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Shah HP, Cohen O, Bourdillon AT, Burtness BA, Boffa DJ, Young M, Judson BL, Mehra S. Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility. Otolaryngol Head Neck Surg 2024. [PMID: 38606669 DOI: 10.1002/ohn.755] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region. STUDY DESIGN Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Single health system and region. METHODS Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence. RESULTS A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18-0.70, P = .003). CONCLUSION Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region.
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Affiliation(s)
- Hemali P Shah
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
| | - Oded Cohen
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, Ben Gurion University of the Negev Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Alexandra T Bourdillon
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine, San Francisco, California, USA
| | - Barbara A Burtness
- Yale Cancer Center, New Haven, Connecticut, USA
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel J Boffa
- Yale Cancer Center, New Haven, Connecticut, USA
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Young
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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O'Brien N, Fernandez Crespo R, O'Driscoll F, Prendergast M, Chana D, Darzi A, Ghafur S. Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study. JMIR Form Res 2024; 8:e50968. [PMID: 38603777 DOI: 10.2196/50968] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care-specific resources to help organizations at different levels of maturity develop their cybersecurity practices. OBJECTIVE This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. METHODS A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. RESULTS A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. CONCLUSIONS The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | | | - Fiona O'Driscoll
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Mabel Prendergast
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Deeph Chana
- Institute for Security Science and Technology, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Saira Ghafur
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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3
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Sturmberg JP, Gainsford L, Goodwin N, Pond D. Systemic failures in nursing home care-A scoping study. J Eval Clin Pract 2024; 30:484-496. [PMID: 38258966 DOI: 10.1111/jep.13961] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/15/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024]
Abstract
Nursing homes (also referred to as residential aged care facilities, or long-term care facilities) cater for older people on a respite or long-term basis for those who are no longer able to live independently at home. Globally the sector struggles to meet societal expectations since it is torn between three competing agendas-meeting the needs of residents, meeting the demands of regulators, and meeting the financial imperatives of nursing home proprietors. Competing demands indicate that the system lacks a clear understanding of its purpose-without a clearly understood purpose any system will become dysfunctional overall and across all its levels of organisation. This scoping study aims to summarise and synthesise what is already known about the systemic function and failures in the nursing home system, and the impact this has on the wider health and aged care system. METHOD MEDLINE, EMBASE, PSYCHINFO, CINAHL and SCOPUS were searched using the terms: (nursing home care OR residential aged care OR nursing home) AND (organisational failure OR institutional failure OR systemic failure), limited to English language articles, including all years up to the end of February 2021. In addition, we used snowballing of article references and Google searches of the grey literature. System-focused articles were defined as those that explored how an issue at one system level impacted other system levels, or how an issue impacted at least two different agents at the same system level. RESULT Thirty-eight articles addressed systemic issues as defined in four different contexts: United States (14), Canada (2), Australia (11) and European countries (11). Only four studies reported whole-of-system findings, whereas the remaining 34 more narrowly addressed systemic features of specific nursing home issues. The thematic analysis identified 29 key systemic issues across five system layers which consistently appear across every country/health system context. The negative outcomes of these systemic failings include: high rates of regulatory reprimands for unacceptable or unsafe practices; dissatisfaction in care experiences on the part of residents, families, and care staff-including a fear of being sent to a nursing home; and the perception amongst staff that nursing homes are not preferred places to work. CONCLUSIONS The key issues affecting nursing home residents, and the care home sector more generally, are systemic in nature arising from two key issues: first, the lack of shared agreement on the care home system's purpose; and second, the lack of clear governance and accountability frameworks for system regulation and performance at a national level. Addressing these two key issues must be the starting point for any 'real' nursing home system redesign that can achieve a seamlessly integrated system that delivers the outcomes nursing home residents and their families expect. 'Systems thinking' is required to simultaneously improve care quality and outcomes for residents, strengthen regulation and accountability, and enable financial viability.
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Affiliation(s)
- Joachim P Sturmberg
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- International Society for Systems and Complexity Sciences for Health, Australia
| | - Len Gainsford
- Australian Government Tertiary Education Quality & Standards Agency Audit & Risk Committee & Chair, Transport Safety Victoria Audit Committee, Australia
- Centre for Enterprise Performance, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Nicholas Goodwin
- Central Coast Research Institute for Integrated Care, University of Newcastle and the Central Coast Local Health District, Newcastle, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Training Centre, University of Tasmania, Hobart, Tasmania, Australia
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Adekunle TB, Ringel JV, Williams MS, Faherty LJ. Continuity of Trust: Health Systems' Role in Advancing Health Equity Beyond the COVID-19 Pandemic. Community Health Equity Res Policy 2024; 44:323-329. [PMID: 37400357 PMCID: PMC10333557 DOI: 10.1177/2752535x231185221] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.
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Affiliation(s)
| | | | | | - Laura J. Faherty
- RAND Corporation, Boston, MA, USA
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
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Haque G, Asif F, Ahmed FA, Ayub F, Syed SUH, Pradhan NA, Hameed M, Siddiqui MMU, Mahmood S, Zaidi T, Siddiqi S, Latif A. Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study. JMIR Res Protoc 2024; 13:e50532. [PMID: 38536223 PMCID: PMC11007612 DOI: 10.2196/50532] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. OBJECTIVE This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. METHODS We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. RESULTS The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. CONCLUSIONS A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50532.
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Affiliation(s)
- Ghazal Haque
- Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Fozia Asif
- Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Fasih Ali Ahmed
- Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Farwa Ayub
- Center for Patient Safety, Aga Khan University, Karachi, Pakistan
| | | | | | - Malika Hameed
- Department of Anesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | | | - Shafaq Mahmood
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Tahani Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Center for Patient Safety, Aga Khan University, Karachi, Pakistan
- Department of Anesthesiology, Aga Khan University Medical College, Karachi, Pakistan
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Alibudbud R. Addressing the Challenges of Private Hospitals in the Philippines. Health Serv Insights 2024; 17:11786329241241905. [PMID: 38516029 PMCID: PMC10956146 DOI: 10.1177/11786329241241905] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Rowalt Alibudbud
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila City, Philippines
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Yeboah I, Dwomoh D, Ndejjo R, Kabwama SN, Ohemeng F, Takyi SA, Issah I, Bawuah SA, Wanyenze RK, Fobil J. Maintaining essential health services during COVID-19 in Ghana: a qualitative study. BMJ Glob Health 2024; 8:e013284. [PMID: 38490688 DOI: 10.1136/bmjgh-2023-013284] [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: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Evidence suggests that non-pharmaceutical interventions such as lockdown policies, restriction of movement and physical distancing to control the novel COVID-19 contributed to the decline in utilisation of essential health services. We explored healthcare providers' and policy-makers' experiences of the barriers, interventions and response actions that contributed to ensuring the continuity of essential health services during the COVID-19 pandemic in Ghana to help inform future practice and policy. METHODS We used a qualitative study approach. Data were analysed using thematic analysis. Thirty Four participants composed of 20 healthcare providers and 14 policy-makers who worked across regions with low and high recorded COVID-19 cases in Ghana during the COVID-19 pandemic were involved in this study. RESULTS Participants reported that essential health services including maternal, reproductive and child health services, communicable and non-communicable disease care, and elective surgeries were disrupted during the COVID-19 pandemic. Barriers to the utilisation of essential services were constructed into three subthemes: (1) fear, (2) poor quality of care at the facility and (3) financial limitation. These barriers were mitigated with population-based interventions underpinned by the socioecological model at the individual and interpersonal level (including psychosocial care for families and home visits), institutional and community levels (such as allocation of funds, training of health workers, public education, triage stations, provision of logistics, appointment scheduling, telemedicine and redeployment of health workers) and public policy level (tax relief packages, transportation arrangements and provision of incentives), which helped in maintaining essential health services during COVID-19. CONCLUSION Disruption of essential health services during COVID-19 in Ghana instigated population-based interventions which aided in expanding the populations' continuous access to essential health services and strengthened health service delivery.
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Affiliation(s)
- Isaac Yeboah
- Employment and Society, University of Professional Studies, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, University of Ghana, Legon, Ghana
| | - Rawlance Ndejjo
- Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Sylvia Akpene Takyi
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | - Ibrahim Issah
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | - Serwaa Akoto Bawuah
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
| | | | - Julius Fobil
- Department of Biological, Environmental, and Occupational Health, University of Ghana, Legon, Ghana
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Mohamed Nur M, Aweesha H, Elsharif M, Esawi A, Omer A, Musa M. Humanitarian-Development Nexus: strengthening health system preparedness, response and resilience capacities to address COVID-19 in Sudan-case study of repositioning external assistance model and focus. Health Policy Plan 2024; 39:327-331. [PMID: 38217482 DOI: 10.1093/heapol/czad087] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/18/2023] [Accepted: 10/17/2023] [Indexed: 01/15/2024] Open
Abstract
The advent of the COVID-19 pandemic and the establishment of a new transitional government in Sudan with rejuvenated relations with the international community paved the way for external assistance to the EU COVID-19 response project, a project with a pioneering design within the region. The project sought to operationalize the humanitarian-development-peace nexus, perceiving the nexus as a continuum rather than sequential due to the protracted nature of emergencies in Sudan and their multiplicity and contextual complexity. It went further into enhancing peace through engaging with conflict and post-conflict-affected states and communities and empowering local actors. Learning from this experience, external assistance models to low- or middle-income countries (LMICs) should apply principles of flexibility and adaptability, while maintaining trust through transparency in exchange, to ensure sustainable and responsive action to domestic needs within changing contexts. Careful selection and diverse project team skills, early and continuous engagement with stakeholders, and robust planning, monitoring and evaluation processes were the project highlights. Yet, the challenges of political turmoil, changing Ministry of Health leadership, competing priorities and inactive coordination mechanisms had to be dealt with. While applying such an approach of a health system lens to health emergencies in LMICs is thought to be a success factor in this case, more robust technical guidance to the nexus implementation is crucial and can be best attained through encouraging further case reports analysing context-specific practices.
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Affiliation(s)
- Muna Mohamed Nur
- Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum 2234, Sudan
| | - Huzeifa Aweesha
- Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum 2234, Sudan
- Department of Epidemiology and Global Health, Umea University, NUS 5B Destination PA, Umea 90185, Sweden
| | - Mahmoud Elsharif
- Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum 2234, Sudan
| | - Ahmed Esawi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto M5T 3M6, Canada
| | - Arwa Omer
- International Health Directorate, Federal Ministry of Health, Nile Avenue, Othman Digna St., Khartoum 303, Sudan
- University of Medical Sciences and Technology, AlRiyad, Africa Street, Khartoum 12810, Sudan
| | - Mohamed Musa
- Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum 2234, Sudan
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Petagna CN, Perez S, Hsu E, Greene BM, Banner I, Bednarczyk RA, Escoffery C. Facilitators and barriers of HPV vaccination: a qualitative study in rural Georgia. Res Sq 2024:rs.3.rs-3979079. [PMID: 38496559 PMCID: PMC10942563 DOI: 10.21203/rs.3.rs-3979079/v1] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Human papillomavirus (HPV) vaccination protects against HPV-associated cancers and genital warts. Healthy People 2030 goal for HPV vaccine uptake is 80%, but as of 2021, only 58.5% of adolescents are up to date in Georgia. The purpose of the study is to assess the attitudes, vaccine practices, facilitators, and barriers to receiving the HPV vaccine in southwest Georgia. Methods We conducted 40 semi-structured interviews with three different audiences (young adults, parents, and providers and public health professionals) guided by the P3 (patient-, provider-, practice-levels) model and used deductive coding approach. Young adults and parents were interviewed to assess their perceived benefits, barriers, and susceptibility of the HPV vaccine. Providers and public health professionals were interviewed about facilitators and barriers of patients receiving the HPV vaccine in their communities. Results Out of the 40 interviews: 10 young adults, 20 parents, and 10 providers and public health professionals were interviewed. Emerging facilitator themes to increase the uptake of the HPV vaccine included existing knowledge (patient level), providers' approach to the HPV vaccine recommendations (provider level) and immunization reminders (practice level). Barrier themes were lack of knowledge around HPV and the HPV vaccine (patient level), need for strong provider recommendation and discussing the vaccine with patients (provider level), and limited patient reminders and information (practice level). Conclusions These interviews revealed key themes around education, knowledge, importance of immunization reminders, and approaches to increasing the HPV vaccination in rural Georgia. This data can inform future interventions across all levels (patient, provider, practice, policy, etc.) to increase HPV vaccination rates in rural communities.
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Papanicolas I, Cylus J, Lorenzoni L. Cross-country comparisons in health price growth over time. Health Serv Res 2024. [PMID: 38454562 DOI: 10.1111/1475-6773.14295] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To examine how the United States compares in terms of health price growth relative to four other countries - Australia, Canada, France, and the Netherlands. DATA SOURCES AND STUDY SETTING Secondary data on health expenditure were extracted from international and national agencies spanning the years 2000-2020. STUDY DESIGN International price indices specific to health were constructed using available international expenditure data and compared to existing health-specific national and general international price indices. DATA COLLECTION/EXTRACTION METHODS Health expenditure data were extracted from the Organization for Economic Cooperation and Development (OECD) database. We obtained a time series of health price indices from the national agencies in each of the study countries. PRINCIPAL FINDINGS We find meaningful variation across countries in the rate at which health prices grow relative to general prices. The United States had the highest cumulative health price growth compared to general price growth over the years 2000-2020 at 14%, followed by Canada and the Netherlands. Unlike the other study countries, health prices in France grew consistently in line with general prices. Price growth for health care paid for by public funds and households grew at different rates across countries, where price growth was higher for public payers. US households faced the greatest mean annual price growth. CONCLUSIONS The choice of price index has major implications for comparative analysis. Despite their widespread use internationally, general price indices likely underestimate the contribution of price growth to overall health expenditure growth. We find that in addition to its reputation for having high health price levels compared to other high-income countries, the United States also faces health price growth for goods and services paid for by government and households in excess of general price growth. Furthermore, US households are exposed to greater health price growth than households in comparator countries.
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Affiliation(s)
- Irene Papanicolas
- Center for Health System Sustainability (CHeSS), Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Policy, London School of Economics, London, UK
| | - Jonathan Cylus
- Center for Health System Sustainability (CHeSS), Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Policy, London School of Economics, London, UK
- European Observatory for Health Systems and Policies, London, United Kingdom
- World Health Organization Barcelona Office for Health Systems Financing, Barcelona, Spain
- Health Services Research and Policy Department, London School of Hygiene and Tropical Medicine, London, UK
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Luca Lorenzoni
- Organization for Economic Co-operation and Development, Paris, France
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Augusti JV, Silva SN. Management of pharmaceutical services in the fight against COVID-19 in universal public health systems: a rapid review. Int J Pharm Pract 2024; 32:109-119. [PMID: 38233348 DOI: 10.1093/ijpp/riad093] [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: 06/22/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic brought new challenges and lessons were learnt for health services. In the field of pharmaceutical care, several interventions have been proposed to optimize and expand the response capacity of services. OBJECTIVE To identify and characterize interventions performed in the management of pharmaceutical services during the COVID-19 pandemic in universal public health systems. METHODS A rapid literature review was conducted and registered in PROSPERO (CRD42022360902). Systematic searches in the MEDLINE (PubMed), Embase, and Virtual Health Library databases were conducted to identify interventions and practices adopted for the management of pharmaceutical care during the COVID-19 pandemic. RESULTS Thirteen articles reporting interventions developed in six countries were included. The interventions were summarized under three major themes: actions for continuous access to medicines, logistical measures for acquisition and storage, and organizational strategies. Telepharmacy services stand out as a typical action adopted in different services, which highlights the use and consolidation of digital technologies in these services. Strategies for process management were described and focused on the reorganization of the internal service of pharmacies, flow of services, and people management. CONCLUSIONS Many interventions were developed during the pandemic, some of which have already been incorporated into routine service delivery. Although the studies did not measure the effect of each intervention, the strategies developed are a source of information for the future delivery of care. Studies should be conducted to evaluate the potential of similar interventions in other health emergency contexts.
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Affiliation(s)
- Júlia Vasconcellos Augusti
- Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 Pampulha, 31270-90 Belo Horizonte, Minas Gerais, Brazil
| | - Sarah Nascimento Silva
- Fundação Oswaldo Cruz, Instituto Rene Rachou, Núcleo de Avaliação de Tecnologias em Saúde, Av. Augusto de Lima, 1715 Barro Preto, 30190-002 Belo Horizonte, Minas Gerais, Brazil
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12
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Jessup RL, Slade S, Roussy V, Whicker S, Pelly J, Rane V, Lewis V, Naccarella L, Lee M, Campbell D, Stockman K, Brooks P. Peer Health Navigators to improve equity and access to health care in Australia: Can we build on successes from the COVID-19 pandemic? Aust N Z J Public Health 2024; 48:100128. [PMID: 38442568 DOI: 10.1016/j.anzjph.2024.100128] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Rebecca L Jessup
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Rural Health, Monash University, Warragul, Australia.
| | - Sian Slade
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Veronique Roussy
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton Australia; EACH Community Health, Ferntree Gully, Australia
| | - Susan Whicker
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Janet Pelly
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Vinita Rane
- Pandemic Wards, Northern Health, Epping Australia; Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Virginia Lewis
- Australian Insititute of Primary Care and Ageing, La Trobe University, Bundoora, Australia
| | - Lucio Naccarella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Max Lee
- Strategic Alliances and Partnerships, DPV Health, Epping, Australia
| | - Donald Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Keith Stockman
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Peter Brooks
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Agwu P, Onwujekwe O, Obi U, McKee M, Odii A, Orjiakor C, Hutchinson E, Balabanova D. Targeting systems not individuals: Institutional and structural drivers of absenteeism among primary healthcare workers in Nigeria. Int J Health Plann Manage 2024; 39:417-431. [PMID: 37947450 DOI: 10.1002/hpm.3736] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
Universal Health Coverage (UHC) can only be achieved if people receive good quality care from health workers, yet in Nigeria, as in many other low- and middle-income countries (LMICs), many health workers are absent from work. Absenteeism is a well-known phenomenon but is often considered as the self-serving behaviour of individuals, independent from the characteristics of health systems structures and processes and the broader contexts that enable it. We undertook a qualitative inquiry among 40 key informants, comprising health facility heads and workers, community leaders and state-level health policymakers in Nigeria. We employed a phenomenology approach to examine their lived experiences and grouped findings into thematic clusters. Absenteeism by health workers was found to be a response to structural problems at two levels -midstream (facility-level) and upstream (government level) - rather than being a result of moral failure of individuals. The problems at midstream level pointed to an inconsistent and unfair application of rules and regulations in facilities and ineffective management, while the upstream drivers relate mainly to political interference and suboptimal health system leadership. Reducing absenteeism requires two-pronged interventions that tackle defects in the upstream and midstream rather than just focusing on sanctioning deviant staff (downstream).
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Affiliation(s)
- Prince Agwu
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
- School of Humanities, Social Sciences, and Law, University of Dundee, Dundee, UK
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu, Nigeria
| | - Uche Obi
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Nigeria
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Aloysius Odii
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Sociology & Anthropology, University of Nigeria, Nsukka, Nigeria
| | - Charles Orjiakor
- Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
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14
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Hassoun N. Global Health Impact: Human rights, access to medicines, and measurement. Dev World Bioeth 2024; 24:37-48. [PMID: 38324653 DOI: 10.1111/dewb.12441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/19/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024]
Abstract
Should people have a legal human right to health? And, if so, what exactly does protecting this right require? This essay defends some answers to these questions recently articulated in Global Health Impact. It explains how these answers depend on a particular way of thinking about health and the minimally good life, how quality of life matters at and over time, what various agents should do to help people who are unable to live well enough, and many other things. Moreover, it suggests some ways of improving common metrics for measuring and advancing our collective global health impact.
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15
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Sarkar S, Wangmo S, Flora MS, Uddin SMJ, Sultan M, Grundy J. Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis. Int J Health Plann Manage 2024; 39:164-174. [PMID: 37904303 DOI: 10.1002/hpm.3724] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.
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Affiliation(s)
- Shila Sarkar
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Sangay Wangmo
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Meerjady Sabrina Flora
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shah Md Jashim Uddin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Murad Sultan
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - John Grundy
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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Musa MK, Abdulsalam A, Haruna UA, Zakariya F, Salisu SM, Onajin-Obembe B, Idris SH, Eliseo Lucero-Prisno D. COVID-19 vaccine wastage in Africa: A case of Nigeria. Int J Health Plann Manage 2024; 39:229-236. [PMID: 38148426 DOI: 10.1002/hpm.3749] [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: 12/21/2022] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023] Open
Abstract
The World Health Organization has launched campaigns to boost immunisation rates to 70 percent globally by the middle of 2022. However, despite the global success of about 64% COVID-19 vaccination coverage, there is a big gap in Nigeria. To date, only 13.8% of the population has received the recommended dose. This demonstrates a significant disparity between the vaccinated and the unvaccinated. Amidst the wide gap in vaccination, COVID-19 vaccine wastage still occurs in Nigeria. At the end of 2021, it was estimated that over a million doses of the COVID-19 vaccine had been wasted. It is anticipated that there will be more COVID-19 vaccine wastage in Nigeria, because of the combined factors that threaten vaccination uptake including vaccine accessibility, lack of appropriate storage facilities, poor electricity supply, insecurity challenges, and inadequate health promotion. This results in concomitant financial and opportunity losses. In this paper, we discuss COVID-19 vaccine wastage in Nigeria including causes, and solutions that can be applied to mitigate this wastage.
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Affiliation(s)
- Muhammad Kabir Musa
- Department of Medicine, Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan
- Global Health Focus, Africa, Abuja, Nigeria
| | - Abdullateef Abdulsalam
- Department of Medicine, Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan
- Global Health Focus, Africa, Abuja, Nigeria
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Usman Abubakar Haruna
- Department of Medicine, Nazarbayev University School of Medicine (NUSOM), Astana, Kazakhstan
- Global Health Focus, Africa, Abuja, Nigeria
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Farida Zakariya
- Global Health Focus, Africa, Abuja, Nigeria
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Sanusi Muhammad Salisu
- Global Health Focus, Africa, Abuja, Nigeria
- Department of Pharmacology and Therapeutics, Ahmadu Bello University Zaria, Zaria, Kaduna State, Nigeria
| | - Bisola Onajin-Obembe
- Department of Anaesthesiology, College of Health Sciences, University of PortHarcourt, Port Harcourt, Rivers State, Nigeria
- University of PortHarcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Suleman Hadejia Idris
- Department of Community Medicine, College of Medical Sciences, Ahmadu Bello University Zaria, Zaria, Kaduna State, Nigeria
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Management and Development Studies, University of the Philippines Open University, Los Baños, Laguna, Philippines
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Hadian M, Jelodar ZK, Khanbebin MJ, Atafimanesh P, Asiabar AS, Dehagani SMH. Challenges of Implementing Telemedicine Technology: A systematized Review. Int J Prev Med 2024; 15:8. [PMID: 38563036 PMCID: PMC10982727 DOI: 10.4103/ijpvm.ijpvm_48_23] [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: 02/19/2022] [Accepted: 06/13/2022] [Indexed: 04/04/2024] Open
Abstract
Background Today, the technologies in the world are rapidly evolving, and global infrastructure of information is spreading rapidly. The health system of different countries is facing a variety of challenges in order to apply telemedicine services. The aim of this study was to determine the challenges facing the health system of different countries in the application of telemedicine. Method The present research was conducted in 2022 as a systematized review of studies related to challenges of telemedicine. In this study, Preferred Reporting Items for Systematic Reviews (PRISMA) and Critical Appraisal Skills Program (CASP) guidelines were used to assess the articles. The keywords "telemedicine," "telehealth," "E-health," and "tele care" were used in combination with the Boolean operators OR and AND. The ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley, and Google Scholar were searched. Results In this study, based on the search strategy, databases were searched from January 2012 to January 2022, and in the final stage, analysis was performed on 27 selected identified articles. The use of telemedicine technology faced major formality and legality, required bandwidth, development of multilingual systems, economic efficiency, available patterns, payment for services, moral barriers, social status, differences and national and legal contradictions in the world, lack of insurance coverage challenges, and so on. Recognizing gaps and challenges can provide a way to fill these gaps and create opportunities for improvement. Conclusions Utilizing telemedicine technology can be considered as an effective step in the health system. This technology has weaknesses that may challenge it. Successful application of telemedicine technology cannot be very effective without removing these barriers.
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Affiliation(s)
- Marziye Hadian
- Assistant Professor of Healthcare Services Management, Health Management and Economics Research Center, Health Management Research Institute, Tehran, Iran
| | - Zahra Khakdel Jelodar
- Clinical Research Development Unit, Fatemi Hospital, Ardabil University of Medical Scinces, Ardabil, Iran
| | - Mohammadreza Jabbari Khanbebin
- Department of Health Services Management, Student Research Committee of School of Management and Medical Information, Health Management and Economics Research Center, Isfahan, Iran
| | - Pezhman Atafimanesh
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarabi Asiabar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
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Irwin R. Politics, law and a lack of sperm: single women and fertility treatment in the Swedish health system. Anthropol Med 2024:1-15. [PMID: 38410056 DOI: 10.1080/13648470.2023.2274684] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 09/20/2023] [Indexed: 02/28/2024]
Abstract
In 2016 Swedish law was amended to allow single women to access fertility treatment with donor sperm. In this paper, based on interviews, document analysis and autoethnographic insights, I examine the implementation of this law using human rights approaches, specifically the availability, accessibility, acceptability, and quality framework (AAAQ Framework). While the law extended the scope of reproductive rights, the health system was unprepared. Five years on, women seek care in the private sector or continue to travel abroad due in large part to waiting times which can be up to four years in some regions. The paper also provides a meeting point between anthropology and policy analysis. The law change provides a pathway for analyzing the Swedish health system and political context, particularly the relationships between the private and public sectors and between different regions, and the balance of responsibility between national and regional levels. While many of the challenges are unique to the Swedish context, they also offer lessons for countries which have or are considering expanding access to fertility treatment for single women and other patient groups, thus demonstrating the importance of ethnographic approaches in health policy analysis.
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Affiliation(s)
- Rachel Irwin
- Arts and Cultural Sciences, Lund University, Lund, Sweden
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Harrison J, Lind P, Sawleshwarkar S, Pasupathy D, Yapa HM. Rapid systematic review of interventions to improve antenatal screening rates for syphilis, hepatitis B, and HIV in low- and middle-income countries. Int J Gynaecol Obstet 2024. [PMID: 38391190 DOI: 10.1002/ijgo.15425] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Infectious diseases including syphilis, HIV, and hepatitis B are major contributors to maternal and neonatal morbidity and mortality worldwide, especially in low- and middle-income countries (LMICs). The World Health Organization has prioritized elimination of vertical transmission of these three diseases. OBJECTIVES To rapidly assess the impact of interventions designed to improve antenatal screening rates for syphilis, HIV, and hepatitis B in LMICs and to identify areas for future implementation research. SEARCH STRATEGY A comprehensive search was conducted across PubMed, Embase, and EconLit, targeting articles published between January 1, 2013, and June 27, 2023. SELECTION CRITERIA We included quantitative interventional studies in English, involving pregnant adults (15 years or older) from LMICs. Exclusions were studies based in high-income countries, qualitative studies, or those investigating accuracy of diagnostic methods. DATA COLLECTION AND ANALYSIS From an initial 5549 potential studies, 27 were finalized for review after various screening stages. Data extraction covered aspects such as study design, intervention details, and outcomes. Findings were qualitatively synthesized within a systems thinking framework. MAIN RESULTS The interventions assessed varied in terms of geographic locations, health care system levels, and modalities. The review highlighted the effectiveness of interventions such as community health interventions, service quality improvements, and financial incentives. CONCLUSIONS The study underscores the potential of specific interventions in enhancing antenatal screening rates in LMICs. However, there is a discernible research gap concerning hepatitis B. The findings emphasize the importance of capacity building and health systems strengthening in public health interventions.
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Affiliation(s)
- J Harrison
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - P Lind
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - S Sawleshwarkar
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - D Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - H M Yapa
- Sydney Infectious Diseases Institute, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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20
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Carter E, Schatz D, Isaacs N, Garcia J, Henry B, Krawczyk N, Williams AR. Application of an opioid use disorder cascade of care in a large public health system. Am J Drug Alcohol Abuse 2024:1-10. [PMID: 38386810 DOI: 10.1080/00952990.2024.2302500] [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] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/01/2024] [Indexed: 02/24/2024]
Abstract
Background: Over the past decade, hospitals and health systems have increasingly adopted interventions to address the needs of patients with substance use disorders. The Opioid Use Disorder (OUD) Cascade of Care provides a framework for organizing and tracking patient health milestones over time and can assist health systems in identifying areas of intervention to maximize the impact of evidence-based services. However, detailed protocols are needed to guide health systems in how to operationalize the OUD Cascade and track outcomes using electronic health records.Objective: In this paper, we describe the process of operationalizing and applying the OUD Cascade in a large, urban, public hospital system.Methods: Through this case example, we describe the technical processes around data mining, as well as the decision-making processes, challenges encountered, lessons learned from compiling preliminary patient data and defining stages and outcome measures for the OUD Cascade of Care, and preliminary dataResults: We identified 33,616 (26.17% female) individuals with an OUD diagnosis. Almost half (48%) engaged with addiction services, while only 10.7% initiated medication-based treatment in an outpatient setting, 6.7% had timely follow-up, and 3.5% were retained for a minimum of 6 months.Conclusion: The current paper serves as a primer for other health systems seeking to implement data-informed approaches to guide more efficient care and improved substance use-related outcomes. An OUD Cascade of Care must be tailored to local systems based on inherent data limitations and services design with an emphasis on early stages wherein drop-off is the greatest.
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Affiliation(s)
- Emily Carter
- NYC Health + Hospitals Office of Behavioral Health, New York, NY, USA
| | - Daniel Schatz
- NYC Health + Hospitals Office of Behavioral Health, New York, NY, USA
| | - Noah Isaacs
- NYC Health + Hospitals Office of Behavioral Health, New York, NY, USA
| | - Juan Garcia
- NYC Health + Hospitals Office of Behavioral Health, New York, NY, USA
| | - Brandy Henry
- College of Education, Consortium on Substance Use and Addiction, Social Science Research Institute, Pennsylvania State University, University Park, PA, USA
| | - Noa Krawczyk
- Department of Population Health, New York University, New York, NY, USA
| | - Arthur Robin Williams
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
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21
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Khan AM, Ahmed I, Jawwad M, Islam M, Tahir R, Anwar S, Nauman AA, Bhutta ZA. A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage. Pathogens 2024; 13:185. [PMID: 38535529 PMCID: PMC10975858 DOI: 10.3390/pathogens13030185] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 04/01/2024] Open
Abstract
Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.
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Affiliation(s)
- Amira M. Khan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
| | - Muhammad Jawwad
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
| | - Rehman Tahir
- Trust for Vaccines and Immunization, Al Sehat Centre, Rafiqui Shaheed Road, Karachi 74350, Pakistan;
| | - Saeed Anwar
- Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan; (S.A.); (A.A.N.)
| | - Ahmed Ali Nauman
- Prime Foundation, Peshawar Medical College, Warsak Road, Peshawar 25160, Pakistan; (S.A.); (A.A.N.)
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G OA4, Canada; (A.M.K.); (M.I.)
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; (I.A.); (M.J.)
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22
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Dadari I, Vilajeliu A, Berdaga V, Rozario S, Meyer P, Nic Lochlainn L, Horemans D, Toro N, Lihemo G, Bhardwaj S, Cowley P, Chang Blanc D, Conteh-Nordman F, Mirza I, Malm S, Ameda IM, Lindstrand A. Key Learnings from the Development and Early Use of Global Guidance on the Integration of COVID-19 Vaccination into Broader Health Systems. Vaccines (Basel) 2024; 12:196. [PMID: 38400179 PMCID: PMC10892213 DOI: 10.3390/vaccines12020196] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics.
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Affiliation(s)
- Ibrahim Dadari
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Alba Vilajeliu
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | - Viorica Berdaga
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Shalini Rozario
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Phoebe Meyer
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Laura Nic Lochlainn
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | - Dirk Horemans
- Integrated Health Services Department, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Nuria Toro
- Integrated Health Services Department, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Gloria Lihemo
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Sanjay Bhardwaj
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Peter Cowley
- Health Systems Governance and Financing, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Diana Chang Blanc
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | | | - Imran Mirza
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Shahira Malm
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Ida Marie Ameda
- UNICEF Eastern and Southern Africa Regional Office, Nairobi P.O. Box 44145, Kenya
| | - Ann Lindstrand
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
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Gutiérrez-Alba G, Muños Hernández JA, Juárez-Ramírez C, Reartes-Peñafiel DL, Reyes-Morales H. Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study. Health Educ Behav 2024:10901981241230492. [PMID: 38334128 DOI: 10.1177/10901981241230492] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. AIMS To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. METHODS This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. RESULTS The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. CONCLUSIONS We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.
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Affiliation(s)
| | | | | | | | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, MOR, México
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24
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Marme G, Kuzma J, Zimmerman PA, Harris N, Rutherford S. Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea. J Public Health (Oxf) 2024:fdae018. [PMID: 38326281 DOI: 10.1093/pubmed/fdae018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. METHODS Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. RESULTS Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. CONCLUSIONS The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.
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Affiliation(s)
- Gigil Marme
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
| | - Jerzy Kuzma
- Department of Medicine, Divine Word University, Madang Province 511, Papua New Guinea
| | - Peta-Anne Zimmerman
- Graduate Infection Prevention and Control Program, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4215, Australia
| | - Neil Harris
- Higher Degree Research, Health Group, School of Medicine and Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
| | - Shannon Rutherford
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD 4215, Australia
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25
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Fantus S, Cole R, Usset TJ, Hawkins LE. Multi-professional perspectives to reduce moral distress: A qualitative investigation. Nurs Ethics 2024:9697330241230519. [PMID: 38317421 DOI: 10.1177/09697330241230519] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. RESEARCH OBJECTIVE The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. PARTICIPANTS & RESEARCH CONTEXT Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. RESEARCH DESIGN Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. ETHICAL CONSIDERATIONS Ethics approval was obtained from the university and medical center institutional review boards. FINDINGS Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. CONCLUSION Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being.
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26
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Finn J, Dixon JM, Moreira F, Herbst C, Bhaumik S, Fleischer CL, Stassen W, Beaty B, Lourens D, Verster J, Fosdick B, Lategan HJ, de Vries S, Uren G, Wylie C, Steyn E, Geduld H, Mould-Millman NK. Patterns of on-scene and healthcare system trauma deaths in the Western Cape of South Africa. World J Surg 2024; 48:320-330. [PMID: 38310308 DOI: 10.1002/wjs.12043] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Injuries account for 8% or 4.4 million deaths annually worldwide, with 90% of injury deaths occurring in low- and middle-income countries. Inter-personal violence and road traffic injuries account for most injury deaths in South Africa, with rates among the highest globally. Understanding the location, timing, and factors of trauma deaths can identify opportunities to strengthen care. METHODS This is a retrospective cross-sectional secondary analysis of trauma deaths from 2021 to 2022 in the Western Cape of South Africa. Healthcare system trauma deaths were identified from a multicenter study paired with a dataset for on-scene (i.e., prior to ambulance or hospital) trauma deaths in the same jurisdictions. We describe locations, timing, injury factors, and cause of death. We assess associations between those factors. RESULTS There were 2418 deaths, predominantly young men, with most (2274, 94.0%) occurring on-scene. The most frequent mechanism of injury for all deaths was firearms (32.6%), followed by road traffic collisions (17.8%). On-scene deaths (33.2%) were significantly more likely to be injured by firearms compared to healthcare system deaths (23.6%) (p-value <0.01). Most healthcare system deaths within 4-24 h of injury occurred in a hospital emergency center. Among healthcare system decedents, half died in the emergency unit. CONCLUSIONS We identified a large burden of deaths from interpersonal violence and road traffic collisions, mostly on-scene. In addition to primary prevention, shortening delays to care can improve mortality outcomes especially for deaths occurring within 4-24 h in emergency centers.
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Affiliation(s)
- Julia Finn
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julia M Dixon
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fabio Moreira
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Celeste Herbst
- Forensic Pathology Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Smitha Bhaumik
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chelsie L Fleischer
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Services (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Denise Lourens
- Forensic Pathology Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Janette Verster
- Division of Forensic Medicine, Stellenbosch University, Cape Town, South Africa
| | - Bailey Fosdick
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Shaheem de Vries
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Grace Uren
- Division of Forensic Medicine, Stellenbosch University, Cape Town, South Africa
| | - Craig Wylie
- Emergency Medical Services, Western Cape Government Health and Wellness, Cape Town, South Africa
| | - Elmin Steyn
- Division of Surgery, Stellenbosch University, Cape Town, South Africa
| | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Nee-Kofi Mould-Millman
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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27
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Zafra-Tanaka JH, Del Valle A, Bernabé-Ortiz A, Miranda JJ, Beran D. Outcomes measured in studies assessing health systems interventions for type 1 diabetes management: A scoping review. Diabet Med 2024; 41:e15223. [PMID: 37683837 DOI: 10.1111/dme.15223] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
AIMS Describe the outcomes reported in research on health systems interventions for type 1 diabetes management in comparison to the outcomes proposed by a core outcome set (COS) for this condition, an essential list of outcomes that studies should measure. METHODS Systematic search of studies published between 2010 and 2021 reporting health systems interventions directed to improve the management of type 1 diabetes using PubMed, EMBASE and CENTRAL. Information on the outcomes was extracted and classified according to a COS: self-management, level of clinical engagement, perceived control over diabetes, diabetes-related quality of life, diabetes burden, diabetes ketoacidosis, severe hypoglycemia, and glycated hemoglobin (HbA1C). RESULTS 187 studies were included. Most of the studies included either children (n = 82/187) or adults (n = 82/187) living with type 1 diabetes. The most common outcome measured was HbA1C (n = 149/187), followed by self-management (n = 105/187). While the least measured ones were diabetes ketoacidosis (n = 15/187), and clinical engagement (n = 0/187). None of the studies measured all the outcomes recommended in the COS. Additionally, different tools were found to be used in measuring the same outcome. CONCLUSIONS This study provides a description of what researchers are measuring when assessing health systems interventions to improve type 1 diabetes management. In contrast to a COS, it was found that there is a predominance of clinical-based outcomes over patient-reported outcome measures.
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Adela Del Valle
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
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28
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Mew EJ, Blas V, Winschel J, Hunt L, Soliai-Lemusu S, Johansson A, Lowe SR, Faiai M, Naseri J, Toelupe RL, Ipou F, Seui M, Ledoux-Sunia T, Sunia F, Galea’i A, Poulin R, Hawley NL, McCutchan-Tofaeono J. "There are still broken or fragmented systems": Qualitative assessment of needs to strengthen adolescent mental health services in American Samoa. Int J Ment Health Nurs 2024; 33:85-92. [PMID: 37691318 PMCID: PMC10872981 DOI: 10.1111/inm.13223] [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: 01/18/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
Mental health challenges appear common among adolescents in American Samoa. There is a community-identified need to better understand the health burden and identify opportunities to strengthen the mental health system to better meet adolescent mental health needs. The goal of this qualitative study was to gather community stakeholders' perceptions of common mental health problems among adolescents in American Samoa, identify existing services for adolescent mental health, and highlight strength-based opportunities to enhance care. Using the Fa'afaletui research framework, semi-structured in-depth interviews (n = 28) were conducted between October 2020 and February 2021 using Zoom. Key informants were adults living in American Samoa, sampled for diversity in profession, age, gender, education, and region of residence. Transcripts were coded in duplicate and analysed using deductive thematic analysis. Participants reported that suicide, depression, anxiety, and post-traumatic stress disorder are the conditions of highest burden. Participants identified an impressive amount of infrastructure and community mobilization, but also limitations in these services in addressing adolescents' health needs. Four themes arose related to the need to: (1) strengthen existing infrastructure; (2) reduce barriers to treatment access; (3) improve sustainability; and (4) encourage collaboration among leaders. Policymakers should prioritize the allocation of resources to strengthen infrastructure, public education, and stakeholder collaboration to improve adolescent mental health in American Samoa.
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Affiliation(s)
- Emma J. Mew
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Vanessa Blas
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Julia Winschel
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Leiema Hunt
- Department of Health, American Samoa Government, Pago Pago, American Samoa, USA
| | | | - Astrid Johansson
- Department of Health, American Samoa Government, Pago Pago, American Samoa, USA
| | - Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Joshua Naseri
- Obesity, Lifestyle, And Genetic Adaptations (OLAGA) Study Group, Pago Pago, American Samoa, USA
| | | | | | | | - Trude Ledoux-Sunia
- Christopher James Foeoletini Ledoux Foundation, Pago Pago, American Samoa, USA
| | - Fiafia Sunia
- Christopher James Foeoletini Ledoux Foundation, Pago Pago, American Samoa, USA
| | - Ariel Galea’i
- Behavioral Health Clinic, Lyndon B. Johnson Tropical Medical Center, Pago Pago, American Samoa, USA
| | - Rhayna Poulin
- Yale College, Yale University, New Haven, Connecticut
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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29
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Balasubramanian M, Shafei AA, Liang Z. Editorial: Innovations in older adult care and health service management: a focus on the Asia-Pacific region. Front Public Health 2024; 12:1369827. [PMID: 38356952 PMCID: PMC10865723 DOI: 10.3389/fpubh.2024.1369827] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Madhan Balasubramanian
- Flinders University, College of Business Government and Law, Healthcare Management and Centre for Social Impact, Adelaide, SA, Australia
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy and Economics, Sydney, NSW, Australia
- The University of Adelaide, Faculty of Health Sciences, Australian Research Centre for Population Oral Health, Adelaide, SA, Australia
| | - Angie A. Shafei
- Flinders University, College of Business Government and Law, Healthcare Management, Adelaide, SA, Australia
| | - Zhanming Liang
- James Cook University, College of Public Health, Medical and Vet Sciences, Australian Institute of Tropical Health and Medicine, Townsville, QLD, Australia
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30
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Fernández-Salido M, Alhambra-Borrás T, Casanova G, Garcés-Ferrer J. Value-Based Healthcare Delivery: A Scoping Review. Int J Environ Res Public Health 2024; 21:134. [PMID: 38397625 PMCID: PMC10888410 DOI: 10.3390/ijerph21020134] [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] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.
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Affiliation(s)
- Mirian Fernández-Salido
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Tamara Alhambra-Borrás
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Georgia Casanova
- Centre for Socio-Economic Research on Ageing, IRCCS-INRCA National Institute of Health & Science on Ageing, 60124 Ancona, Italy;
| | - Jorge Garcés-Ferrer
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
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31
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Forbes RA, Crossley R, Stevens A, James R, Black M, Foster CR, Such E. What's love got to do with it? Exploring social love and public health. Perspect Public Health 2024:17579139231220557. [PMID: 38270083 DOI: 10.1177/17579139231220557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- R A Forbes
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Street, Sheffield S1 4DA, UK
| | - R Crossley
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - A Stevens
- Yorkshire and Humber School of Public Health, Leeds, UK
| | - R James
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M Black
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - C R Foster
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - E Such
- Anne McLaren Fellow, School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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32
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Janssen AB, Kavisha S, Johnson A, Marinic A, Teede H, Shaw T. Implementation of Artificial Intelligence Applications in Australian Healthcare Organisations: Environmental Scan Findings. Stud Health Technol Inform 2024; 310:1136-1140. [PMID: 38269992 DOI: 10.3233/shti231142] [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] [Indexed: 01/26/2024]
Abstract
Artificial Intelligence (AI) has great potential to improve healthcare, but implementation into routine practice remains a challenge. This study scoped the extent to which AI and Natural Language Processing (NLP) is being implemented into routine practice in Australian healthcare organisations. An environmental scan of publicly available data was undertaken to identify AI applications. Publicly available data consisted of news posts from Australian public healthcare organisations and conference proceedings from key research organisations. Two researchers reviewed and analysed posts related to AI applications to create a list of potential implementation case studies. The final list of AI applications was reviewed by a governance committee in order to identify any missing applications. One application was identified by the governance committee and subsequently added. The environmental scan identified eighteen AI applications, of which eleven met all eligibility criteria. Only one application included NLP. Twelve applications were included when the application identified by the governance committee was added to the list. Implementation of AI applications is spread across four broad categories of use: 1) Decision Support, 2) Monitoring Treatment Effectiveness, 3) Personalised Care and 4) Risk Prediction.
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Affiliation(s)
- Anna B Janssen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shah Kavisha
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Anna Marinic
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, Melbourne, VIC, Australia
- Monash Centre for Health Research Implementation, School of Public Health, Monash University, Melbourne, VIC, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Sparkes SP, Shroff ZC, Hanson K. Still rethinking external assistance for health. Health Policy Plan 2024; 39:i1-i3. [PMID: 38253448 DOI: 10.1093/heapol/czad103] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva 1211, Switzerland
- Department of Health Financing and Economics, World Health Organization, Geneva 1211, Switzerland
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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34
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Neel AH, Rodríguez DC, Sikazwe I, Pillay Y, Barron P, Pereira SK, Makakole-Nene S, Bennett SC. HIV programme sustainability in Southern and Eastern Africa and the changing role of external assistance for health. Health Policy Plan 2024; 39:i107-i117. [PMID: 38253440 PMCID: PMC10803196 DOI: 10.1093/heapol/czad091] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/13/2023] [Indexed: 01/24/2024] Open
Abstract
High human immunodeficiency virus (HIV)-prevalence countries in Southern and Eastern Africa continue to receive substantial external assistance (EA) for HIV programming, yet countries are at risk of transitioning out of HIV aid without achieving epidemic control. We sought to address two questions: (1) to what extent has HIV EA in the region been programmed and delivered in a way that supports long-term sustainability and (2) how should development agencies change operational approaches to support long-term, sustainable HIV control? We conducted 20 semi-structured key informant interviews with global and country-level respondents coupled with an analysis of Global Fund budget data for Malawi, Uganda, and Zambia (from 2017 until the present). We assessed EA practice along six dimensions of sustainability, namely financial, epidemiological, programmatic, rights-based, structural and political sustainability. Our respondents described HIV systems' vulnerability to donor departure, as well as how development partner priorities and practices have created challenges to promoting long-term HIV control. The challenges exacerbated by EA patterns include an emphasis on treatment over prevention, limiting effects on new infection rates; resistance to service integration driven in part by 'winners' under current EA patterns and challenges in ensuring coverage for marginalized populations; persistent structural barriers to effectively serving key populations and limited capacity among organizations best positioned to respond to community needs; and the need for advocacy given the erosion of political commitment by the long-term and substantive nature of HIV EA. Our recommendations include developing a robust investment case for primary prevention, providing operational support for integration processes, investing in local organizations and addressing issues of political will. While strategies must be locally crafted, our paper provides initial suggestions for how EA partners could change operational approaches to support long-term HIV control and the achievement of universal health coverage.
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Affiliation(s)
- Abigail H Neel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), 34620 Lukasu Road, Mass Media, Lusaka 10101, Zambia
| | - Yogan Pillay
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Shreya K Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Sara C Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Kim E, Park YL, Lo YR, Keoprasith B, Panyakeo S. Sustaining essential health services in Lao PDR in the context of donor transition and COVID-19. Health Policy Plan 2024; 39:i131-i136. [PMID: 38253449 DOI: 10.1093/heapol/czad090] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/08/2023] [Indexed: 01/24/2024] Open
Abstract
Lao People's Democratic Republic (Lao PDR) aims at graduating from least developed country status by 2026 and must increase the level of domestic financing for health. This paper examines how the government has prepared for the decline of external assistance and how donors have applied their transition approaches. Adapting a World Health Organization (WHO) framework, reflections and lessons were generated based on literature review, informal and formal consultations and focus group discussions with the Lao PDR government and development partners including budget impact discussion. The government has taken three approaches to transition from external to domestic funding: mobilizing domestic resources, increasing efficiency across programs and prioritization with a focus on strengthening primary health care (PHC). The government has increased gradually domestic government health expenditures as a share of the government expenditure from 2.6% in 2013 to 4.9% in 2019. The Ministry of Health has made efforts to design and roll out integrated service delivery of maternal, newborn, child, and adolescent health services, immunization and nutrition; integrated 13 information systems of key health programs into one single District Health Information Software 2; and prioritized PHC, which has led to shifting donors towards supporting PHC. Donors have revisited their aid policies designed to improve sustainability and ownership of the government. However, the government faces challenges in improving cross-programmatic efficiency at the operational level and in further increasing the health budget due to the economic crisis aggravated during Coronavirus disease 2019 (COVID-19). Working to implement donor transition strategies under the current economic situation and country challenges, calls into question the criteria used to evaluate transition. This criterion needs to include more appropriate indicators other than gross national income per capita, which does not reflect a country's readiness and capacity of the health system. There should be a more country-tailored strategy and support for considering the context and system-wide readiness during donor transition.
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Affiliation(s)
- Eunkyoung Kim
- Health System Development team, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Yu Lee Park
- Health System Development team, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Ying-Ru Lo
- WHO Representative to Lao People's Democratic Republic, World Health Organization Country Office for the Lao People's Democratic Republic, 125 Saphanthong Road, Unit 5, Ban Saphanthongtai, Sisattanak District, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Bounserth Keoprasith
- Department of Planning and Finance, Ministry of Health, Ban Thatkhao, Sisattanack District, Rue Simeuang, Vientiane Capital 0103, Lao People's Democratic Republic
| | - Suphab Panyakeo
- Department of Planning and Finance, Ministry of Health, Ban Thatkhao, Sisattanack District, Rue Simeuang, Vientiane Capital 0103, Lao People's Democratic Republic
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Zakumumpa H, Paina L, Ssegujja E, Shroff ZC, Namakula J, Ssengooba F. The impact of shifts in PEPFAR funding policy on HIV services in Eastern Uganda (2015-21). Health Policy Plan 2024; 39:i21-i32. [PMID: 38253438 PMCID: PMC10803197 DOI: 10.1093/heapol/czad096] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/24/2024] Open
Abstract
Although donor transitions from HIV programmes are increasingly common in low-and middle-income countries, there are limited analyses of long-term impacts on HIV services. We examined the impact of changes in President's Emergency Plan for AIDS Relief (PEPFAR) funding policy on HIV services in Eastern Uganda between 2015 and 2021.We conducted a qualitative case study of two districts in Eastern Uganda (Luuka and Bulambuli), which were affected by shifts in PEPFAR funding policy. In-depth interviews were conducted with PEPFAR officials at national and sub-national levels (n = 46) as well as with district health officers (n = 8). Data were collected between May and November 2017 (Round 1) and February and June 2022 (Round 2). We identified four significant donor policy transition milestones: (1) between 2015 and 2017, site-level support was withdrawn from 241 facilities following the categorization of case study districts as having a 'low HIV burden'. Following the implementation of this policy, participants perceived a decline in the quality of HIV services and more frequent commodity stock-outs. (2) From 2018 to 2020, HIV clinic managers in transitioned districts reported drastic drops in investments in HIV programming, resulting in increased patient attrition, declining viral load suppression rates and increased reports of patient deaths. (3) District officials reported a resumption of site-level PEPFAR support in October 2020 with stringent targets to reverse declines in HIV indicators. However, PEPFAR declared less HIV-specific funding. (4) In December 2021, district health officers reported shifts by PEPFAR of routing aid away from international to local implementing partner organizations. We found that, unlike districts that retained PEPFAR support, the transitioned districts (Luuka and Bulambuli) fell behind the rest of the country in implementing changes to the national HIV treatment guidelines adopted between 2017 and 2020. Our study highlights the heavy dependence on PEPFAR and the need for increasing domestic financial responsibility for the national HIV response.
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Affiliation(s)
- Henry Zakumumpa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, P O Box 7061, Kampala, Uganda
| | - Ligia Paina
- Bloomberg School of Public Health, Johns Hopkins University, P O Box 7062, Kampala, Uganda
| | - Eric Ssegujja
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, P O Box 7061, Kampala, Uganda
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Justin Namakula
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, P O Box 7061, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, P O Box 7061, Kampala, Uganda
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Rannan-Eliya RP, Ghaffoor A, Amarasinghe S, Nirmani MD, Wijemunige N, Perera S, Samarage S, Dalpatadu K, Wisidagama N, Fonseka S, Kumara N, Selvaratnam A, Dananjana T. Sri Lanka's COVID-19 response and maintaining health services: implications for future pandemics. BMJ Glob Health 2024; 8:e013286. [PMID: 38238029 PMCID: PMC10846852 DOI: 10.1136/bmjgh-2023-013286] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/24/2023] [Indexed: 01/23/2024] Open
Abstract
This study examines how Sri Lanka, a lower-middle income country, managed its COVID-19 response and maintained health services. It draws on an extensive document review, key informant interviews and a national survey of public experience and opinion to assess what Sri Lanka did, its effectiveness and why.Owing to a strong health system and luck, Sri Lanka stopped the first wave of COVID-19 infections, and it adopted a 'Zero-COVID' approach with the explicit goal of stopping outbreaks. This was initially effective. Outbreaks reduced healthcare use, but with minimal impact on health outcomes. But from end-2020, Sri Lanka switched its approach to tolerating transmission and mitigation. It took proactive actions to maintain healthcare access, and it pursued a COVID-19 vaccination effort that was successful in covering its adult population rapidly and with minimal disparities. Despite this, widespread transmission during 2021-2022 disrupted health services through the pressure on health facilities of patients with COVID-19 and infection of healthcare workers, and because COVID-19 anxiety discouraged patients from seeking healthcare. This led to substantial mortality and more than 30 000 excess deaths by 2022.We find that Sri Lanka abandoned its initially successful approach, because it failed to understand that its chosen strategy required symptomatic PCR testing in primary care. Failure to invest in testing was compounded by groupthink and a medical culture averse to testing.Sri Lanka's experience confirms that strong public health capacities, robust healthcare systems and intersectoral action are critical for pandemic response. It shows that civilian-military collaboration can be beneficial but contested, and that lack of fiscal space will undermine any response. It also demonstrates that pandemic preparedness cannot guarantee a successful pandemic response. Policy and research must pay more attention to improving decision-making processes when faced with pandemics involving novel pathogens, rapid spread, and substantial scientific uncertainty.
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Maliqi B, Cocoman O, Dohlsten M, Dussey S, Hinton R, Mannah MT, Muzigaba M, Rammal T, Sabiiti J, Yaqub N, Banerjee A. Strengthening the policy, implementation, and accountability environment for quality care: experiences from quality of care network countries. Front Health Serv 2024; 3:1292510. [PMID: 38292915 PMCID: PMC10825031 DOI: 10.3389/frhs.2023.1292510] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
Despite global commitment to universal health coverage with quality, poor quality of care (QOC) continues to impact health outcomes for mothers and newborns, especially in low-and-middle income countries. Although there is much experience from small-scale projects, without a long-term perspective it is unclear how to implement quality of care effectively and consistently for impact. In 2017, ten countries together with the WHO and a coalition of partners established the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network). The Network agreed to pursue four strategic objectives-Leadership, Action, Learning and Accountability (LALA) for QOC. This paper describes, analyses and reflects on what has worked and some of the challenges faced in implementation of the LALA framework. The implementation of the LALA framework has served as a catalyst to develop an enabling environment for QOC in the Network countries through strengthening the policy, implementation, accountability and community engagement for quality care. Developing an enabling health system environment takes time, but it is possible and shows results. The implementation shows that health systems continue to face persistent challenges such as capacities to quickly scale up changes across subnational levels, limited workforce capability to implement quality improvement consistently and gaps in quality of relevant data. The implementation has also highlighted the need to develop new mechanisms for community engagement and learning systems that inform scaling up of good QOC practices across programmes and levels of care. Moving forward, the Network countries will build on the experiences and lessons learned and continue to strengthen the implementation of LALA strategic objectives for impact. We hope the Network experience will encourage other countries and partners to adopt the Network implementation model to enable delivery of quality care for everyone, everywhere, and actively collaborate and contribute to the QOC global learning network.
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Affiliation(s)
- Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Olive Cocoman
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Martin Dohlsten
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Selina Dussey
- Quality Management Unit, Ministry of Health, Accra, Ghana
| | | | - Margaret T. Mannah
- National Quality Management Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Tala Rammal
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Jesca Sabiiti
- Department of Reproductive and Child Health, Ministry of Health, Kampala, Uganda
| | - Nuhu Yaqub
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
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Rada I, Cabieses B. Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems. Front Public Health 2024; 11:1125090. [PMID: 38274523 PMCID: PMC10809178 DOI: 10.3389/fpubh.2023.1125090] [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: 12/15/2022] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.
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Affiliation(s)
- Isabel Rada
- Centro de Salud Global Intercultural (CeSGI), Facultad de Medicina Clínica Alemana, Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
- Programa de Doctorado en Ciencias e Innovación en Medicina, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Baltica Cabieses
- Centro de Salud Global Intercultural (CeSGI), Facultad de Medicina Clínica Alemana, Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, York, United Kingdom
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Kuhlmann E, Falkenbach M, Brînzac MG, Correia T, Panagioti M, Ungureanu MI. The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries. Int J Health Plann Manage 2024. [PMID: 38193752 DOI: 10.1002/hpm.3752] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The healthcare workforce (HCWF) globally is facing high stress levels and deteriorating mental health due to workplace, labour market and policy deficiencies that further exacerbate the existing crisis. However, comprehensive and effective action is missing. AIMS We adopt a health system and governance perspective to address the mental health needs of healthcare workers (HCWs), considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. MATERIAL AND METHODS A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. We conducted a rapid assessment of HCWF developments in the European context (Germany, Portugal, Romania, Switzerland and the United Kingdom), drawing on secondary sources and country experts. RESULTS AND DISCUSSION Awareness of mental health threats among HCWs increased, but policy discourse is driven by service delivery and labour market demands. The attention to HCWs' needs is stronger on the international level and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. CONCLUSION Adopting a health system approach is important but not sufficient. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms.
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Affiliation(s)
- Ellen Kuhlmann
- Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Frankfurt, Germany
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Michelle Falkenbach
- European Observatory on Health Systems and Policies, Brussels, Belgium
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Monica-Georgiana Brînzac
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Tiago Correia
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Marius-Ionut Ungureanu
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisbon, Portugal
- Faculty of Political, Administrative and Communication Sciences, Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Faculty of Political, Administrative and Communication Sciences, Center for Health Workforce Research and Policy, Babeș-Bolyai University, Cluj-Napoca, Romania
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Wang X, Yang E, Zheng C, Yuan S. Effects of vertical integration on the healthcare system in China: a systematic review and meta-analysis. Health Policy Plan 2024; 39:66-79. [PMID: 37768012 PMCID: PMC10775222 DOI: 10.1093/heapol/czad085] [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] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/04/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023] Open
Abstract
Vertical integration is one possible way to improve the performance of a healthcare system; however, its effects are inconsistent, and there is a lack of evidence from undeveloped nations. This study aims to systematically review the evidence regarding effects of vertical integration on healthcare systems in China. We searched PubMed, Embase, Cochrane Library, Web of Science, ProQuest Health & Medicine Collection, China Knowledge Resource Integrated Database and Wanfang databases from April 2009 (initiation of new healthcare reform) to May 2021 for randomized controlled trials (RCTs), controlled before and after (CBA) trials, cohort studies and interrupted time series (ITS) trials. Vertical integration in the included studies must involve both primary health institutions and secondary or tertiary hospitals. After screening 3109 records, we ultimately analysed 47 studies, including 27 CBA trials, 18 RCTs and 2 ITS trials. The narrative synthesis shows that all but three studies indicated that vertical integration improved efficiency (utilization and cost of health services), quality of public health services and medical services, health provider-centred outcomes (knowledge and skill) and patient-centred outcomes (patients' clinical outcomes, behaviour and satisfaction). Despite the heterogeneity of vertical integration interventions across different studies, the meta-analysis reveals that it lowered diastolic blood pressure (mean difference (MD) -8.41, 95% confidence interval (CI) -15.18 to -1.65) and systolic blood pressure (MD-5.83, 95% CI -9.25 to -2.40) among hypertension patients, and it lowered HbA1c levels (MD -1.95, 95% CI -2.69 to -1.21), fasting blood glucose levels (MD -1.02, 95% CI -1.53 to -0.50) and 2-hour postprandial blood glucose levels (MD -1.78, 95% CI -2.67 to -0.89). The treatment compliance behaviour was improved for hypertension participants (risk ratio (RR) 1.08, 95% CI 1.04-1.13) and for diabetes patients (RR 1.32, 95% CI 1.08-1.61). Vertical integration in China can improve efficiency, quality of care, health provider-centred outcomes and patient-centred outcomes, but high-quality original studies are highly needed.
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Affiliation(s)
- Xin Wang
- School of public health, Sun Yat-Sen University, No. 74 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Enming Yang
- School of Labor and Human Resources, Renmin University of China, No.59 Zhongguancun Street, Beijing 100872, China
- Organization and Personnel Department, Beijing Hospitals Authority, No. 70 Zaolinqian Street, Xicheng District, Beijing 100053, China
| | - Caiyun Zheng
- School of public health, Sun Yat-Sen University, No. 74 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Shasha Yuan
- Center for Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 3 Yabao Road, Chaoyang District, Beijing 100020, China
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Ruffner M, Reid M, Nandakumar A, Bartee M, Dominis S, Saya UY, Nkengasong JN. Accelerating and sustaining progress: PEPFAR's path to achieving 95-95-95 by 2030. BMJ Glob Health 2024; 9:e014513. [PMID: 38184300 PMCID: PMC10773333 DOI: 10.1136/bmjgh-2023-014513] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 01/08/2024] Open
Affiliation(s)
- Michael Ruffner
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
| | - Michael Reid
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
- Institute of Global Health Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Allyala Nandakumar
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
- Institute for Global Health and Development, Heller Graduate School, Brandeis University, Waltham, Massachusetts, USA
| | - Maureen Bartee
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
| | - Sarah Dominis
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
| | - Uzaib Y Saya
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
| | - John N Nkengasong
- Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief, Washington, District of Columbia, USA
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Eze P, Idemili CJ, Lawani LO. Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis. Inquiry 2024; 61:469580241235759. [PMID: 38456456 PMCID: PMC10924553 DOI: 10.1177/00469580241235759] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.
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Affiliation(s)
- Paul Eze
- Penn State University, University Park, PA, USA
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Attwood LO, O'Keefe D, Higgs P, Vujovic O, Doyle JS, Stewardson AJ. Epidemiology of acute infections in people who inject drugs in Australia. Drug Alcohol Rev 2024; 43:304-314. [PMID: 37995135 PMCID: PMC10952783 DOI: 10.1111/dar.13772] [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] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
ISSUES People who inject drugs are at risk of acute infections, such as skin and soft tissue infections, infective endocarditis, bone and joint infections and bloodstream infections. There has been an increase in these infections in people who inject drugs internationally over the past 10 years. However, the local data regarding acute infections in Australia has not been well described. APPROACH We review the epidemiology of acute infections and associated morbidity and mortality amongst people who inject drugs in Australia. We summarise risk factors for these infections, including the concurrent social and psychological determinants of health. KEY FINDINGS The proportion of people who report having injected drugs in the prior 12 months in Australia has decreased over the past 18 years. However, there has been an increase in the burden of acute infections in this population. This increase is driven largely by skin and soft tissue infections. People who inject drugs often have multiple conflicting priorities that can delay engagement in care. IMPLICATIONS Acute infections in people who inject drugs are associated with significant morbidity and mortality. Acute infections contribute to significant bed days, surgical requirements and health-care costs in Australia. The increase in these infections is likely due to a complex interplay of microbiological, individual, social and environmental factors. CONCLUSION Acute infections in people who inject drugs in Australia represent a significant burden to both patients and health-care systems. Flexible health-care models, such as low-threshold wound clinics, would help directly target, and address early interventions, for these infections.
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Affiliation(s)
- Lucy O. Attwood
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical SchoolMonash UniversityMelbourneAustralia
| | | | - Peter Higgs
- Burnet InstituteMelbourneAustralia
- Department of Public HealthLa Trobe UniversityMelbourneAustralia
| | - Olga Vujovic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical SchoolMonash UniversityMelbourneAustralia
| | - Joseph S. Doyle
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical SchoolMonash UniversityMelbourneAustralia
- Burnet InstituteMelbourneAustralia
| | - Andrew J. Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical SchoolMonash UniversityMelbourneAustralia
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Umar N, Hill Z, Schellenberg J, Sambo NU, Shuaibu A, Aliyu AM, Kulani KK, Abdullahi MU, Usman A, Mohammed H, Adamu H, Ibrahim M, Mohammed A, Abdulhamid A, Muhammed Z, Alfayo A, Marchant T. Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment. BMJ Glob Health 2023; 8:e013498. [PMID: 38148109 PMCID: PMC10753731 DOI: 10.1136/bmjgh-2023-013498] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has accelerated the use of mobile phones to provide primary health care services and maintain continuity of care. This study aims to understand rural women's preferences for telephone call engagement with primary health care providers in Nigeria. METHODS A discrete choice experiment was conducted alongside an action research project that empowered primary health care workers to develop and implement a telephone call intervention to assess and enhance experiences with facility childbirth care. Between January and March 2022, 30 providers from 10 primary health care facilities implemented the choice experiment among rural women who had institutional childbirth to elicit service user preferences for telephone call engagement. The women were asked to express their preferred scenario for telephone call engagement with their primary health care providers. Generalised linear mixed models were used to estimate women's preferences. RESULTS Data for 460 women were available for the discrete choice experiment. The study showed that rural women have preferences for telephone call engagement with primary health care providers. Specifically, women preferred engaging with female to male callers (β=1.665 (95% CI 1.41, 1.93), SE=0.13, p<0.001), preferred call duration under 15 min (β=1.287 (95% CI 0.61, 1.96), SE=0.34, p<0.001) and preferred being notified before the telephone engagement (warm calling) (β=1.828 (95% CI 1.10, 2.56), SE=0.37, p<0.001). Phone credit incentive was also a statistically significant predictor of women's preferences for engagement. However, neither the availability of scheduling options, the period of the day or the day of the week predicts women's preferences. CONCLUSIONS The study highlights the importance of understanding rural women's preferences for telephone call engagement with healthcare providers in low-income and middle-income countries. These findings can inform the development of mobile phone-based interventions and improve acceptability and broader adoption.
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Affiliation(s)
- Nasir Umar
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Abdulrahman Shuaibu
- Office of the Executive Secretary, State Primary Health Care Development Agency, Gombe, Nigeria
| | | | | | | | - Ahmed Usman
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hafsat Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Hajara Adamu
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Maryam Ibrahim
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adamu Mohammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Adama Abdulhamid
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Zainab Muhammed
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Afodiya Alfayo
- Gombe State Primary Health Care Development Agency, Gombe, Nigeria
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Mataria A, Majdzadeh R, Al Asfoor D, Salah H, Mirza Z. Translating political commitments into actions to enhance Universal Health Coverage in the Eastern Mediterranean Region. East Mediterr Health J 2023; 29:980-986. [PMID: 38279866 DOI: 10.26719/emhj.23.112] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/26/2023] [Indexed: 01/29/2024]
Abstract
Background Many countries in the Eastern Mediterranean Region (EMR) have developed packages of services for achieving Universal Health Coverage (UHC), however, policymakers, especially in resource-constrained countries, still face challenges in delivering equitable, efficient and sustainable health services. Aims To provide guidance for EMR countries and develop packages of services for UHC. Methods We used information gathered from narrative reviews, national experiences and expert consultations to develop step-by-step guidance for the development of national packages of services for the achievement of UHC by countries in the EMR. Results The processes used to develop packages of services varied between EMR countries and these processes may not have involved all relevant stakeholders. We highlight in this paper the iterative processes, including several phases and steps, to be used by EMR countries for developing packages of services for UHC. These processes also make provision for continuous monitoring and revision to make necessary improvements as morbidity patterns evolve. Conclusion Developing a package of services for the achievement of UHC is a significant milestone for EMR countries and it is central to shaping the healthcare system for effective delivery of services.
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Affiliation(s)
- Awad Mataria
- Universal Health Coverage and Health Systems Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Reza Majdzadeh
- Interdisciplinary Research and Practice Division, School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Deena Al Asfoor
- Universal Health Coverage and Health Systems Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hassan Salah
- Universal Health Coverage and Health Systems Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Zafar Mirza
- Universal Health Coverage and Health Systems Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Shifa Tameer-i-Millat University, Islamabad, Pakistan
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Mani V, Pomer A, Madsen C, Coles CL, Schoenfeld AJ, Weissman JS, Koehlmoos TP. Filling the Gaps in the Pandemic Response: Impact of COVID-19 on Telehealth in the Military Health System. Telemed J E Health 2023. [PMID: 38126844 DOI: 10.1089/tmj.2023.0478] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Introduction: As a result of the COVID-19 pandemic, telehealth use became widespread, allowing for continued health care while minimizing COVID-19 transmission risk for patients and providers. This rapid scale-up highlighted shortcomings of the current telehealth infrastructure in many health systems. We aimed to identify and address gaps in the United States Military Health System (MHS) response to the COVID-19 pandemic related to the implementation and utilization of telehealth. Methods: We conducted semistructured key informant interviews of MHS stakeholders, including policymakers, program managers, and health care providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo. Results: We interviewed 28 key informants. Several themes emerged from the interviews and were categorized into four defined areas of obstacles to the effective utilization of telehealth: administrative, technical, organizational, and quality issues. While respondents had positive perceptions of telehealth, issues such as billing, licensure portability, network connectivity and technology, and ability to monitor health outcomes represent major barriers in the current system, preventing the potential for further expansion. Conclusions: While the shift to telehealth during the COVID-19 pandemic demonstrated robust potential within the MHS, it highlighted shortcomings that impair the utility and expansion of telehealth on a level comparable to that of other large health systems. Future focus should be directed toward generating and implementing actionable recommendations that target these identified challenges in the MHS.
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Affiliation(s)
- Vivitha Mani
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
| | - Cathaleen Madsen
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Christian L Coles
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
- Department of Health Policy and Management, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracey Pèrez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Adhikari B, Bayo M, Peto TJ, Callery JJ, Tripura R, Dysoley L, Mshamu S, Gesase S, von Seidlein L, Dondorp AM. Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania. BMJ Glob Health 2023; 8:e013593. [PMID: 38070880 PMCID: PMC10729139 DOI: 10.1136/bmjgh-2023-013593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Makhily Bayo
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - James J Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Lek Dysoley
- C.N.M National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Salum Mshamu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
- CSK Research Solutions, Mtwara, Tanzania
| | - Samwel Gesase
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
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Douedari Y, Alhaffar M, Khanshor A, Alrashid Alhiraki O, Marzouk M, Howard N. ' COVID-19 is just another way to die…': a qualitative longitudinal study of frontline COVID-19 response governance across Syria. BMJ Glob Health 2023; 8:e013199. [PMID: 38084479 PMCID: PMC10711850 DOI: 10.1136/bmjgh-2023-013199] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Governance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control. To improve response governance, better understanding of frontline response policy implementation across the country is needed. This study thus explored perspectives of COVID-19 response governance among frontline healthcare providers over time and across major areas of control. METHODS We used a qualitative longitudinal study design, conducting five rounds of remote semistructured interviews in Arabic (ie, approximately eight interviews each in March 2020, July 2020, September 2020, December 2020 and September 2021) with 14 purposively sampled public and private healthcare providers in the three main areas of control (ie, opposition-controlled area, Autonomous Administration-controlled area and al-Assad government-controlled area (GCA)). We conducted integrative thematic analysis in Arabic within and across geography and time. RESULTS Almost all participants across all areas and rounds expressed distrust of local health authorities and dissatisfaction with COVID-19 response governance. This was most apparent in initial rounds and in GCA. Response planning was identified as insufficient, non-participatory and non-transparent. Limited infrastructure and resources were the main challenges across time, though anticipated rapid virus spread and health systems' collapse did not occur and participant optimism increased over time. Public adherence to prevention measures varied-initially weak due to general scepticism, increasing after first cases were confirmed and then fluctuating with case numbers and challenges of insecurity and misinformation. Perceptions of COVID-19 vaccination varied, with low uptake and hesitancy attributed to misinformation, disinformation and disinterest. Suggested improvements to COVID-19 response governance focused on strengthening health systems' capacity and coordination. CONCLUSION This is a unique longitudinal study of COVID-19 responses. Addressing transparency and misinformation should be a first step to improving public engagement and trust and thus response governance for health emergencies in Syria.
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Affiliation(s)
- Yazan Douedari
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Free Aleppo University, Azaz, Syria
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Mervat Alhaffar
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Ahmad Khanshor
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Omar Alrashid Alhiraki
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Acute Medicine Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Manar Marzouk
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Webb B, Carter-Templeton H, Cunningham T. An Integrative Review of "The Pause" After Patient Death. J Holist Nurs 2023:8980101231218366. [PMID: 38056072 DOI: 10.1177/08980101231218366] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Background: Healthcare providers are engrossed in high-stakes, high-stress situations during their daily work with patient death being a potential negative outcome of work-related stress. Many interventions exist to combat work-related stress among nurses. The Pause, an intervention to offer a moment of silence for the healthcare team after a patient death, is one example. Objective: An integrative review of The Pause was conducted to investigate its use and how it impacts healthcare providers and their work environments. Methods: The integrative review methodology by Whittemore and Knafl was used to guide this study. Steps included were problem identification, literature search, data evaluation, data analysis, and presentation. Content analysis was used to identify themes. Results: Seven databases were searched in 2022 and seven studies were identified for inclusion in this review. Two themes were identified: personal benefits and professional benefits. Findings reveal benefits from self-care and grief processing to a better work environment. Conclusions: The Pause is a low-cost, low-risk intervention that can be implemented at an organizational level to help reduce burnout, unresolved grief, increase resilience, increase retention, and improve patient outcomes. Future research should include an examination of how The Pause may affect patient outcomes and workplace culture.
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