao EM, Hanefeld J. Reflections from the COVID-19 pandemic in Germany: lessons for global health. BMJ Glob Health 2023; 8:e013913. [PMID: 37748795 PMCID: PMC10533693 DOI: 10.1136/bmjgh-2023-013913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Lothar H Wieler
- Digital Global Public Health, Hasso Plattner Institute for Digital Engineering GmbH, Potsdam, Germany
- Robert Koch Institute, Berlin, Germany
| | - Esther-Maria Antao
- Digital Global Public Health, Hasso Plattner Institute for Digital Engineering GmbH, Potsdam, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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Squires N, Hanefeld J, Sandifer Q. Building the evidence base for Integrated Disease Surveillance as a tool for strengthened health security. Public Health 2023; 221:198-200. [PMID: 37480746 DOI: 10.1016/j.puhe.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Affiliation(s)
- N Squires
- UKHSA, 10 South Colonnade, Canary Wharf, London E14 4PU, UK.
| | | | - Q Sandifer
- IANPHI Secretariat, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
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Müller SA, Agweyu A, Akanbi OA, Alex-Wele MA, Alinon KN, Arora RK, Balam S, Barekye B, Ben Hamida A, Bergeri I, Boddington N, Böff L, Boone I, Conradie A, Demirchyan A, Dudareva S, El Bcheraoui C, Evans M, Farley E, Hunger I, Jones JM, Kagucia EW, Kimani M, Lewis HC, Mazuguni F, Mwakasungula S, Mwenda JM, Nesterova O, Nepolo E, Nghitukwa N, Nyagwange J, Offergeld R, Okwor TJ, Reichert F, Sahakyan S, Shaikh S, Sikuvi KA, Weiss S, Whelan M, Winter CH, Ziraba AK, Hanefeld J. Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response. Lancet 2023; 402:356-358. [PMID: 37247625 PMCID: PMC10219629 DOI: 10.1016/s0140-6736(23)00964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
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Manji K, Perera S, Hanefeld J, Vearey J, Olivier J, Gilson L, Walls H. An analysis of migration and implications for health in government policy of South Africa. Int J Equity Health 2023; 22:82. [PMID: 37158907 PMCID: PMC10165765 DOI: 10.1186/s12939-023-01862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/15/2023] [Indexed: 05/10/2023] Open
Abstract
For over a decade, the global health community has advanced policy engagement with migration and health, as reflected in multiple global-led initiatives. These initiatives have called on governments to provide universal health coverage to all people, regardless of their migratory and/or legal status. South Africa is a middle-income country that experiences high levels of cross-border and internal migration, with the right to health enshrined in its Constitution. A National Health Insurance Bill also commits the South African public health system to universal health coverage, including for migrant and mobile groups. We conducted a study of government policy documents (from the health sector and other sectors) that in our view should be relevant to issues of migration and health, at national and subnational levels in South Africa. We did so to explore how migration is framed by key government decision makers, and to understand whether positions present in the documents support a migrant-aware and migrant-inclusive approach, in line with South Africa's policy commitments. This study was conducted between 2019 and 2021, and included analysis of 227 documents, from 2002-2019. Fewer than half the documents identified (101) engaged directly with migration as an issue, indicating a lack of prioritisation in the policy discourse. Across these documents, we found that the language or discourse across government levels and sectors focused mainly on the potential negative aspects of migration, including in policies that explicitly refer to health. The discourse often emphasised the prevalence of cross-border migration and diseases, the relationship between immigration and security risks, and the burden of migration on health systems and other government resources. These positions attribute blame to migrant groups, potentially fuelling nationalist and anti-migrant sentiment and largely obscuring the issue of internal mobility, all of which could also undermine the constructive engagement necessary to support effective responses to migration and health. We provide suggestions on how to advance engagement with issues of migration and health in order for South Africa and countries of a similar context in regard to migration to meet the goal of inclusion and equity for migrant and mobile groups.
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Grants
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
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Affiliation(s)
- Karima Manji
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
| | - Shehani Perera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Johanna Hanefeld
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucy Gilson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Helen Walls
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.
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Gotsche CI, Weishaar H, Hanefeld J. Global health in Germany: Understanding interdisciplinarity in the academic sector. Health Policy 2023; 130:104715. [PMID: 36753792 DOI: 10.1016/j.healthpol.2023.104715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Global Health (GH) in Germany increasingly becomes subject of political priority and scientists and policy makers. The aim of this study was to gain understanding of the current state, potential barriers and enablers of interdisciplinarity in GH in the academic sector in Germany. METHODS Between October 2019 and February 2020, we conducted thirteen semi-structured interviews with ten academics and three policymakers engaged in GH in Germany. Purposive and maximum contrast sampling based on review of the literature was performed to ensure a heterogenous set of study participants. FINDINGS We found that interdisciplinary exchange in GH research and education is limited in the German academic setting. Several context-specific barriers of interdisciplinary collaboration in the academic sector in Germany were detected, including terminological ambiguities and more biomedical actors being involved in global health compared to other disciplines. At the same time, enablers such as promotion of young academics and fostering topic-specific collaboration in GH research and education were identified to improve interdisciplinary working. CONCLUSION The importance of following an interdisciplinary approach is discussed and acknowledged across scientists working on GH in Germany. The current challenge is to identify which GH topics lend themselves to the collaboration of Germany-based scientists from various backgrounds and to establish common goals to advance interdisciplinarity research.
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Affiliation(s)
- Caroline I Gotsche
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Heide Weishaar
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
| | - Johanna Hanefeld
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom; Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
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Marten R, Hanefeld J, Smith RD. How states engage in and exercise power in global health: Indonesian and Japanese engagement in the conceptualization of Sustainable Development Goal 3. Soc Sci Med 2023; 321:115455. [PMID: 36854234 DOI: 10.1016/j.socscimed.2022.115455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/14/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
While long overlooked, power is central to understand how actors engage in global health policymaking. We reviewed how the Japanese and Indonesian governments exerted power and engaged in global health diplomacy during negotiations to conceptualize the post-2015 Sustainable Development Goal for health (SDG3). We conducted deliberative policy analysis including semi-structured, in-depth, interviews with more than 71 policymakers, which we analyzed adapting Barnett and Duvall's power framework. We find that both Japan and Indonesia exerted non-material power (institutional, productive and structural power) to advance largely domestic political interests. Japan's government mainly exerted institutional power, leveraging relationships within the World Bank and the World Health Organization, whereas Indonesia's government focused on structural power, with its president serving as co-chair of the UN Secretary-General's High-Level Post-2015 Panel. Our analysis suggests that the ways in which states engage in global health diplomacy is shaped by the relationship between different intra-state institutions, particularly the Ministry of Foreign Affairs and the Ministry of Health, and is further determined by broader foreign policy and diplomatic priorities. We find that the decline of states' influence is over-stated: states continue to exercise significant power in global health diplomacy, pursuing domestic political imperatives and strategies to improve population health. As states expand their global health engagement, researchers should seek to better understand how states participate in an increasingly crowded and contested global health field.
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Affiliation(s)
- Robert Marten
- London School of Hygiene and Tropical Medicine, University of London, London, WC1H 9SH, UK.
| | - Johanna Hanefeld
- London School of Hygiene and Tropical Medicine, University of London, London, WC1H 9SH, UK
| | - Richard D Smith
- University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
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Boklage E, Weiss B, Hanefeld J, Steinecke K, Jansen A, Anvarov K, Valihanov A, Alimov A, Seybold J, Spies C, Sabirov U. Telemedicine in emergency responses: reflections from a critical care telemedicine programme between Uzbekistani and German clinicians during COVID-19. BMJ Health Care Inform 2023; 30:bmjhci-2022-100675. [PMID: 36801830 PMCID: PMC9943691 DOI: 10.1136/bmjhci-2022-100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Affiliation(s)
- Evgeniya Boklage
- Centre for International Health Protection, Robert Koch Institut, Berlin, Germany
| | - Björn Weiss
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institut, Berlin, Germany
| | - Karin Steinecke
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Jansen
- Centre for International Health Protection, Robert Koch Institut, Berlin, Germany
| | - Khikmat Anvarov
- Republican Research Centre of Emergency Medicine, Tashkent, Uzbekistan
| | - Abror Valihanov
- Republican Research Centre of Emergency Medicine, Tashkent, Uzbekistan
| | - Azamat Alimov
- Republican Research Centre of Emergency Medicine, Tashkent, Uzbekistan
| | - Joachim Seybold
- Medical Directorate, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Ulugbek Sabirov
- Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
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Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag 2022; 11:2155-2165. [PMID: 34814662 PMCID: PMC9808299 DOI: 10.34172/ijhpm.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. METHODS We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. RESULTS The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. CONCLUSION Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.
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Affiliation(s)
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingrid Wolfe
- Institute for Women and Children's Health, King's College London, London, UK
| | - Christine Lau
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Emma Dickins
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Joeanne McSweeney
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Mary McCaskill
- Integrated Care Project, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Raghu Lingam
- University of New South Wales, Sydney, NSW, Australia
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Rose TC, Pennington A, Kypridemos C, Chen T, Subhani M, Hanefeld J, Ricciardiello L, Barr B. Analysis of the burden and economic impact of digestive diseases and investigation of research gaps and priorities in the field of digestive health in the European Region—White Book 2: Executive summary. United European Gastroenterol J 2022; 10:657-662. [PMID: 36093599 PMCID: PMC9486501 DOI: 10.1002/ueg2.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tanith C. Rose
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
| | - Andy Pennington
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
| | - Tao Chen
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
| | - Moeez Subhani
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
| | - Johanna Hanefeld
- Department of Global Health and Development Faculty of Public Health and Policy London School of Hygiene and Tropical Medicine London UK
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy
| | - Ben Barr
- Department of Public Health, Policy and Systems Institute of Population Health University of Liverpool Liverpool UK
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14
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Reeves A, Brown C, Hanefeld J. Female political representation and the gender health gap: a cross-national analysis of 49 European countries. Eur J Public Health 2022; 32:684-689. [PMID: 36087336 PMCID: PMC9527963 DOI: 10.1093/eurpub/ckac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Does increased female participation in the social and political life of a country improve health? Social participation may improve health because it ensures that the concerns of all people are heard by key decision-makers. More specifically, when women’s social participation increases this may lead to health gains because women are more likely to vote for leaders and lobby for policies that will enhance the health of everyone. This article tries to examine whether female participation is correlated with measures of health inequality. Methods We draw on data from the World Health Organization Health Equity Status Report initiative and the Varieties of Democracy project to assess whether health is better and health inequalities are smaller in countries where female political representation is greater. Results We find consistent evidence that greater female political representation is associated with lower geographical inequalities in infant mortality, smaller inequalities in self-reported health (for both women and men) and fewer disability-adjusted life-years lost for women and men. Finally, we find that greater female political representation is not only correlated with better health for men and women but is also correlated with a smaller gap between men and women because men seem to experience better health in such contexts. Conclusions Greater female political representation is associated with better health for everyone and smaller inequalities.
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Affiliation(s)
- Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford , Oxford, UK
- International Inequalities Institute, London School of Economics and Political Science , London, UK
| | - Chris Brown
- WHO European Office for Investment for Health and Development , Venice, Italy
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine , London, UK
- Robert Koch Institute , Berlin, Germany
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Khan M, Rahman-Shepherd A, Bory S, Chhorn S, Durrance-Bagale A, Hasan R, Heng S, Phou S, Prien C, Probandari A, Saphonn V, Suy S, Wiseman V, Wulandari LPL, Hanefeld J. How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan. BMJ Glob Health 2022; 7:bmjgh-2022-008596. [PMID: 35589155 PMCID: PMC9121421 DOI: 10.1136/bmjgh-2022-008596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background There has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups—policymakers, healthcare providers and pharmaceutical companies—that can create COI, and elucidate the impacts of COI on stages of the policy process. Methods Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. Findings We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Interpretation Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
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Affiliation(s)
- Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK .,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Anna Durrance-Bagale
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rumina Hasan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan
| | | | | | - Chanra Prien
- University of Health Sciences, Phnom Penh, Cambodia
| | | | | | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Center for International Health Protection, Robert Koch Institut, Berlin, Germany
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16
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Uthman OA, Adetokunboh OO, Wiysonge CS, Al-Awlaqi S, Hanefeld J, El Bcheraoui C. Classification Schemes of COVID-19 High Risk Areas and Resulting Policies: A Rapid Review. Front Public Health 2022; 10:769174. [PMID: 35284361 PMCID: PMC8916531 DOI: 10.3389/fpubh.2022.769174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has posed a significant global health threat since January 2020. Policies to reduce human mobility have been recognized to effectively control the spread of COVID-19; although the relationship between mobility, policy implementation, and virus spread remains contentious, with no clear pattern for how countries classify each other, and determine the destinations to- and from which to restrict travel. In this rapid review, we identified country classification schemes for high-risk COVID-19 areas and associated policies which mirrored the dynamic situation in 2020, with the aim of identifying any patterns that could indicate the effectiveness of such policies. We searched academic databases, including PubMed, Scopus, medRxiv, Google Scholar, and EMBASE. We also consulted web pages of the relevant government institutions in all countries. This rapid review's searches were conducted between October 2020 and December 2021. Web scraping of policy documents yielded additional 43 country reports on high-risk area classification schemes. In 43 countries from which relevant reports were identified, six issued domestic classification schemes. International classification schemes were issued by the remaining 38 countries, and these mainly used case incidence per 100,000 inhabitants as key indicator. The case incidence cut-off also varied across the countries, ranging from 20 cases per 100,000 inhabitants in the past 7 days to more than 100 cases per 100,000 inhabitants in the past 28 days. The criteria used for defining high-risk areas varied across countries, including case count, positivity rate, composite risk scores, community transmission and satisfactory laboratory testing. Countries either used case incidence in the past 7, 14 or 28 days. The resulting policies included restrictions on internal movement and international travel. The quarantine policies can be summarized into three categories: (1) 14 days self-isolation, (2) 10 days self-isolation and (3) 14 days compulsory isolation.
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Affiliation(s)
- Olalekan A. Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, United Kingdom
| | - Olatunji O. Adetokunboh
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- *Correspondence: Charbel El Bcheraoui
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17
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Abrokwa SK, Müller SA, Méndez-Brito A, Hanefeld J, El Bcheraoui C. Recurrent SARS-CoV-2 infections and their potential risk to public health - a systematic review. PLoS One 2021; 16:e0261221. [PMID: 34882750 PMCID: PMC8659325 DOI: 10.1371/journal.pone.0261221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To inform quarantine and contact-tracing policies concerning re-positive cases-cases testing positive among those recovered. MATERIALS AND METHODS We systematically reviewed and appraised relevant literature from PubMed and Embase for the extent of re-positive cases and their epidemiological characteristics. RESULTS In 90 case reports/series, a total of 276 re-positive cases were found. Among confirmed reinfections, 50% occurred within 90 days from recovery. Four reports related onward transmission. In thirty-five observational studies, rate of re-positives ranged from zero to 50% with no onward transmissions reported. In eight reviews, pooled recurrence rate ranged from 12% to 17.7%. Probability of re-positive increased with several factors. CONCLUSION Recurrence of a positive SARS-CoV-2 test is commonly reported within the first weeks following recovery from a first infection.
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Affiliation(s)
- Seth Kofi Abrokwa
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Alba Méndez-Brito
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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18
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Müller SA, Wood RR, Hanefeld J, El-Bcheraoui C. Seroprevalence and Risk Factors of COVID-19 in Healthcare Workers From Eleven African Countries: A Scoping Review and Appraisal of Existing Evidence. Health Policy Plan 2021; 37:505-513. [PMID: 34726740 PMCID: PMC8689910 DOI: 10.1093/heapol/czab133] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
A better understanding of serological data and risk factors for COVID-19 infection in healthcare workers are especially important in African countries where human resources and health services are more constrained. We reviewed and appraised the evidence of SARS-CoV-2 seroprevalence and its risk factors in healthcare workers in Africa to inform response and preparedness strategies during the SARS CoV-2 pandemic. We followed the PRISMA-ScR guidelines in this scoping review. Databases including PubMed, Embase and preprint servers were searched accordingly from the start of the COVID-19 pandemic to 19th April 2021. Our search yielded twelve peer-reviewed and four pre-print articles comprising data on 9,223 HCWs from eleven countries in Africa. Seroprevalence varied widely and ranged from 0% to 45.1%. Seropositivity was associated with older age, lower education, working as a nurse/non- clinical HCW, or in gynaecology, emergency, outpatient or surgery departments. Asymptomatic rates were high and half of the studies recommended routine testing of HCWs. This scoping review found a varying, but often high SARS-CoV-2 seroprevalence in HCWs in eleven African countries and identified certain risk factors. COVID-19 public health strategies for policy and planning should consider these risk factors and the potential for high seroprevalence among HCWs when prioritizing infection prevention and control measures and vaccine deployment.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Rebekah Ruth Wood
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
| | - Charbel El-Bcheraoui
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany
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19
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Bou-Karroum L, Khabsa J, Jabbour M, Hilal N, Haidar Z, Abi Khalil P, Khalek RA, Assaf J, Honein-AbouHaidar G, Samra CA, Hneiny L, Al-Awlaqi S, Hanefeld J, El-Jardali F, Akl EA, El Bcheraoui C. Public health effects of travel-related policies on the COVID-19 pandemic: A mixed-methods systematic review. J Infect 2021; 83:413-423. [PMID: 34314737 PMCID: PMC8310423 DOI: 10.1016/j.jinf.2021.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To map travel policies implemented due to COVID-19 during 2020, and conduct a mixed-methods systematic review of health effects of such policies, and related contextual factors. DESIGN Policy mapping and systematic review. DATA SOURCES AND ELIGIBILITY CRITERIA: for the policy mapping, we searched websites of relevant government bodies and used data from the Oxford COVID-19 Government Response Tracker for a convenient sample of 31 countries across different regions. For the systematic review, we searched Medline (Ovid), PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and COVID-19 specific databases. We included randomized controlled trial, non-randomized studies, modeling studies, and qualitative studies. Two independent reviewers selected studies, abstracted data and assessed risk of bias. RESULTS Most countries adopted a total border closure at the start of the pandemic. For the remainder of the year, partial border closure banning arrivals from some countries or regions was the most widely adopted measure, followed by mandatory quarantine and screening of travelers. The systematic search identified 69 eligible studies, including 50 modeling studies. Both observational and modeling evidence suggest that border closure may reduce the number of COVID-19 cases, disease spread across countries and between regions, and slow the progression of the outbreak. These effects are likely to be enhanced when implemented early, and when combined with measures reducing transmission rates in the community. Quarantine of travelers may decrease the number of COVID-19 cases but its effectiveness depends on compliance and enforcement and is more effective if followed by testing, especially when less than 14 day-quarantine is considered. Screening at departure and/or arrival is unlikely to detect a large proportion of cases or to delay an outbreak. Effectiveness of screening may be improved with increased sensitivity of screening tests, awareness of travelers, asymptomatic screening, and exit screening at country source. While four studies on contextual evidence found that the majority of the public is supportive of travel restrictions, they uncovered concerns about the unintended harms of those policies. CONCLUSION Most countries adopted full or partial border closure in response to COVID-19 in 2020. Evidence suggests positive effects on controlling the COVID-19 pandemic for border closure (particularly when implemented early), as well as quarantine of travelers (particularly with higher levels of compliance). While these positive effects are enhanced when implemented in combination with other public health measures, they are associated with concerns by the public regarding some unintended effects.
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Affiliation(s)
- Lama Bou-Karroum
- Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Clinical Research Institute, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mathilda Jabbour
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Nadeen Hilal
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Zeinab Haidar
- Clinical Research Institute, American University of Beirut Medical Center, Clinical Research Institute, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Pamela Abi Khalil
- Clinical Research Institute, American University of Beirut Medical Center, Clinical Research Institute, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Rima Abdul Khalek
- Economic and Social Commission of Western Asia, P.O. Box 11-8575, Riad el-Solh Square, Beirut, Lebanon
| | - Jana Assaf
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Gladys Honein-AbouHaidar
- Rafic Hariri School of Nursing, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Clara Abou Samra
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Nordufer. 20, Berlin 13353, Germany
| | - Johanna Hanefeld
- Center for International Health Protection, Robert Koch Institute, Nordufer. 20, Berlin 13353, Germany
| | - Fadi El-Jardali
- Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Charbel El Bcheraoui
- Evidence-Based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Nordufer. 20, Berlin 13353, Germany.
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El Bcheraoui C, Müller SA, Vaughan EC, Jansen A, Cook R, Hanefeld J. De-escalation strategies for non-pharmaceutical interventions following infectious disease outbreaks: a rapid review and a proposed dynamic de-escalation framework. Global Health 2021; 17:106. [PMID: 34530861 PMCID: PMC8444163 DOI: 10.1186/s12992-021-00743-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally. METHODS We reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework. RESULTS We identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers). De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system. CONCLUSIONS This rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.
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Affiliation(s)
- Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Eleanor C Vaughan
- The Economist Intelligence Unit, 20 Cabot Square, E14 4QW, London, UK
| | - Andreas Jansen
- Information Centre for International Health Protection, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Robert Cook
- The Economist Intelligence Unit, 20 Cabot Square, E14 4QW, London, UK
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
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21
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Wulandari LPL, Khan M, Liverani M, Ferdiana A, Mashuri YA, Probandari A, Wibawa T, Batura N, Schierhout G, Kaldor J, Guy R, Law M, Day R, Hanefeld J, Parathon H, Jan S, Yeung S, Wiseman V. Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study. BMJ Glob Health 2021; 6:e004993. [PMID: 34344668 PMCID: PMC8336216 DOI: 10.1136/bmjgh-2021-004993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia. METHODS Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client requesting it. We used multivariable random effects logistic regression to assess factors associated with the primary outcome and conducted 31 interviews with drug outlet staff to explore these factors in greater depth. RESULTS Antibiotic dispensing without prescription occurred in 69% of SP visits. Dispensing antibiotics without a prescription was more likely in standalone pharmacies and pharmacies attached to clinics compared with drug stores, with an OR of 5.9 (95% CI 3.2 to 10.8) and OR of 2.2 (95% CI 1.2 to 3.9); and more likely for TB and URTI SP-performed cases compared with child diarrhoea cases, with an OR of 5.7 (95% CI 3.1 to 10.8) and OR of 5.2 (95% CI 2.7 to 9.8). Interviews revealed that inappropriate antibiotic dispensing was driven by strong patient demand for antibiotics, unqualified drug sellers dispensing medicines, competition between different types of drug outlets, drug outlet owners pushing their staff to sell medicines, and weak enforcement of regulations. CONCLUSION This study shows that inappropriate dispensing of antibiotics by private drug retail outlets is widespread. Interventions will need to address not only the role of drug sellers, but also the demand for antibiotics among clients and the push from drug outlet owners to compete with other outlets.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Pathology & Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Astri Ferdiana
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Mataram, Mataram, Nusa Tenggara Barat, Indonesia
| | - Yusuf Ari Mashuri
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Ari Probandari
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Tri Wibawa
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Gill Schierhout
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Day
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Harry Parathon
- Antibiotic Resistance Control Committee, Indonesian Ministry of Health, Jakarta, Indonesia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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22
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Khan MS, Durrance-Bagale A, Mateus A, Sultana Z, Hasan R, Hanefeld J. What are the barriers to implementing national antimicrobial resistance action plans? A novel mixed-methods policy analysis in Pakistan. Health Policy Plan 2021; 35:973-982. [PMID: 32743655 DOI: 10.1093/heapol/czaa065] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 12/25/2022] Open
Abstract
Despite political commitment to address antimicrobial resistance (AMR), countries are facing challenges to implementing policies to reduce inappropriate use of antibiotics. Critical factors to the success of policy implementation in low- and middle-income countries (LMIC), such as capacity for enforcement, contestation by influential stakeholders and financial interests, have been insufficiently considered. Using Pakistan as a case study representing a populous country with extremely high antibiotic usage, we identified 195 actors who affect policies on antibiotic use in humans and animals through a snowballing process and interviewed 48 of these who were nominated as most influential. We used a novel card game-based methodology to investigate policy actors' support for implementation of different regulatory approaches addressing actions of frontline healthcare providers and antibiotic producers across the One Health spectrum. We found that there was only widespread support for implementing hard regulations (prohibiting certain actions) against antibiotic suppliers with little power-such as unqualified/informal healthcare providers and animal feed producers-but not to target more powerful groups such as doctors, farmers and pharmaceutical companies. Policy actors had limited knowledge to develop implementation plans to address inappropriate use of antibiotics in animals, even though this was recognized as a critical driver of AMR. Our results indicate that local political and economic dynamics may be more salient to policy actors influencing implementation of AMR national action plans than solutions presented in global guidelines that rely on implementation of hard regulations. This highlights a disconnect between AMR action plans and the local contexts where implementation takes place. Thus if the global strategies to tackle AMR are to become implementable policies in LMIC, they will need greater appreciation of the power dynamics and systemic constraints that relate to many of the strategies proposed.
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Affiliation(s)
- Mishal S Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Anna Durrance-Bagale
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Ana Mateus
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London WC1H 9SH, UK
| | - Zia Sultana
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Pakistan.,Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Johanna Hanefeld
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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23
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de Gruchy T, Vearey J, Opiti C, Mlotshwa L, Manji K, Hanefeld J. Research on the move: exploring WhatsApp as a tool for understanding the intersections between migration, mobility, health and gender in South Africa. Global Health 2021; 17:71. [PMID: 34210311 PMCID: PMC8248753 DOI: 10.1186/s12992-021-00727-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagement with the process of migration; (2) exclusion of internal migrants; and (3) lack of methodologies that are able to capture 'real-time' data about health needs and healthcare seeking experiences over both time and place. In this paper, we reflect on a four-month pilot project which explored the use of WhatsApp Messenger - a popular mobile phone application used widely in sub-Saharan Africa - and assessed its feasibility as a research tool with migrant and mobile populations in order to inform a larger study that would address these challenges. METHOD A four-month pilot was undertaken with eleven participants between October 2019 and January 2020. Using Survey Node, an online platform that allows for the automatic administration of surveys through WhatsApp, monthly surveys were administered. The GPS coordinates of participants were also obtained. Recruited through civil society partners in Gauteng, participants were over the age of 18, comfortable engaging in English, and owned WhatsApp compatible cell phones. Enrolment involved an administered survey and training participants in the study protocol. Participants received reimbursement for their travel costs and monthly cell phone data. RESULTS Out of a possible eighty eight survey and location responses, sixty one were received. In general, participants responded consistently to the monthly surveys and shared their location when prompted. Survey Node proved an efficient and effective way to administer surveys through WhatsApp. Location sharing via WhatsApp proved cumbersome and led to the development of a secure platform through which participants could share their location. Ethical concerns about data sharing over WhatsApp were addressed. CONCLUSIONS The success of the pilot indicates that WhatsApp can be used as a tool for data collection with migrant and mobile populations, and has informed the finalisation of the main study. Key lessons learnt included the importance of research design and processes for participant enrolment, and ensuring that the ethical concerns associated with WhatsApp are addressed.
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Affiliation(s)
- Thea de Gruchy
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa.
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa.,School of Social and Political Studies, University of Edinburgh, Edinburgh, Scotland
| | - Calvin Opiti
- Opiti Consulting, Pretoria, South Africa.,Department of Geography, University of the Witwatersrand, Johannesburg, South Africa
| | - Langelihle Mlotshwa
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa
| | - Karima Manji
- London School of Hygiene & Tropical Medicine (LSHTM), London, England
| | - Johanna Hanefeld
- London School of Hygiene & Tropical Medicine (LSHTM), London, England
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24
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Manji K, Hanefeld J, Vearey J, Walls H, de Gruchy T. Using WhatsApp messenger for health systems research: a scoping review of available literature. Health Policy Plan 2021; 36:594-605. [PMID: 33860314 PMCID: PMC8173666 DOI: 10.1093/heapol/czab024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Globally, the use of mobile phones for improving access to healthcare and conducting health research has gained traction in recent years as rates of ownership increase, particularly in low- and middle-income countries (LMICs). Mobile instant messaging applications, including WhatsApp Messenger, provide new and affordable opportunities for health research across time and place, potentially addressing the challenges of maintaining contact and participation involved in research with migrant and mobile populations, for example. However, little is known about the opportunities and challenges associated with the use of WhatsApp as a tool for health research. To inform our study, we conducted a scoping review of published health research that uses WhatsApp as a data collection tool. A key reason for focusing on WhatsApp is the ability to retain contact with participants when they cross international borders. Five key public health databases were searched for articles containing the words ‘WhatsApp’ and ‘health research’ in their titles and abstracts. We identified 69 articles, 16 of which met our inclusion criteria for review. We extracted data pertaining to the characteristics of the research. Across the 16 studies—11 of which were based in LMICs—WhatsApp was primarily used in one of two ways. In the eight quantitative studies identified, seven used WhatsApp to send hyperlinks to online surveys. With one exception, the eight studies that employed a qualitative (n = 6) or mixed-method (n = 2) design analysed the WhatsApp content generated through a WhatsApp-based programmatic intervention. We found a lack of attention paid to research ethics across the studies, which is concerning given the controversies WhatsApp has faced with regard to data protection in relation to end-to-end encryption. We provide recommendations to address these issues for researchers considering using WhatsApp as a data collection tool over time and place.
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Affiliation(s)
- Karima Manji
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Johanna Hanefeld
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand (Wits), Solomon Mahlangu House, Braamfontein Campus East, Private Bag 3, Johannesburg 2000, South Africa
| | - Helen Walls
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Thea de Gruchy
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand (Wits), Solomon Mahlangu House, Braamfontein Campus East, Private Bag 3, Johannesburg 2000, South Africa
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25
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Sié A, Hanefeld J, Chaponda M, Chico RM, LeDoare K, Mayaud P, Drexler JF, Jaenisch T. Congenital malformations in sub-Saharan Africa-warnings of a silent epidemic? Lancet Infect Dis 2021; 21:594-596. [PMID: 33773619 PMCID: PMC9760594 DOI: 10.1016/s1473-3099(21)00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Ali Sié
- National Institute of Public Health, Burkina Faso
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK,Zentrum Internationaler Gesundheitsschutz, Robert Koch Institute, Berlin 14195, Germany
| | | | - R Matthew Chico
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirsty LeDoare
- Paediatric Infectious Diseases Research Group, St George's Medical School, London, UK
| | - Philippe Mayaud
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Jan Felix Drexler
- Charité-Universitätsmedizin Berlin Universität Berlin, Humbolt-Universität zu Berlin, Berlin, Germany,Institute of Virology, Berlin, Germany
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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Abstract
Robert Marten and colleagues highlight the benefits of co-production during covid-19 and call for it to be become embedded in policy making
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Affiliation(s)
- Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Fadi El-Jardali
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Johanna Hanefeld
- Robert Koch-Institute, Berlin, Germany
- London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriel M Leung
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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27
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Beermann S, Denkel L, Hanefeld J. Weltweit zunehmende Masernfälle sind auch für Deutschland relevant. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1443-1444. [PMID: 33231735 PMCID: PMC7683581 DOI: 10.1007/s00103-020-03248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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El Bcheraoui C, Weishaar H, Pozo-Martin F, Hanefeld J. Assessing COVID-19 through the lens of health systems' preparedness: time for a change. Global Health 2020; 16:112. [PMID: 33213482 PMCID: PMC7675393 DOI: 10.1186/s12992-020-00645-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022] Open
Abstract
The last months have left no-one in doubt that the COVID-19 pandemic is exerting enormous pressure on health systems around the world, bringing to light the sub-optimal resilience of even those classified as high-performing. This makes us re-think the extent to which we are using the appropriate metrics in evaluating health systems which, in the case of this pandemic, might have masked how unprepared some countries were. It also makes us reflect on the strength of our solidarity as a global community, as we observe that global health protection remains, as this pandemic shows, focused on protecting high income countries from public health threats originating in low and middle income countries. To change this course, and in times like this, all nations should come together under one umbrella to respond to the pandemic by sharing intellectual, human, and material resources. In order to work towards stronger and better prepared health systems, improved and resilience-relevant metrics are needed. Further, a new model of development assistance for health, one that is focused on stronger and more resilient health systems, should be the world’s top priority.
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Affiliation(s)
- Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Heide Weishaar
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Johanna Hanefeld
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
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29
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Han E, Tan MMJ, Turk E, Sridhar D, Leung GM, Shibuya K, Asgari N, Oh J, García-Basteiro AL, Hanefeld J, Cook AR, Hsu LY, Teo YY, Heymann D, Clark H, McKee M, Legido-Quigley H. Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. Lancet 2020. [PMID: 32979936 DOI: 10.1016/s0140-6736(20032007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.
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Affiliation(s)
- Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eva Turk
- Department of Nursing and Health Sciences, University of South East Norway, Drammen, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Devi Sridhar
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Gabriel M Leung
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kenji Shibuya
- Institute for Population Health, King's College London, London, UK
| | - Nima Asgari
- Asia Pacific Observatory on Health Systems and Policies, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Juhwan Oh
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de InvestigaÇão em SaÚde de ManhiÇa, Maputo, Mozambique
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - David Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
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30
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Han E, Tan MMJ, Turk E, Sridhar D, Leung GM, Shibuya K, Asgari N, Oh J, García-Basteiro AL, Hanefeld J, Cook AR, Hsu LY, Teo YY, Heymann D, Clark H, McKee M, Legido-Quigley H. Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. Lancet 2020; 396:1525-1534. [PMID: 32979936 PMCID: PMC7515628 DOI: 10.1016/s0140-6736(20)32007-9] [Citation(s) in RCA: 420] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.
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Affiliation(s)
- Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eva Turk
- Department of Nursing and Health Sciences, University of South East Norway, Drammen, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Devi Sridhar
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Gabriel M Leung
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kenji Shibuya
- Institute for Population Health, King's College London, London, UK
| | - Nima Asgari
- Asia Pacific Observatory on Health Systems and Policies, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Juhwan Oh
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de InvestigaÇão em SaÚde de ManhiÇa, Maputo, Mozambique
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - David Heymann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
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31
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Rexroth U, Hamouda O, Hanefeld J, Ruehe B, Wieler LH, Schaade L. Letter to the editor: Wide indication for SARS-CoV-2-testing allowed identification of international risk areas during the early phase of the COVID-19 pandemic in Germany. Euro Surveill 2020; 25. [PMID: 32553063 PMCID: PMC7403636 DOI: 10.2807/1560-7917.es.2020.25.23.2001119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Purpose
The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries.
Design/methodology/approach
The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy.
Findings
Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations.
Originality/value
This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.
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Khan MS, Bory S, Rego S, Suy S, Durrance-Bagale A, Sultana Z, Chhorn S, Phou S, Prien C, Heng S, Hanefeld J, Hasan R, Saphonn V. Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries? Hum Resour Health 2020; 18:10. [PMID: 32046723 PMCID: PMC7014603 DOI: 10.1186/s12960-020-0452-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/30/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low- and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs. METHODS We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR-Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries. RESULTS Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education. CONCLUSIONS In light of the weaknesses in HCP professionalism identified, we conclude that global guidelines urging patients to only seek care at qualified HCPs should consider whether HCP professional education is equipping them to act in the best interest of the patient and society. Our findings suggest that improvements to HCP professional education are needed urgently and that these should focus not only on the curriculum content and learning methods, but also on the social purpose of graduates.
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Affiliation(s)
- Mishal S Khan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
- Aga Khan University, Karachi, Pakistan.
| | - Sothavireak Bory
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Sonia Rego
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Sovanthida Suy
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Anna Durrance-Bagale
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | | | | | - Socheata Phou
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Chanra Prien
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Johanna Hanefeld
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom
| | - Rumina Hasan
- Aga Khan University, Karachi, Pakistan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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34
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Hanefeld J, Smith R. Is the NHS really "off the table" in post-Brexit talks with the US? BMJ 2019; 367:l6898. [PMID: 31822487 DOI: 10.1136/bmj.l6898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Affiliation(s)
- Johanna Hanefeld
- London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Chris Brown
- WHO Office for Investment for Health and Development, Venice, Italy
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Khan MS, Durrance-Bagale A, Legido-Quigley H, Mateus A, Hasan R, Spencer J, Hanefeld J. 'LMICs as reservoirs of AMR': a comparative analysis of policy discourse on antimicrobial resistance with reference to Pakistan. Health Policy Plan 2019; 34:178-187. [PMID: 30977804 DOI: 10.1093/heapol/czz022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2019] [Indexed: 11/12/2022] Open
Abstract
Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. We compared representations of AMR across nine policy documents produced by multilateral agencies, donor countries and an LMIC at the forefront of the global response to AMR-Pakistan. We analysed the texts in relation to five narratives that have been commonly used to frame health issues as requiring action: economic impact, stunting of human development, consequences for health equity, health security threats and relationship with food production. We found that AMR was most frequently framed as a threat to human health security and economic progress, with several US, UK and international documents depicting LMICs as 'hotspots' for AMR. Human development and equity dimensions of the problem were less frequently discussed as reasons to address the growing burden of AMR. It is clear that no single coherent narrative on AMR has emerged, with notable differences in framing in Pakistani and external agency led documents, as well as across stakeholders primarily working on human vs animal health. While framing AMR as a threat to economic growth and human security has achieved high-level political attention and catalysed action from governments in high-income countries, our analysis suggests that conflicting narratives relevant to policymakers in Pakistan may affect policy-making and impede the development and implementation of integrated initiatives needed to tackle AMR.
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Affiliation(s)
- Mishal S Khan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Julia Spencer
- London School of Hygiene and Tropical Medicine, London, UK
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Suy S, Rego S, Bory S, Chhorn S, Phou S, Prien C, Heng S, Wu S, Legido-Quigley H, Hanefeld J, Saphonn V, Khan MS. Invisible medicine sellers and their use of antibiotics: a qualitative study in Cambodia. BMJ Glob Health 2019; 4:e001787. [PMID: 31637030 PMCID: PMC6768357 DOI: 10.1136/bmjgh-2019-001787] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Global attention to antimicrobial resistance has increased interest in tackling the widespread inappropriate dispensing of antibiotics by informal, for-profit healthcare providers (HCPs). We provide new evidence on an understudied group of informal HCPs: invisible medicine sellers (IMS) who operate without any marked facility. We investigated factors that influence community decisions on which HCPs to purchase medicines from, focusing on reasons for using IMS, and compared different HCPs' knowledge of antibiotic use. METHODS We conducted community focus group discussions (FGDs) in seven purposively selected villages representing high and low informal HCPs use in two peri-urban districts in Phnom Penh, Cambodia. Using information from the FGDs to identify HCPs that sell medicines, we interviewed 35 participants: 21 HCPs (including five IMS) and 14 key informants, including government HCPs and village leaders. We adopted an interpretative approach and conducted a thematic analysis. RESULTS Community members typically knew of several formal and informal HCPs selling medicines nearby, and IMS were common, as were doctors that sell medicines covertly. Two factors were most salient in influencing the choice of HCP for medicine purchasing. The first was trust in the effectiveness of medicines provided, judged by the speed of symptomatic relief. This pushed HCPs to provide several medicines, including antibiotics, at the first consultation. The second was the convenience offered by IMS and other informal HCPs: supplying medicines when other facilities are closed, accepting delayed payments, providing incomplete courses of medication and selling human antibiotics for animal use. CONCLUSION This first study focusing on IMS indicates that it is important, but challenging, for public health agencies to engage with them to reduce inappropriate use of antibiotics. Although public health facilities must fill some gaps that informal HCPs are currently addressing, such as access to medicines at night, reducing demand for unnecessary antibiotics is also critical.
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Affiliation(s)
- Sovanthida Suy
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Sonia Rego
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sothavireak Bory
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Socheata Phou
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Chanra Prien
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Helena Legido-Quigley
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Johanna Hanefeld
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mishal S Khan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Walls H, Smith R, Cuevas S, Hanefeld J. International trade and investment: still the foundation for tackling nutrition related non-communicable diseases in the era of Trump? BMJ 2019; 365:l2217. [PMID: 31164325 PMCID: PMC6547839 DOI: 10.1136/bmj.l2217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Trade and investment policy strongly influence diet, nutrition, and risk of non-communicable disease—but what does this mean in the context of recent global political developments?
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Affiliation(s)
- Helen Walls
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | | | - Soledad Cuevas
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Johanna Hanefeld
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
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Abstract
Cross border movement of patients and health workers is often portrayed negatively but Johanna Hanefeld and Richard Smith discuss how it can benefit both source and recipient countries as long as the risks are properly managed
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Affiliation(s)
- Johanna Hanefeld
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Abstract
Gorik Ooms and Johanna Hanefeld argue that low and middle income countries could increase access to medicines by forming an alliance to credibly threaten companies with compulsory licences
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Affiliation(s)
- Gorik Ooms
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Spencer J, McRobie E, Dar O, Rahman-Shepherd A, Hasan N, Hanefeld J, Khan M. Is the current surge in political and financial attention to One Health solidifying or splintering the movement? BMJ Glob Health 2019; 4:e001102. [PMID: 30899558 PMCID: PMC6407571 DOI: 10.1136/bmjgh-2018-001102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The global health field has witnessed the rise, short-term persistence and fall of several movements. One Health, which addresses links between human, animal and environmental health, is currently experiencing a surge in political and financial attention, but there are well-documented barriers to collaboration between stakeholders from different sectors. We examined how stakeholder dynamics and approaches to operationalising One Health have evolved further to recent political and financial support for One Health. METHODS We conducted a mixed methods study, first by qualitatively investigating views of 25 major policymakers and funders of One Health programmes about factors supporting or impeding systemic changes to strengthen the One Health movement. We then triangulated these findings with a quantitative analysis of the current operations of 100 global One Health Networks. RESULTS We found that recent attention to One Health at high-level political fora has increased power struggles between dominant human and animal health stakeholders, in a context where investment in collaboration building skills is lacking. The injection of funding to support One Health initiatives has been accompanied by a rise in organisations conducting diverse activities under the One Health umbrella, with stakeholders shifting operationalisation in directions most aligned with their own interests, thereby splintering and weakening the movement. While international attention to antimicrobial resistance was identified as a unique opportunity to strengthen the One Health movement, there is a risk that this will further drive a siloed, disease-specific approach and that structural changes required for wider collaboration will be neglected. CONCLUSION Our analysis indicated several opportunities to capitalise on the current growth in One Health initiatives and funding. In particular, evidence from better monitoring and evaluation of ongoing activities could support the case for future funding and allow development of more precise guidelines on best practices.
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Affiliation(s)
- Julia Spencer
- Centre on Global Health Security, Chatham House, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen McRobie
- Centre on Global Health Security, Chatham House, London, UK
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Osman Dar
- Centre on Global Health Security, Chatham House, London, UK
| | | | - Nadeem Hasan
- Centre on Global Health Security, Chatham House, London, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Legido-Quigley H, Khan MS, Durrance-Bagale A, Hanefeld J. Something Borrowed, Something New: A Governance and Social Construction Framework to Investigate Power Relations and Responses of Diverse Stakeholders to Policies Addressing Antimicrobial Resistance. Antibiotics (Basel) 2018; 8:antibiotics8010003. [PMID: 30586853 PMCID: PMC6466563 DOI: 10.3390/antibiotics8010003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022] Open
Abstract
While antimicrobial resistance (AMR) has rapidly ascended the political agenda in numerous high-income countries, developing effective and sustainable policy responses in low- and middle-income countries (LMIC) is far from straightforward, as AMR could be described as a classic ‘wicked problem’. Effective policy responses to combat AMR in LMIC will require a deeper knowledge of the policy process and its actors at all levels—global, regional and national—and their motivations for supporting or opposing policies to combat AMR. The influence of personal interests and connections between for-profit organisations—such as pharmaceutical companies and food producers—and policy actors in these settings is complex and very rarely addressed. In this paper, the authors describe the role of policy analysis focusing on social constructions, governance and power relations in soliciting a better understanding of support and opposition by key stakeholders for alternative AMR mitigation policies. Owing to the lack of conceptual frameworks on the policy process addressing AMR, we propose an approach to researching policy processes relating to AMR currently tested through our empirical programme of research in Cambodia, Pakistan, Indonesia and Tanzania. This new conceptualisation is based on theories of governance and a social construction framework and describes how the framework is being operationalised in several settings.
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Affiliation(s)
- Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
- Saw Swee Hock School of Public Health, National University of Singapore, 119077 Singapore, Singapore.
| | - Mishal S Khan
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| | | | - Johanna Hanefeld
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
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Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, Liverani M, Yei Mokuwa E, McKay G, Balabanova D. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan 2018; 33:1144. [PMID: 30517618 PMCID: PMC6415725 DOI: 10.1093/heapol/czy087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Abstract
BACKGROUND The achievement of Universal Health Coverage (UHC) is a key aim of the global health agenda, and an important target of the Sustainable Development Goals. There is increasing recognition that some groups may fall behind in efforts to achieve UHC, including the 1 billion people globally living with disabilities. A fundamental question for debate is - can UHC be achieved without the inclusion of people with disabilities? MAIN TEXT People with disabilities are more likely to experience poor health. They will therefore have greater need for general healthcare services, as well as rehabilitation and specialist services, related to their underlying impairment. People with disabilities also frequently face additional difficulties in accessing healthcare, incur greater costs when seeking healthcare and often report experiencing worse quality services than others. As a consequence of these different challenges, people with disabilities face specific and added difficulties across three dimensions of UHC: coverage, access to services needed, and at reasonable cost. A focus on people with disabilities is therefore essential to achieving UHC, particularly since they constitute 15% of the global population. To ensure the realisation of UHC is inclusive of and addresses the needs of people with disabilities, health systems need to adapt. A twin-tracked approach is recommended, which means that there is a focus on including people with disabilities in mainstream services, as well as targeting them with specific services needed. There also must be efforts to improve the quality of services (e.g. through healthcare staff training) and enhance cost protection for people with disabilities (e.g. through social protection). A key challenge to changing UHC strategies to be more inclusive is the lack of evidence on what is needed and works, and more research is needed urgently on this topic. CONCLUSIONS It will be difficult to achieve UHC without a focus on people with disabilities. Changes made to improve coverage for people with disabilities will likely benefit a wider group, including older people, ethnic minorities, and people with short-term functional difficulties. Disability-inclusive strategies will therefore improve health system equity and ensure that we "Leave no one behind" as we move towards UHC.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Suzana M, Walls H, Smith R, Hanefeld J. Understanding medical travel from a source country perspective: a cross sectional study of the experiences of medical travelers from the Maldives. Global Health 2018; 14:58. [PMID: 29921295 PMCID: PMC6010160 DOI: 10.1186/s12992-018-0375-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services (with outgoing medical travelers), through offering a comprehensive universal health care package for its people that includes subsidized treatment abroad for services unavailable in the country. By the end of the first year of the scheme approximately US$11.6 m had been spent by the government of Maldives to treat patients abroad. In this study, affordability, continuity and quality of this care were assessed from the perspective of the medical traveler to provide recommendations for safer and more cost effective medical travel policy. RESULTS Despite universal health care, a substantial proportion of Maldivian travelers have not accessed the government subsidy, and a third reported not having sufficient funds for the treatment episode abroad. Among the five most visited hospitals in this study, none were JCI accredited at the time of the study period and only three from India had undergone the National Accreditation Board for Hospitals (NABH) in India. Satisfaction with treatment received was high amongst travelers but concern for the continuity of care was very high, and more than a third of the patients had experienced complications arising from the treatment overseas. CONCLUSION Source countries can use their bargaining power in the trade of health services to offer a more comprehensive package for medical travelers. Source countries with largely public funded health systems need to ensure that medical travel is truly affordable and universal, with measures for quality control such as the use of accredited foreign hospitals to make it safer and to impose measures that ensure the continuity of care for travelers.
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Affiliation(s)
- Mariyam Suzana
- Department of Public Health, Faculty of Health Sciences, The Maldives National University, Haveeree Higun, Malé, 20-04, Republic of Maldives.
| | - Helen Walls
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Richard Smith
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, WC1E 7HT, UK
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Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, Liverani M, Yei Mokuwa E, McKay G, Balabanova D. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan 2018; 33:355-367. [PMID: 29325025 PMCID: PMC6277919 DOI: 10.1093/heapol/czx183] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 11/14/2022] Open
Abstract
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013-16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify '3 plus 2' critical dimensions of particular relevance to health systems' ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: 'health information systems' (having the information and the knowledge to make a decision on what needs to be done); 'funding/financing mechanisms' (investing or mobilising resources to fund a response); and 'health workforce' (who should plan and implement it and how). These intersect with two cross-cutting aspects: 'governance', as a fundamental function affecting all other system dimensions; and predominant 'values' shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the '3 plus 2' dimensions can inform pragmatic policies seeking to increase health systems resilience.
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Affiliation(s)
- Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Susannah Mayhew
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, Singapore
| | - Frederick Martineau
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | | | - Karl Blanchet
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
- Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | | | - Gillian McKay
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
- Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
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Suzana M, Walls H, Smith R, Hanefeld J. Evaluation of public subsidy for medical travel: does it protect against household impoverishment? Int J Equity Health 2018; 17:30. [PMID: 29510756 PMCID: PMC5840843 DOI: 10.1186/s12939-018-0726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. METHODS We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure. RESULTS Most of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect - diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care. CONCLUSION Evidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP expenditures on health among Maldivian medical travellers were similar between the poor and the rich. However, we conclude mixed evidence on the linkages between public financing of medical travel and impoverishment which needs to be further explored with comparison of impoverishment levels between households with and without medical travel.
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Affiliation(s)
- Mariyam Suzana
- Faculty of Health Sciences, The Maldives National University, Handhuvaree Higun, Malé, Maldives
| | - Helen Walls
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, England WC1E 7HT
| | - Richard Smith
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, England WC1E 7HT
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel street, London, England WC1E 7HT
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Abstract
Background Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. Methods Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu. Findings Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS. Interpretation Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.
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Affiliation(s)
- Mariyam Suzana
- Faculty of Health Sciences, The Maldives National University, Male, Maldives
| | - Helen Walls
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Smith
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.
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Affiliation(s)
- Rumina Hasan
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Johanna Hanefeld
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
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McRobie E, Matovu F, Nanyiti A, Nonvignon J, Abankwah DNY, Case KK, Hallett TB, Hanefeld J, Conteh L. National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda. Health Policy Plan 2018; 33:17-33. [PMID: 29040476 PMCID: PMC5886235 DOI: 10.1093/heapol/czx132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 12/11/2022] Open
Abstract
Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, programme and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Programme on HIV/AIDS set 'ambitious' treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by programme, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to '90-90-90'. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in programme-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analysed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh's policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of programme activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV programme from 'business as usual' to approaches targeting geographies and populations.
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Affiliation(s)
- Ellen McRobie
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Fred Matovu
- School of Economics, Makerere University, Kampala, Uganda
- Policy Analysis & Development Research Institute, Kampala, Uganda
| | - Aisha Nanyiti
- School of Economics, Makerere University, Kampala, Uganda
| | - Justice Nonvignon
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Daniel Nana Yaw Abankwah
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Kelsey K Case
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Johanna Hanefeld
- Anthropology, Politics and Policy Group, Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lesong Conteh
- Health Economics Group, School of Public Health, Imperial College London, London, UK
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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