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Paina L, Young R, Oladapo O, Leandro J, Chen Z, Igusa T. Prospective policy analysis-a critical interpretive synthesis review. Health Policy Plan 2024; 39:429-441. [PMID: 38412286 PMCID: PMC11005837 DOI: 10.1093/heapol/czae009] [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: 09/11/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Most policy analysis methods and approaches are applied retrospectively. As a result, there have been calls for more documentation of the political-economy factors central to health care reforms in real-time. We sought to highlight the methods and previous applications of prospective policy analysis (PPA) in the literature to document purposeful use of PPA and reflect on opportunities and drawbacks. We used a critical interpretive synthesis (CIS) approach as our initial scoping revealed that PPA is inconsistently defined in the literature. While we found several examples of PPA, all were researcher-led, most were published recently and few described mechanisms for engagement in the policy process. In addition, methods used were often summarily described and reported on relatively short prospective time horizons. Most of the studies stemmed from high-income countries and, across our sample, did not always clearly outline the rationale for a PPA and how this analysis was conceptualized. That only about one-fifth of the articles explicitly defined PPA underscores the fact that researchers and practitioners conducting PPA should better document their intent and reflect on key elements essential for PPA. Despite a wide recognition that policy processes are dynamic and ideally require multifaceted and longitudinal examination, the PPA approach is not currently frequently documented in the literature. However, the few articles reported in this paper might overestimate gaps in PPA applications. More likely, researchers are embedded in policy processes prospectively but do not necessarily write their articles from that perspective, and analyses led by non-academics might not make their way into the published literature. Future research should feature examples of testing and refining the proposed framework, as well as designing and reporting on PPA. Even when policy-maker engagement might not be feasible, real-time policy monitoring might have value in and of itself.
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Affiliation(s)
- Ligia Paina
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Ruth Young
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Oyinkansola Oladapo
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Jose Leandro
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Zhixi Chen
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, 3400 N Charles Street, Baltimore, MD 21218, USA
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Skiba EM, Drewitz KP, Panchyrz I, Deckert S, Apfelbacher C, Piontek K. [Follow-up outpatient clinics for patients with post COVID: a survey to assess and characterize aspects of care]. Dtsch Med Wochenschr 2024; 149:e48-e57. [PMID: 38621680 PMCID: PMC11018383 DOI: 10.1055/a-2255-9252] [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: 04/17/2024]
Abstract
After acute infection with the SARS-CoV-2 virus, up to 10 % of affected individuals suffer from long-term health impairments, also referred to as "Post-COVID". In Germany, specialized outpatient clinics have been established to care for patients with Post-COVID. A structured survey of the care situation is not yet available, but essential for a demand-oriented care. The present study aimed to systematically assess and describe structural and process-related aspects of care, and to perform an inventory and needs analysis of Post-COVID outpatient clinics in Germany.An online survey was developed assessing the structure and organization of the outpatient clinics, service offerings and networking of care from the perspective of the outpatient clinic directors. A total of 95 outpatient clinics were identified, and an invitation to participate in the online survey was sent via e-mail to the directors of the outpatient clinics. Data were collected between February and May 2022. Descriptive data analysis was performed.A total of 28 outpatient clinic managers (29 %) took part in the survey. Participants were between 32 and 66 years old, and 61 % (n = 17) were male. The outpatient clinics were most frequently affiliated with the specialties of pneumology (n = 10; 36 %), internal medicine, psychiatric and psychosomatic medicine, and neurology (n = 8; 29 %, respectively). Among the outpatient clinic directors, 64 % (n = 18) stated that the time spent waiting for an appointment was more than one month. Utilization (n = 25; 89 %), appointment demand (n = 26; 93 %), and the need for more Post-COVID outpatient clinics (n = 20; 71 %) were rated as high by the outpatient clinic directors. Nearly all directors reported networking with in-clinic facilities (n = 27; 96 %), with primary care physicians and with specialists in private practice (n = 21; 75 %, respectively).The main focus of care is pneumology. Internal medicine, psychiatry/psychosomatics and neurology are also equally represented. Our data further suggest a high demand for Post-COVID outpatient clinics and the need to expand this care offer.
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Affiliation(s)
- Eva-Maria Skiba
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Karl Philipp Drewitz
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Ivonne Panchyrz
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Stefanie Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Christian Apfelbacher
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
| | - Katharina Piontek
- Institut für Sozialmedizin und Gesundheitssystemforschung, Universitätsmedizin Magdeburg
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Guo B, Fan V, Strange A, Grépin KA. Understanding China's shifting priorities and priority-setting processes in development assistance for health. Health Policy Plan 2024; 39:i65-i78. [PMID: 38253445 PMCID: PMC10803198 DOI: 10.1093/heapol/czad095] [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: 01/24/2023] [Revised: 06/16/2023] [Accepted: 10/23/2023] [Indexed: 01/24/2024] Open
Abstract
Over the past two decades, China has become a distinctive and increasingly important donor of development assistance for health (DAH). However, little is known about what factors influence China's priority-setting for DAH. In this study, we provide an updated analysis of trends in the priorities of Chinese DAH and compare them to comparable trends among OECD Development Assistance Committee (DAC) donors using data from the AidData's Global Chinese Development Finance Dataset (2000-2017, version 2.0) and the Creditor Reporting System (CRS) database (2000-2017). We also analyse Chinese medical aid exports before and after the start of the COVID-19 pandemic using a Chinese Aid Exports Database. We further explore the potential factors influencing China's shifting priority-setting processes by reviewing Chinese official documents following Walt and Gilson's policy analysis framework (context-actors-process-content) and by testing our conjectures empirically. We find that China has become an important DAH donor to most regions if measured using project value, including but not limited to Africa. China has prioritized aid to African and Asian countries as well as to CRS subsectors that are not prioritized by DAC donors, such as medical services and basic health infrastructure. Chinese quarterly medical aid exports almost quintupled after the start of the COVID-19 pandemic. Noticeably, China has allocated more attention to Asia, eye diseases and infectious disease outbreaks over time. In contrast, the priority given to malaria has declined over the same period. Regarding factors affecting priority shifts, the outbreaks of SARS and Ebola, the launch of the Belt and Road Initiative and the COVID-19 pandemic appear to be important milestones in the timeline of Chinese DAH. Unlike stereotypes of China as a 'lone wolf' donor, our analysis suggests multilateral processes are influential in informing and setting Chinese DAH priorities.
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Affiliation(s)
- Bingqing Guo
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pok Fu Lam, Hong Kong SAR, Peoples’ Republic of China
| | - Victoria Fan
- Senior Fellow, Center for Global Development, Washington, DC 20036, The United States
| | - Austin Strange
- Assistant Professor, Department of Politics and Public Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, Peoples’ Republic of China
| | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pok Fu Lam, Hong Kong SAR, Peoples’ Republic of China
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Kahn NF, Asante PG, Coker TR, Kidd KM, Christakis DA, Richardson LP, Sequeira GM. Demographic Differences in Gender Dysphoria Diagnosis and Access to Gender-Affirming Care Among Adolescents. LGBT Health 2024. [PMID: 38190267 DOI: 10.1089/lgbt.2023.0273] [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: 01/10/2024] Open
Abstract
Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13-17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60-0.63) and of having accessed GAC was 0.48 (95% CI = 0.46-0.50). Various significant demographic differences emerged. Notably, Black/African American youth were the least likely to have received a GD diagnosis (Pr = 0.43, 95% CI = 0.33-0.54) and accessed GAC (Pr = 0.32, 95% CI = 0.22-0.43). Although there were no significant differences in GD diagnosis by insurance type, youth using Medicaid, other government insurance, or self-pay/charity care were less likely to have accessed GAC compared with youth using commercial/private insurance. Conclusion: Results indicate significant differences in both receipt of GD diagnosis and accessing GAC by various demographic characteristics, particularly among Black/African American youth. Identification of these differences provides an opportunity to further understand potential barriers and promote more equitable access to GAC among adolescents who desire this care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Peter G Asante
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dimitri A Christakis
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Lazo-Porras M, Penniecook T. Health equity: access to quality services and caring for underserved populations. Health Policy Plan 2023; 38:ii1-ii2. [PMID: 37995262 PMCID: PMC10666925 DOI: 10.1093/heapol/czad073] [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: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 11/25/2023] Open
Abstract
Barriers to access to quality services and caring for underserved populations are a call to action for researchers and other key partners to achieve health equity. In order to accomplish this, several key partners play important roles. More participation of younger generations, women and people of color from different contexts should be encouraged and facilitated. This editorial serves to present this journal issue that includes the articles of young women from low- and middle-income countries. Different methodologies are used to demonstrate the problem of access to quality services and care in a comprehensive way. After understanding the public health problems using an equity lens, we need to implement evidence-based interventions to improve the health system response.
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Affiliation(s)
- Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Lima 15074, Perú
| | - Tricia Penniecook
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, United States
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Lee NM, Singini D, Janes CR, Grépin KA, Liu JA. Identifying barriers to the production and use of routine health information in Western Province, Zambia. Health Policy Plan 2023; 38:996-1005. [PMID: 37655995 PMCID: PMC10566315 DOI: 10.1093/heapol/czad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/21/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Abstract
Recent decades of improvements to routine health information systems in low- and middle-income countries (LMICs) have increased the volume of health data collected. However, countries continue to face several challenges with quality production and use of information for decision-making at sub-national levels, limiting the value of health information for policy, planning and research. Improving the quality of data production and information use is thus a priority in many LMICs to improve decision-making and health outcomes. This qualitative study identified the challenges of producing and using routine health information in Western Province, Zambia. We analysed the interview responses from 37 health and social sector professionals at the national, provincial, district and facility levels to understand the barriers to using data from the Zambian health management information system (HMIS). Respondents raised several challenges that we categorized into four themes: governance and health system organization, geographic barriers, technical and procedural barriers, and challenges with human resource capacity and staff training. Staff at the facility and district levels were arguably the most impacted by these barriers as they are responsible for much of the labour to collect and report routine data. However, facility and district staff had the least authority and ability to mitigate the barriers to data production and information use. Expectations for information use should therefore be clearly outlined for each level of the health system. Further research is needed to understand to what extent the available HMIS data address the needs and purposes of the staff at facilities and districts.
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Affiliation(s)
- Na-Mee Lee
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Douglas Singini
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Western Province Health Office, Plot No. 4503, Independence Avenue, Mongu, Western Province, Zambia
| | - Craig R Janes
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Karen A Grépin
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Jennifer A Liu
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
- Department of Anthropology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
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Hunt M, Niyonsaba M, Uwitonze JM, Nyinawankusi JD, Davies J, Maine R, Nkeshimana M, Jayaraman S, Watt MH. Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda. PREHOSP EMERG CARE 2023; 28:501-505. [PMID: 37339274 PMCID: PMC10755071 DOI: 10.1080/10903127.2023.2225195] [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: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. METHODS Between August 2021 and April 2022, we conducted 13 in-depth interviews with three stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, and policymakers. Semi-structured interview guides covered three domains: 1) the process of locating an emergency, including challenges faced; 2) how challenges affect prehospital care; and 3) what opportunities exist for improvement. Interviews lasted approximately 60 min, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across the three domains. NVivo (version 12) was used to code and organize data. RESULTS The current process of locating a patient experiencing a medical emergency in Kigali is hampered by a lack of adequate technology, a reliance on local knowledge of both the caller and response team to locate the emergency, and the necessity of multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to how challenges affect prehospital care: increased response interval, variability in response interval based on both the caller's and dispatcher's individual knowledge of the area, and inefficient communication between the caller, dispatch, and ambulance. Three themes emerged related to opportunities for processes and tools to improve the location of emergencies: technology to geolocate an emergency accurately and improve the response interval, improvements in communication to allow for real-time information sharing, and better location data from the public. CONCLUSION This study has identified challenges faced by the EMS system in Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the timely locating of emergencies.
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Affiliation(s)
- McKenna Hunt
- College of Social and Behavioral Science and Honors College, University of Utah, Salt Lake City, United States
| | - Mediatrice Niyonsaba
- Division of Emergency Medical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | - Jean Marie Uwitonze
- Division of Emergency Medical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rebecca Maine
- Department of Surgery, University of Washington, Seattle, United States
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), Kigali, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah, Salt Lake City, United States
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, United States
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Glandon D, Hasan Z, Mann M, Gupta S, Marsteller J, Paina L, Bennett S. "All my co-workers are good people, but…": Collaboration dynamics between frontline workers in rural Uttar Pradesh, India. Health Policy Plan 2023:7156521. [PMID: 37148361 DOI: 10.1093/heapol/czad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/07/2023] [Accepted: 05/04/2023] [Indexed: 05/08/2023] Open
Abstract
Multi-sectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves over 100 million people annually across more than one million villages, a key point of multi-sectoral collaboration - or "convergence", as it is often called in India - is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW), and auxiliary nurse midwife (ANM), or "AAA" workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it. Informed by a conceptual framework of collaborative governance, this study applies inductive thematic analysis of in-depth interviews with 18 AAA workers and 6 medical officers from six villages across three administrative blocks in Hardoi district of Uttar Pradesh state to identifiy key elements of collaboration. These are grouped into three broad categories: organizational (including interdependence, role clarity, guidance/support, and resource availability); relational (interpersonal, conflict resolution); and personal (flexibility, diligence, locus of control). These findings underscore the importance of personal and relational collaboration features, which are underemphasized in India's ICDS, the largest of its kind globally, and in the multi-sectoral collaboration literature more broadly - both of which place greater emphasis on organizational aspects of collaboration. These findings are largely consistent with prior studies, but are notably different in that they highlight the importance of flexibility, locus of control, and conflict resolution in collaborative relationships, all of which relate to one's ability to adapt to unexpected obstacles and find mutually workable solutions with colleagues. From a policy perspective, supporting these key element of collaboration may involve giving frontline workers more autonomy in how they get the work done, which may in some cases be impeded by additional training to reinforce worker role delineation, closer monitoring, or other top-down efforts to push greater convergence. Given the essential role that frontline workers play in multi-sectoral initiatives in India and around the world, there is a clear need for policymakers and managers to understand the elements affecting collaboration between these workers when designing and implementing programs.
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Affiliation(s)
| | - Zabir Hasan
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Shivam Gupta
- Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Ligia Paina
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, USA
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Woodward A, Sondorp E, Barry AS, Dieleman MA, Fuhr DC, Broerse JEW, Akhtar A, Awwad M, Bawaneh A, Bryant R, Sijbrandij M, Cuijpers P, Roberts B. Scaling up task-sharing psychological interventions for refugees in Jordan: a qualitative study on the potential barriers and facilitators. Health Policy Plan 2023; 38:310-320. [PMID: 36631951 PMCID: PMC10019561 DOI: 10.1093/heapol/czad003] [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: 10/12/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Training nonspecialists in providing evidence-based psychological interventions (i.e. task-sharing) can effectively increase community access to psychological support. However, task-sharing interventions for this purpose are rarely used at scale. The aim of this study was to examine the factors influencing the potential for scaling up (i.e. scalability) of a task-sharing psychological intervention called Problem Management Plus (PM+) for Syrian refugees in Jordan. Semi-structured individual (n = 17) and group interviews (n = 20) were conducted with stakeholders knowledgeable about PM+ and the mental health system for Syrian refugees in Jordan. Using 'system innovation perspective', this study conceptualized the context as landscape developments, and systemic considerations were divided into culture (shared ways of thinking) and structure (ways of organizing). Political momentum was identified as a landscape trend likely facilitating scaling up, while predicted reductions in financial aid was regarded as a constraint. In terms of culture, the medicalized approach to mental health, stigma and gender were reported barriers for scaling up PM+. Using non-stigmatizing language and offering different modalities, childcare options and sessions outside of working hours were suggestions to reduce stigma, accommodate individual preferences and increase the demand for PM+. In relation to structure, the feasibility of scaling up PM+ largely depends on the ability to overcome legal barriers, limitations in human and financial resources and organizational challenges. We recommend sustainable funding to be made available for staff, training, supervision, infrastructure, coordination, expansion and evaluation of 'actual' scaling up of PM+. Future research may examine the local feasibility of various funding, training and supervision models. Lessons learned from actual scaling up of PM+ and similar task-sharing approaches need to be widely shared.
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Affiliation(s)
- Aniek Woodward
- *Corresponding author. KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands. E-mail:
| | - Egbert Sondorp
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
| | - Alexandra S Barry
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
- NHS England, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Marjolein A Dieleman
- KIT Royal Tropical Institute, KIT Health, Mauritskade 64, Amsterdam 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen 28359, Germany
- University of Bremen, Health Sciences, Bibliothekstrasse 1, Bremen 28359, Germany
| | - Jacqueline E W Broerse
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam 1081 HV, The Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Kensington, Sydney NSW 2052, Australia
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Solnavägen 1, Solna 171 77, Sweden
| | - Manar Awwad
- International Medical Corps, Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
| | - Ahmad Bawaneh
- International Medical Corps, Al Shareef Abd Al Hameed Sharaf St 9, Amman, Jordan
| | - Richard Bryant
- School of Psychology, University of New South Wales, Kensington, Sydney NSW 2052, Australia
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam 1081 HV, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam 1081 HV, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, 37 Republicii Street, Cluj-Napoca, Romania
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Goodman SH, Zahn M, Boden-Albala B, Lakon CM. Insurance Status, Comorbidity Diagnosis, and Hepatitis C Diagnosis Among Antibody-Positive Patients: A Retrospective Cohort Study. Health Serv Res Manag Epidemiol 2023; 10:23333928231175795. [PMID: 37197291 PMCID: PMC10184194 DOI: 10.1177/23333928231175795] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
Background In California, laboratories report all hepatitis C (HCV)-positive antibody tests to the state; however, that does not accurately reflect active infection among those patients without a viral load test confirming a patient's HCV diagnosis. These public health surveillance disease incident records do not include patient details such as comorbidities or insurance status found in electronic medical records (EMRs). Objective This research seeks to understand how insurance type, insurance status, patient comorbidities, and other sociodemographic factors related to HCV diagnosis as defined by a positive viral load test among HCV antibody-positive persons from January 1, 2010 to March 1, 2020. Methods HCV antibody-positive individuals reported to the California Reportable Disease Information Exchange (CalREDIE), with a medical record number associated with the University of California, Irvine Medical Center, and an unrestricted EMR (n = 521) were extracted using manual chart review. Main Outcomes and measures HCV diagnosis as indicated in a patient's EMR in the problem list or disease registry. Results Less than a quarter of patients in this sample were diagnosed as having HCV in their EMR, with 0.4% of those diagnosed (5/116) patients with indicated HCV treatment in the medication field of their charts. After adjusting for multiple comorbidities, a multinomial logistic regression found that the relative risk ratios (RRRs) of HCV diagnosis found that patients with insurance were more likely to be diagnosed compared to those without insurance. When comparing uninsured patients to those with government insurance at the P < .05 level (RRR = 10.61 (95% confidence interval (CI): 4.14-27.22)) and those uninsured to private insurance (RRR = 6.79 (95% CI: 2.31-19.92). Conclusions These low frequencies of HCV diagnosis among the study population, particularly among the uninsured, indicate a need for increased viral load testing and linkage to care. Reflex testing on existing samples and improving HCV screening and diagnosis can help increase linkage to care and work towards eliminating this disease.
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Affiliation(s)
- Sara H. Goodman
- Department of Pediatrics – Infectious Diseases, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Health, Society, and Behavior, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Matthew Zahn
- Communicable Disease Control, Orange County Health Care Agency, Santa Ana, CA, USA
| | - Bernadette Boden-Albala
- Department of Health, Society, and Behavior, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Cynthia M. Lakon
- Department of Health, Society, and Behavior, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
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11
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Becerril-Montekio V, García-Bello LA, Torres-Pereda P, Alcalde-Rabanal J, Reveiz L, Langlois EV. Collaboration between health system decision makers and professional researchers to coproduce knowledge, a scoping review. Int J Health Plann Manage 2022; 37 Suppl 1:45-58. [PMID: 35643849 DOI: 10.1002/hpm.3513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent literature uses different terms and approaches to the collaboration between researchers and health system decision-makers in the research process. In 2012, the World Health Organisation proposed to "Embed research within decision-making processes". Yet, important contributions use other terms and perspectives for the same issue. This scoping review aimed to identify these terms, approaches, their application and eventual influence on the utilization of evidence. METHODS We searched papers published between January 2000 and February 2019 in English, Spanish, French and Portuguese in the databases of PubMed, Scielo, Google Scholar and EBSCOhost, thus accessing MedicLatina, MEDLINE Complete and eBook Collection. Our main inclusion criterion was the participation of health personnel in non-clinical research activities. We considered three domains for in depth analysis: Definition, name and description of the participation of decision makers and health staff; Forms of collaboration and actual/effective participation of health staff in research; Eventual influence on the utilization of research results. RESULTS We identified 607 articles and selected 74 for full text analysis. Nineteen different terms are currently used in twelve countries to describe the participation of health decision-makers and staff in research activities. Most publications refer to Integrated Knowledge Translation or Embedded Research, and were published in Canada and the United Kingdom. Forty-five papers discuss the participation of health staff in research activities; 20 leading the whole process and 21 as collaborators. CONCLUSIONS The identification of the different terms and approaches to the close collaboration of health staff and decision-makers with professional researchers is essential to promote its effective application and influence on the utilization of evidence. Yet, it is also necessary to insist in their co-participation throughout the whole investigation process as a relevant way to improve research results uptake, strengthen health systems and advance towards universal health coverage.
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Affiliation(s)
| | | | | | | | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, Columbia, USA
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
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12
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Neill R, Neel AH, Cardona C, Bishai D, Gupta S, Mohan D, Jain N, Basu S, Closser S. Everyday capabilities were a path to resilience during COVID-19: a case study of five countries. Health Policy Plan 2022; 38:192-204. [PMID: 36222381 PMCID: PMC9619747 DOI: 10.1093/heapol/czac085] [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: 06/15/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/14/2022] Open
Abstract
COVID-19 demanded urgent responses by all countries, with wide variations in the scope and sustainability of those responses. Scholarship on resilience has increasingly emphasized relational considerations such as norms and power and how they influence health systems' responses to evolving challenges. In this study, we explored what influenced countries' national pandemic responses over time considering a country's capacity to test for COVID-19. To identify countries for inclusion, we used daily reports of COVID-19 cases and testing from 184 countries between 21st January 2020 and 31st December 2020. Countries reporting test data consistently and for at least 105 days were included, yielding a sample of 52 countries. We then sampled five countries representing different geographies, income levels and governance structures (Belgium, Ethiopia, India, Israel and Peru) and conducted semi-structured key informant interviews with stakeholders working in, or deeply familiar with, national responses. Across these five countries, we found that existing health systems capacities and political leadership determined how responses unfolded, while emergency plans or pandemic preparedness documents were not fit-for-purpose. While all five countries were successful at reducing COVID-19 infections at a specific moment in the pandemic, political economy factors complicated the ability to sustain responses, with all countries experiencing larger waves of the virus in 2021 or 2022. Our findings emphasize the continued importance of foundational public health and health systems capacities, bolstered by clear leadership and multisectoral coordination functions. Even in settings with high-level political leadership and a strong multisectoral response, informants wished that they-and their country's health system-were more prepared to address the pandemic and maintain an effective response over time. Our findings challenge emergency preparedness as the dominant frame in pandemic preparedness and call for a continued emphasis on health systems strengthening to respond to future health shocks and a pandemic moving to endemic status.
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Affiliation(s)
- Rachel Neill
- Corresponding author. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. E-mail:
| | - Abigail H Neel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Nishant Jain
- Indo-German Social Security Program, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, 5/1, Second Floor, Safdarjung Enclave, New Delhi 110029, India
| | - Sharmishtha Basu
- Indo German Programme on Universal Health Coverage ((IGUHC), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, 5/1, Second Floor, Safdarjung Enclave, New Delhi 110029, India
| | - Svea Closser
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Cassidy R, Borghi J, Rwashana Semwanga A, Binyaruka P, Singh NS, Blanchet K. How to do (or not to do)…Using Causal Loop Diagrams for Health System Research in Low- and Middle-Income Settings. Health Policy Plan 2022; 37:1328-1336. [PMID: 35921232 PMCID: PMC9661310 DOI: 10.1093/heapol/czac064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/01/2022] [Revised: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Causal loop diagrams (CLDs) are a systems thinking method that can be used to visualize and unpack complex health system behaviour. They can be employed prospectively or retrospectively to identify the mechanisms and consequences of policies or interventions designed to strengthen health systems and inform discussion with policymakers and stakeholders on actions that may alleviate sub-optimal outcomes. Whilst the use of CLDs in health systems research has generally increased, there is still limited use in low- and middle-income settings. In addition to their suitability for evaluating complex systems, CLDs can be developed where opportunities for primary data collection may be limited (such as in humanitarian or conflict settings) and instead be formulated using secondary data, published or grey literature, health surveys/reports and policy documents. The purpose of this paper is to provide a step-by-step guide for designing a health system research study that uses CLDs as their chosen research method, with particular attention to issues of relevance to research in low- and middle-income countries (LMICs). The guidance draws on examples from the LMIC literature and authors’ own experience of using CLDs in this research area. This paper guides researchers in addressing the following four questions in the study design process; (1) What is the scope of this research? (2) What data do I need to collect or source? (3) What is my chosen method for CLD development? (4) How will I validate the CLD? In providing supporting information to readers on avenues for addressing these key design questions, authors hope to promote CLDs for wider use by health system researchers working in LMICs.
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Affiliation(s)
- Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK
| | - Agnes Rwashana Semwanga
- Information Systems Department, College of Computing and Information Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Peter Binyaruka
- Ifakara Health Institute, PO Box 78373, Dar Es Salaam, Tanzania
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva and the Graduate Institute, Rue Rothschild 22, 1211, Genève, Switzerland
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14
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Haakenstad A, Coates M, Buhkman G, McConnell M, Verguet S. Comparative Health Systems Analysis of Differences in the Catastrophic Health Expenditure Associated with Non-Communicable Versus Communicable Diseases Among Adults in Six Countries. Health Policy Plan 2022; 37:1107-1115. [PMID: 35819006 PMCID: PMC9557357 DOI: 10.1093/heapol/czac053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/15/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
The growing burden of non-communicable diseases (NCDs) in low- and middle-income countries may have implications for health system performance in the area of financial risk protection, as measured by catastrophic health expenditure (CHE). We compare NCD CHE to the CHE cases caused by communicable diseases (CDs) across health systems to examine whether: (1) disease burden and CHE are linked, (2) NCD CHE disproportionately affects wealthier households and (3) whether the drivers of NCD CHE differ from the drivers of CD CHE. We used the Study on Global Aging and Adult Health survey, which captured nationally representative samples of 44 089 adults in China, Ghana, India, Mexico, Russia and South Africa. Using two-part regression and random forests, we estimated out-of-pocket spending and CHE by disease area. We compare the NCD share of CHE to the NCD share of disability-adjusted life years (DALYs) or years of life lost to disability and death. We tested for differences between NCDs and CDs in the out-of-pocket costs per visit and the number of visits occurring before spending crosses the CHE threshold. NCD CHE increased with the NCD share of DALYs except in South Africa, where NCDs caused more than 50% of CHE cases but only 30% of DALYs. A larger share of households incurred CHE due to NCDs in the lowest than the highest wealth quintile. NCD CHE cases were more likely to be caused by five or more health care visits relative to communicable disease CHE cases in Ghana (P = 0.003), India (P = 0.004) and China (P = 0.093). Health system attributes play a key mediating factor in how disease burden translates into CHE by disease. Health systems must target the specific characteristics of CHE by disease area to bolster financial risk protection as the epidemiological transition proceeds.
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Affiliation(s)
- Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, MA 98121, USA
| | - Matthew Coates
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Gene Buhkman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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15
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Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, Rafenoarivamalala FH, Finnegan KE, Andrianirinarison JC, Rakotonirina J, Herbreteau V, Bonds MH. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy Plan 2021; 36:1659-1670. [PMID: 34331066 PMCID: PMC8597972 DOI: 10.1093/heapol/czab087] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Abstract
Poor geographic access can persist even when affordable and well-functioning health systems are in place, limiting efforts for universal health coverage (UHC). It is unclear how to balance support for health facilities and community health workers in UHC national strategies. The goal of this study was to evaluate how a health system strengthening (HSS) intervention aimed towards UHC affected the geographic access to primary care in a rural district of Madagascar. For this, we collected the fokontany of residence (lowest administrative unit) from nearly 300 000 outpatient consultations occurring in facilities of Ifanadiana district in 2014-2017 and in the subset of community sites supported by the HSS intervention. Distance from patients to facilities was accurately estimated following a full mapping of the district's footpaths and residential areas. We modelled per capita utilization for each fokontany through interrupted time-series analyses with control groups, accounting for non-linear relationships with distance and travel time among other factors, and we predicted facility utilization across the district under a scenario with and without HSS. Finally, we compared geographic trends in primary care when combining utilization at health facilities and community sites. We find that facility-based interventions similar to those in UHC strategies achieved high utilization rates of 1-3 consultations per person year only among populations living in close proximity to facilities. We predict that scaling only facility-based HSS programmes would result in large gaps in access, with over 75% of the population unable to reach one consultation per person year. Community health delivery, available only for children under 5 years, provided major improvements in service utilization regardless of their distance from facilities, contributing to 90% of primary care consultations in remote populations. Our results reveal the geographic limits of current UHC strategies and highlight the need to invest on professionalized community health programmes with larger scopes of service.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, University Montpellier, CNRS, IRD, 911 Avenue Agropolis, 34394 Montpellier, Montpellier, France
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
| | | | - Christophe Révillion
- Université de La Réunion, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), 40 Av De Soweto, 97410 Saint-Pierre, Réunion, France
| | | | - Mauricianot Randriamihaja
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- School of Management and Technological innovation, University of Fianarantsoa, BP 1135 Andrainjato, 301 Fianarantsoa, Madagascar
| | | | | | - Karen E Finnegan
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
| | - Jean Claude Andrianirinarison
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- National Institut of Public Health, Befelatanana, 101 Antananarivo, Madagascar
| | - Julio Rakotonirina
- Ministry of Public Health, Ambohidahy, 101 Antananarivo, Madagascar
- Faculty of Medicine, BP. 375, 101 Antananarivo, Madagascar
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), B.P. 86, Phnom Penh, Cambodia
| | - Matthew H Bonds
- NGO PIVOT, BP23 Ranomafana, 312 Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, USA
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16
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Abstract
Document analysis is one of the most commonly used and powerful methods in health policy research. While existing qualitative research manuals offer direction for conducting document analysis, there has been little specific discussion about how to use this method to understand and analyse health policy. Drawing on guidance from other disciplines and our own research experience, we present a systematic approach for document analysis in health policy research called the READ approach: (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. We provide practical advice on each step, with consideration of epistemological and theoretical issues such as the socially constructed nature of documents and their role in modern bureaucracies. We provide examples of document analysis from two case studies from our work in Pakistan and Niger in which documents provided critical insight and advanced empirical and theoretical understanding of a health policy issue. Coding tools for each case study are included as Supplementary Files to inspire and guide future research. These case studies illustrate the value of rigorous document analysis to understand policy content and processes and discourse around policy, in ways that are either not possible using other methods, or greatly enrich other methods such as in-depth interviews and observation. Given the central nature of documents to health policy research and importance of reading them critically, the READ approach provides practical guidance on gaining the most out of documents and ensuring rigour in document analysis.
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Affiliation(s)
- Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.,Institute for Global Health, University College London, Institute for Global Health 3rd floor, 30 Guilford Street, London WC1N 1EH, UK
| | - Hina Khalid
- School of Humanities and Social Sciences, Information Technology University, Arfa Software Technology Park, Ferozepur Road, Lahore 54000, Pakistan
| | - Shannon A McMahon
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany
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17
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McKinney EL, McKinney V, Swartz L. Access to healthcare for people with disabilities in South Africa: Bad at any time, worse during COVID-19? S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 34342484 PMCID: PMC8335793 DOI: 10.4102/safp.v63i1.5226] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.
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Affiliation(s)
- Emma L McKinney
- Interdisciplinary Centre for Sports Science and Development, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town.
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18
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Kinney MV, Walugembe DR, Wanduru P, Waiswa P, George A. Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors. Health Policy Plan 2021; 36:955-973. [PMID: 33712840 PMCID: PMC8227470 DOI: 10.1093/heapol/czab011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems). Literature was sourced from six electronic databases, online searches and key experts. Selection criteria included studies from LMIC published in English from 2004 to July 2018 detailing factors influencing implementation of MPDSR, or any related form of MPDSR. After a systematic screening process, data for identified records were extracted and analysed through content and thematic analysis. Of 1027 studies screened, the review focuses on 58 studies from 24 countries, primarily in Africa, that are mainly qualitative or mixed methods. The literature mostly examines implementation factors related to MPDSR as an intervention, and to its inner and outer setting, with less attention to the individuals involved. From a health systems perspective, almost half the literature focuses on the tangible inputs addressed by the service delivery lens, though these are often measured inadequately or through incomparable ways. Though less studied, the societal and health system factors show that people and their relationships, motivations, implementation climate and ability to communicate influence implementation processes; yet their subjective experiences and relationships are inadequately explored. MPDSR implementation contributes to accountability and benefits from a culture of learning, continuous improvement and accountability, but few have studied the complex interplay and change dynamics involved. Better understanding MPDSR will require more research using health policy and systems approaches, including the use of implementation frameworks.
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Affiliation(s)
- Mary V Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - David Roger Walugembe
- School of Health Studies and Faculty of Information and Media Studies, The University of Western Ontario, London, ON, Canada
| | - Phillip Wanduru
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Asha George
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Kwamie A, Ha S, Ghaffar A. Applied systems thinking: unlocking theory, evidence and practice for health policy and systems research. Health Policy Plan 2021; 36:1715-1717. [PMID: 34131699 PMCID: PMC8597965 DOI: 10.1093/heapol/czab062] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
While systems thinking has been generally acknowledged as important to the field of health policy and systems research (HPSR), it remains underutilized. In particular, systems thinking has been perceived as predominantly conceptual, with fewer applications of systems thinking documented. This commentary makes three key points, namely that (1) advances in applied systems thinking in HPSR have been hindered by an imprecision in terminology, conflating ‘[health] systems approaches’ with complex adaptive systems theory; (2) limited examples of applied systems thinking have been highlighted and recognized in research, but have not been fully and equally appreciated in policymaking and practice and (3) explicit use of theory, long-term research-policy collaborations and better documentation of evidence can increase the use and usefulness of applied systems thinking in HPSR. By addressing these matters, the potentials of systems thinking in HPSR can be truly unlocked.
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Affiliation(s)
- Aku Kwamie
- Alliance for Health Policy and Systems Research, World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Solip Ha
- Alliance for Health Policy and Systems Research, World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland
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Manji K, Hanefeld J, Vearey J, Walls H, de Gruchy T. Using WhatsApp messenger for health systems research: a scoping review of available literature. Health Policy Plan 2021; 36:594-605. [PMID: 33860314 PMCID: PMC8173666 DOI: 10.1093/heapol/czab024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Globally, the use of mobile phones for improving access to healthcare and conducting health research has gained traction in recent years as rates of ownership increase, particularly in low- and middle-income countries (LMICs). Mobile instant messaging applications, including WhatsApp Messenger, provide new and affordable opportunities for health research across time and place, potentially addressing the challenges of maintaining contact and participation involved in research with migrant and mobile populations, for example. However, little is known about the opportunities and challenges associated with the use of WhatsApp as a tool for health research. To inform our study, we conducted a scoping review of published health research that uses WhatsApp as a data collection tool. A key reason for focusing on WhatsApp is the ability to retain contact with participants when they cross international borders. Five key public health databases were searched for articles containing the words ‘WhatsApp’ and ‘health research’ in their titles and abstracts. We identified 69 articles, 16 of which met our inclusion criteria for review. We extracted data pertaining to the characteristics of the research. Across the 16 studies—11 of which were based in LMICs—WhatsApp was primarily used in one of two ways. In the eight quantitative studies identified, seven used WhatsApp to send hyperlinks to online surveys. With one exception, the eight studies that employed a qualitative (n = 6) or mixed-method (n = 2) design analysed the WhatsApp content generated through a WhatsApp-based programmatic intervention. We found a lack of attention paid to research ethics across the studies, which is concerning given the controversies WhatsApp has faced with regard to data protection in relation to end-to-end encryption. We provide recommendations to address these issues for researchers considering using WhatsApp as a data collection tool over time and place.
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Affiliation(s)
- Karima Manji
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Johanna Hanefeld
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand (Wits), Solomon Mahlangu House, Braamfontein Campus East, Private Bag 3, Johannesburg 2000, South Africa
| | - Helen Walls
- Department of Global Health and Development Affiliation, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine (LSHTM), 15-17 Tavistock Place, Kings Cross, London WC1H 9SH, UK
| | - Thea de Gruchy
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand (Wits), Solomon Mahlangu House, Braamfontein Campus East, Private Bag 3, Johannesburg 2000, South Africa
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21
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Colombini M, Alkaiyat A, Shaheen A, Garcia Moreno C, Feder G, Bacchus L. Exploring health system readiness for adopting interventions to address intimate partner violence: a case study from the occupied Palestinian Territory. Health Policy Plan 2020; 35:245-256. [PMID: 31828339 PMCID: PMC7152725 DOI: 10.1093/heapol/czz151] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/14/2022] Open
Abstract
Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems' readiness to respond to DV. This article describes the use of a health system's readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.
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Affiliation(s)
- Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdulsalam Alkaiyat
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, PO Box 7, Nablus, Palestine
| | - Amira Shaheen
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Rafidia Street, PO Box 7, Nablus, Palestine
| | - Claudia Garcia Moreno
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gene Feder
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Loraine Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Xu J, Gorsky M, Mills A. A path dependence analysis of hospital dominance in China (1949-2018): lessons for primary care strengthening. Health Policy Plan 2020; 35:167-179. [PMID: 31778184 DOI: 10.1093/heapol/czz145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 11/13/2022] Open
Abstract
Although China's community health system helped inspire the 1978 Alma Ata Declaration on Health for All, it currently faces the challenge of strengthening primary care in response to hospital sector dominance. As the world reaffirms its commitment towards primary health services, China's recent history provides a salient case study of the issues at stake in optimizing the balance of care. In this study, we have used path dependence analysis to explain China's coevolution of hospital and primary care facilities between 1949 and 2018. We have identified two cycles of path-dependent development (1949-78 and 1978-2018) involving four sets of institutions related to medical professionalization, financing, organization and governance of health facilities. Both cycles started with a critical juncture amid a radically changing societal context, when institutions favouring hospitals were initiated or renewed, leading to a process of self-reinforcement empowering the hospitals. Later in each cycle, events occurred that modified this hospital dominance. However, pro-primary care policies during these conjunctures encountered resilience from the existing institutional environment. The result was continued consolidation of hospital dominance over the long term. These recurrent constraints suggest that primary care strengthening is unlikely to be successful without a comprehensive set of policy reforms driven by a primary care coalition with strong professional, bureaucratic and community stakes, co-ordinated and sustained over a prolonged period. Our findings imply that it is important to understand the history of health systems in China, where the challenges of health systems strengthening go beyond limited resources and include different developmental paths as compared with Western countries.
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Affiliation(s)
- Jin Xu
- China Center for Health Development Studies, Peking University, No 38, Xueyuan Road, Haidian District, 100191 Beijing, China
| | - Martin Gorsky
- Centre for History in Public Health, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1E 7HT, UK
| | - Anne Mills
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1E 7HT, UK
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Zachariah R, Rust S, Thekkur P, Khogali M, Kumar AM, Davtyan K, Diro E, Satyanarayana S, Denisiuk O, Griensven JV, Hermans V, Berger SD, Saw S, Reid A, Aseffa A, Harries AD, Reeder JC. Quality, Equity and Utility of Observational Studies during 10 Years of Implementing the Structured Operational Research and Training Initiative in 72 Countries. Trop Med Infect Dis 2020; 5:E167. [PMID: 33172059 DOI: 10.3390/tropicalmed5040167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Observational studies are often inadequately reported, making it difficult to assess their validity and generalizability and judge whether they can be included in systematic reviews. We assessed the publication characteristics and quality of reporting of observational studies generated by the Structured Operational Research and Training Initiative (SORT IT). Methods: A cross-sectional analysis of original publications from SORT IT courses. SORT IT is a global partnership-based initiative aimed at building sustainable capacity for conducting operational research according to country priorities and using the generated evidence for informed decision-making to improve public health. Reporting quality was independently assessed using an adapted version of ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) checklist. Results: In 392 publications, involving 72 countries, 50 journals, 28 publishers and 24 disease domains, low- and middle-income countries (LMICs) first authorship was seen in 370 (94%) and LMIC last authorship in 214 (55%). Publications involved LMIC-LMIC collaboration in 90% and high-income-country-LMIC collaboration in 87%. The majority (89%) of publications were in immediate open access journals. A total of 346 (88.3%) publications achieved a STROBE reporting quality score of >85% (excellent), 41 (10.4%) achieved a score of 76–85% (good) and 5 (1.3%) a score of 65–75% (fair). Conclusion: The majority of publications from SORT IT adhere to STROBE guidelines, while also ensuring LMIC equity and collaborative partnerships. SORT IT is, thus, playing an important role in ensuring high-quality reporting of evidence for informed decision-making in public health.
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Parashar R, Gawde N, Gupt A, Gilson L. Unpacking the implementation blackbox using 'actor interface analysis': how did actor relations and practices of power influence delivery of a free entitlement health policy in India? Health Policy Plan 2020; 35:ii74-ii83. [PMID: 33156935 PMCID: PMC7646725 DOI: 10.1093/heapol/czaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 09/03/2020] [Indexed: 11/14/2022] Open
Abstract
Exploring the implementation blackbox from a perspective that considers embedded practices of power is critical to understand the policy process. However, the literature is scarce on this subject. To address the paucity of explicit analyses of everyday politics and power in health policy implementation, this article presents the experience of implementing a flagship health policy in India. Janani Shishu Suraksha Karyakram (JSSK), launched in the year 2011, has not been able to fully deliver its promises of providing free maternal and child health services in public hospitals. To examine how power practices, influence implementation, we undertook a qualitative analysis of JSSK implementation in one state of India. We drew on an actor-oriented perspective of development and used 'actor interface analysis' to guide the study design and analysis. Data collection included in-depth interviews of implementing actors and JSSK service recipients, document review and observations of actor interactions. A framework analysis method was used for analysing data, and the framework used was founded on the constructs of actor lifeworlds, which help understand the often neglected and lived realities of policy actors. The findings illustrate that implementation was both strengthened and constrained by practices of power at various interface encounters. The implementation decisions and actions were influenced by power struggles such as domination, control, resistance, contestation, facilitation and collaboration. Such practices were rooted in: Social and organizational power relationships like organizational hierarchies and social positions; personal concerns or characteristics like interests, attitudes and previous experiences and the worldviews of actors constructed by social and ideological paradigms like their values and beliefs. Application of 'actor interface analysis' and further nuancing of the concept of 'actor lifeworlds' to understand the origin of practices of power can be useful for understanding the influence of everyday power and politics on the policy process.
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Affiliation(s)
- Rakesh Parashar
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai , India and Health Systems, Oxford Policy Management Limited, India
| | - Nilesh Gawde
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Anadi Gupt
- National Health Mission, Government of Himachal Pradesh, Shimla, India
| | - Lucy Gilson
- Division of Health Policy and Systems, School of Public Health and Family Medicine, University of Cape Town, South Africa and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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25
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Peven K, Bick D, Purssell E, Rotevatn TA, Nielsen JH, Taylor C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review. Health Policy Plan 2020; 35:ii47-ii65. [PMID: 33156939 PMCID: PMC7646733 DOI: 10.1093/heapol/czaa122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/02/2023] Open
Abstract
Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3-31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1-4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, 57 Waterloo Road, London SE1 8WA, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Hyldgaard Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
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26
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Goderis G, Colman E, Irusta LA, Van Hecke A, Pétré B, Devroey D, Van Deun E, Faes K, Charlier N, Verhaeghe N, Remmen R, Anthierens S, Sermeus W, Macq J. Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium. Int J Integr Care 2020; 20:12. [PMID: 33024426 PMCID: PMC7518071 DOI: 10.5334/ijic.5435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The twelve Integrated Care Program pilot projects (ICPs) created by the government plan 'Integrated Care for Better Health' aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme. METHODS A scientific team was commissioned to co-design and implement an evaluation protocol in close collaboration with the government, the ICPs and several other involved stakeholders. RESULTS A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Processes and outcomes of all the projects will be monitored using indicators based on administrative data on population health and the quality and costs of care. A yearly survey will be organized to collect data on patient-reported outcomes and experiences and on provider-reported measures of inter-professional collaboration and proper wellbeing. Using both quantitative and qualitative data, we will develop theories about the mechanisms and the associated contextual factors that lead to integrated care and the Quadruple Aim outcomes. DISCUSSION The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs. Some challenges due to the large scale of the project and the multiple stakeholders involved may impede the successful implementation of this proposal.
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Affiliation(s)
- Geert Goderis
- Academic Center of General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer Leuven, BE
| | - Elien Colman
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, BE
- Department of Nursing, Ghent University Hospital, Ghent, BE
| | - Lucia Alvarez Irusta
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs Brussels, BE
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, BE
- Department of Nursing, Ghent University Hospital, Ghent, BE
| | - Benoit Pétré
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate, Liège, BE
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
| | | | - Kristof Faes
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
| | - Nathan Charlier
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate, Liège, BE
| | - Nick Verhaeghe
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, BE
- Research Group Social and Economic Policy and Social Inclusion, KU Leuven, Parkstraat, Leuven, BE
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
| | - Sibyl Anthierens
- Department of Primary and Interdisciplinary Care (ELIZA)—Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat Antwerp, BE
| | | | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs Brussels, BE
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Pratt B, Seshadri T, Srinivas PN. What should community organisations consider when deciding to partner with researchers? A critical reflection on the Zilla Budakattu Girijana Abhivrudhhi Sangha experience in Karnataka, India. Health Res Policy Syst 2020; 18:101. [PMID: 32912247 PMCID: PMC7488535 DOI: 10.1186/s12961-020-00617-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Community organisations and community members are increasingly being involved in health research projects worldwide as part of the engagement movement. Achieving deeper forms of community engagement like partnership demands that decision-making power be shared with community partners. However, how can community partners assess if meaningful engagement and shared decision-making will be possible when approached by prospective research partners? In this paper, we explore how community organisations decide to join health research projects when approached by health researchers. Methods Case study research was undertaken on a health systems research project in Karnataka, India called Participation for Local Action, which was carried out by local researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, a community development organisation. In-depth interviews were conducted with the researchers, Sangha leaders and field investigators from their community. Results Thematic analysis identified two main themes – ‘context’ and ‘deciding to engage’. The Sangha’s experience offers lessons to other community organisations that can help them when deciding to engage with researchers in terms of what features to look for in research partners and in proposed research projects, what requests to make of prospective research partners, and what sorts of outcomes or partnership agreements to accept. These lessons may be especially applicable in contexts where relationships of trust already exist between partners and where they have the skills to lead data collection and analysis. Conclusions We hope that this guidance will help empower community organisations to select good research partners and promote more equitable partnerships between community partners and academic researchers.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St., Carlton, Victoria, 3053, Australia.
| | - Tanya Seshadri
- Institute of Public Health, 3009, II-A Main, 17th Cross, Krishna Rajendra Rd, Banashankari Stage II, Bangalore, Karnataka, 560070, India.,Vivekananda Girijana Kalyana Kendra, BR hills, Chamarajanagar district, Karnataka, 571441, India
| | - Prashanth N Srinivas
- Institute of Public Health, 3009, II-A Main, 17th Cross, Krishna Rajendra Rd, Banashankari Stage II, Bangalore, Karnataka, 560070, India
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Hakoum MB, Bou-Karroum L, Al-Gibbawi M, Khamis AM, Raslan AS, Badour S, Agarwal A, Alturki F, Guyatt G, El-Jardali F, Akl EA. Reporting of conflicts of interest by authors of primary studies on health policy and systems research: a cross-sectional survey. BMJ Open 2020; 10:e032425. [PMID: 32690493 PMCID: PMC7371338 DOI: 10.1136/bmjopen-2019-032425] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the frequency and types of conflict of interest (COI) disclosed by authors of primary studies of health policy and systems research (HPSR). DESIGN We conducted a cross-sectional survey using standard systematic review methodology for study selection and data extraction. We conducted descriptive analyses. SETTING We collected data from papers published in 2016 in 'health policy and service journals' category in Web of Science database. PARTICIPANTS We included primary studies (eg, randomised controlled trials, cohort studies, qualitative studies) of HPSR published in English in 2016 peer-reviewed health policy and services journals. OUTCOME MEASURES Reported COI disclosures including whether authors reported COI or not, form in which COI disclosures were provided, number of authors per paper who report any type of COI, number of authors per paper who report specific types and subtypes of COI. RESULTS We included 200 eligible primary studies of which 132 (66%) included COI disclosure statements of authors. Of the 132 studies, 19 (14%) had at least one author reporting at least one type of COI and the most frequently reported type was individual financial COI (n=15, 11%). None of the authors reported individual intellectual COIs or personal COIs. Financial and individual COIs were reported more frequently compared with non-financial and institutional COIs. CONCLUSION A low percentage of HPSR primary studies included authors reporting COI. Non-financial or institutional COIs were the least reported types of COI.
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Affiliation(s)
- Maram B Hakoum
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Assem M Khamis
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | - Sanaa Badour
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arnav Agarwal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fadel Alturki
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Godinho MA, Ashraf MM, Narasimhan P, Liaw ST. Community health alliances as social enterprises that digitally engage citizens and integrate services: A case study in Southwestern Sydney (protocol). Digit Health 2020; 6:2055207620930118. [PMID: 32637148 PMCID: PMC7313330 DOI: 10.1177/2055207620930118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/12/2020] [Indexed: 01/02/2023] Open
Abstract
South Western Sydney (SWS) is one of the fastest growing regions in the state of New South Wales (Australia). Much of the population live in local government areas (LGAs) with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behavioural factors. This necessitates the management of social determinants of health through the integrated provision of primary and social care. The SWS Local Health District and Primary Health Network is exploring the potential of community health alliances (CHAs) as an innovative approach to support the provision of integrated health services. CHAs are a population health approach for addressing health challenges faced by people who share a common area of residence, sociocultural characteristic or health need, and are characterised by a shared mission, shared resource needs and acquiring/developing necessary organisational knowledge and skills. We explore how CHAs operate as social enterprises that utilise digital health and citizen engagement to deliver integrated people-centred health services (IPCHS) by conducting two case studies of CHAs operating in SWS: in Wollondilly and Fairfield LGAs. Using this approach, we aim to unpack the conceptual convergence that enables social enterprises to utilise digital health interventions and citizen engagement strategies to co-produce IPCHS with a view to developing theory and a framework for engaging digital citizens in integrated primary health care via social enterprise.
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Affiliation(s)
- Myron Anthony Godinho
- World Health Organization Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia.,Yunus Social Business Health Hub, School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Md Mahfuz Ashraf
- World Health Organization Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia.,Yunus Social Business Health Hub, School of Public Health and Community Medicine, UNSW Sydney, Australia.,Entrepreneurship and Innovation, Crown Institute of Higher Education, Australia
| | - Padmanesan Narasimhan
- World Health Organization Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia.,Yunus Social Business Health Hub, School of Public Health and Community Medicine, UNSW Sydney, Australia
| | - Siaw-Teng Liaw
- World Health Organization Collaborating Centre for eHealth, School of Public Health and Community Medicine, UNSW Sydney, Australia.,Yunus Social Business Health Hub, School of Public Health and Community Medicine, UNSW Sydney, Australia
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Macarayan EK, Balabanova D, Gotsadze G. Assessing the field of health policy and systems research using symposium abstract submissions and machine learning techniques. Health Policy Plan 2020; 34:721-731. [PMID: 31550374 DOI: 10.1093/heapol/czz086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
The field of health policy and systems research (HPSR) has grown rapidly in the past decade. Examining recently aggregated data from the Global Symposia on Health Systems Research, a key global fora for HPSR convened by the largest international society-Health Systems Global (HSG)-provides opportunities to enhance existing research on HPSR capacity using novel analytical techniques. This addresses the demand not only to map the field but also to examine potential predictors of acceptance to, and participation at, these global conferences to inform future work and strategies in promoting HPSR. We examined data from the abstracts submitted for two Global Symposia on Health Systems Research in 2016 and 2018 by type of institution, countries, regional groupings and gender. After mapping hotspot areas for HPSR production, we then examined how the corresponding author's characteristics were associated with being accepted to present at the Global Symposia. Our findings showed that submissions for the Global Symposia increased by 12% from 2016 to 2018. Submissions increased across all participant groups, in particular, the for-profit organizations and research/consultancy firms showing the highest increases, at 58% for both. We also found reduced submissions from high-income countries, whereas submissions from low- and middle-income countries (LMICs), Sub-Saharan Africa and Latin America, increased substantially revealing the inclusivity values of Symposium organizers. Submissions increased to a larger extent among women than men. Being a woman, coming from a high-income country and having multiple abstracts submitted were found to be significant predictors for an abstract to be accepted and presented in the Symposia. Findings provide critical baseline information on the extent of interest and engagement in a global forum of various institutions and researchers in HPSR that can be useful for setting future directions of HSG and other similar organizations to support the advancement of HPSR worldwide.
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Affiliation(s)
- Erlyn K Macarayan
- Department of Health Policy and Management, Harvard Global Health Institute, Harvard TH Chan School of Public Health, Cambridge, MA 02138, USA
- Faculty of Information and Communication Studies, University of the Philippines Open, Los Baños, Laguna 4031, Philippines
- Health Systems Global, Morgenstrasse 129, Bern 3018, Switzerland
| | - Dina Balabanova
- Health Systems Global, Morgenstrasse 129, Bern 3018, Switzerland
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - George Gotsadze
- Health Systems Global, Morgenstrasse 129, Bern 3018, Switzerland
- Curatio International Foundation, 3, 0179 Lado Kavsadze St, T'bilisi, Georgia
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Farrenkopf BA, Lee CW. Mapping health workforce development strategies across key global health agencies: an assessment of objectives and key interventions. Health Policy Plan 2020; 34:461-468. [PMID: 31219593 DOI: 10.1093/heapol/czz015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/14/2022] Open
Abstract
The political and financial commitment to addressing the global shortage of health workers is stronger than ever before. Therefore, the global effort to strengthen human resources for health (HRH) must be co-ordinated and aligned to strategically utilize the current momentum and create sustainable impact. This paper assesses HRH strategies to (1) create greater understanding on the collective global action towards improving HRH, and (2) identify opportunities for greater co-ordination to improve sustainable health workforce development. We searched published and grey literature to identify the HRH strategies of select large-scale global health organizations. The most common approaches were increasing the supply of health workers, facilitating training and education and improving health worker management capacities. Overall, our analysis shows there is a need to (1) improve co-ordination among development partners, (2) ensure strong engagement and leadership of national governments and (3) generate scientific evidence on the best approaches for sustainable workforce development.
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Affiliation(s)
- Brooke A Farrenkopf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and
| | - Chung-Won Lee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
The Global Forum for Health Research (GFHR) was founded in 1998. It was the culmination of an advocacy movement started in 1987 to campaign for the expansion and coordination of health research benefitting low- and middle-income countries. It was largely funded by the World Bank and embraced that institution's emphasis on cost effectiveness. But its small budget prevented it from assuming the central role in global health research that its supporters had envisaged. It took on more modest tasks, focusing on advocacy, organising an annual conference and monitoring research funding. In 2010, it was absorbed amid general indifference by another small organization, the Council on Health Research for Development (COHRED) and eventually disappeared from sight. We argue in this paper that its fate had two major causes. First, it resulted from operational and budgetary problem and its inability to attract the new money that was pouring into Global Health (GH). Second, it reflected the aggressive efforts by the WHO to reclaim leadership in this domain. Underlying this failure, however, was the inherent difficulty of coordinating the ideologically fragmented and individualistically oriented GH research domain.
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Affiliation(s)
- George Weisz
- Social Studies of Medicine, McGill University, Montreal, Canada
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Glandon D, Mondal S, Okeyo I, Zaidi S, Khan MS, Dar O, Bennett S. Methodological gaps and opportunities for studying multisectoral collaboration for health in low- and middle-income countries. Health Policy Plan 2020; 34:ii7-ii17. [PMID: 31723973 DOI: 10.1093/heapol/czz116] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
The current body of research into multisectoral collaborations (MSCs) for health raises more questions than it answers, both in terms of how to implement MSCs and how to study them. This article reflects on current methodological gaps and opportunities for advancing MSC research, based on a targeted review of existing literature and qualitative input from researchers and practitioners at the 2018 Health Systems Research (HSR) Symposium in Liverpool. Through framework analysis of 205 MSC research papers referenced in a separately published MSC 'overview of reviews' paper, this article identifies six broad MSC question domains ('meta questions') and applies content analysis to estimate the relative frequency with which these meta questions and the research method(s) used to answer them are present in the literature. Results highlight a preponderance of research exploring MSC implementation using case study methods, which, in aggregate, does not seem to adequately meet policymakers' and practitioners' needs for generalizable or transferable insights. The content analysis is complemented by qualitative insights from HSR Symposium participants and the authors' own experience to identify six key methodological gaps in research on MSC for health. For each of these gaps, we propose areas in which we believe there are opportunities for methodological development and innovation to help advance this field of study, including: better understanding the role of power dynamics in shaping MSCs; development of a classification framework (or frameworks) of governance arrangements; exploring divergence of perspective and experience among MSC partners; identifying or generating theoretical frameworks for MSC that work across sectors and disciplines; developing intermediate indicators of collaboration; and increasing transferability of insights to other contexts. Collaboration with researchers outside of the health sector will enhance efforts in each of these areas, as will the establishment and strengthening of pluralistic MSC evidence networks also involving policymakers and practitioners.
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Affiliation(s)
- Douglas Glandon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
| | - Shinjini Mondal
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, Canada
| | - Ida Okeyo
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Republic of South Africa
| | - Shehla Zaidi
- Department of Community Health Sciences and Women & Child Health Division, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Mishal S Khan
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Osman Dar
- Global Public Health Directorate, Public Health England, 7th Floor Wellington House, 133-155 Waterloo Road, London, UK
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
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Abstract
INTRODUCTION The quadruple burden of disease in South Africa, including the HIV/AIDS epidemic, has placed enormous strains on public healthcare (PHC) facilities. These strains specifically compromised the resources available to deal with high volumes of chronic diseases that contribute to medicine shortages and poor service delivery. In an attempt to address these challenges, the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, which aimed to provide public sector patients with alternative access to vital antiretroviral and other chronic medication, was implemented. This paper describes the protocol for a process evaluation of the programme compliance at the facility level in Namakwa district, to assess patient experiences and staff expectations of the programme; as well as, identifying factors that may affect the programme implementation so that guidance can be given on which approach to take to achieve programme objectives. METHODS AND ANALYSIS A multimethod approach will be used in a cross-sectional process evaluation of the CCMDD programme at 11 PHC facilities in Namakwa district. These methods will use checklists to assess programme compliance and subsequently gain an understanding of whether the programme was implemented as planned. Structured questionnaires together with focus group discussions will be conducted with selected patients enrolled in the programme and facility staff to determine patient experiences with and staff expectations of the programme, respectively. Furthermore, in-depth interviews will be conducted with key actors to explore barriers and facilitators of the programme implementation. Descriptive statistics will be conducted to analyse the quantitative data and an inductive interpretive approach will be used to analyse the qualitative data. ETHICS AND DISSEMINATION The protocol was approved by Stellenbosch University Health Research Ethics Committee (S19/02/047) and the study will be conducted in line with the principles of the Declaration of Helsinki (1964). Findings from the study will be communicated to the study population, and at appropriate local and international conferences, in addition to publishing in peer-reviewed journals.
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Affiliation(s)
- Kim Grace Smith
- Division of Health Systems and Public Health, Global Health Department, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Edward Nicol
- Division of Health Systems and Public Health, Global Health Department, Stellenbosch University, Cape Town, Western Cape, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
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Arsenault C, English M, Gathara D, Malata A, Mandala W, Kruk ME. Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys. Trop Med Int Health 2020; 25:442-453. [PMID: 31828923 PMCID: PMC7217001 DOI: 10.1111/tmi.13361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor‐quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care. Methods We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random‐intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient‐, provider‐ and facility‐level and subnational divisions). Results Only 61–66% of basic elements of competent and respectful care were performed. In adjusted models, better‐staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV‐positive women received higher‐quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage‐point gap between Nairobi and the Coast region. Quality was also higher in higher‐volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient‐level characteristics in Malawi. Conclusions Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher‐volume facilities – along with promotion of respectful care in these facilities – should be considered in sub‐Saharan Africa to improve outcomes for mothers and newborns.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan school of Public Health, Boston, MA, USA
| | - Mike English
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Gathara
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Address Malata
- The Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Wilson Mandala
- The Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan school of Public Health, Boston, MA, USA
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Wright KJ, Biney A, Kushitor M, Awoonor-Williams JK, Bawah AA, Phillips JF. Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana. Glob Health Action 2020; 13:1705460. [PMID: 32008468 PMCID: PMC7034453 DOI: 10.1080/16549716.2019.1705460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving 'Health for All.' The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana's flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services.Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved.Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15-24.Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women's health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services.Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal.
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Affiliation(s)
- Kalifa J. Wright
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Adriana Biney
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Ghana
| | - Mawuli Kushitor
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | | | - Ayaga A. Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Ghana
| | - James F. Phillips
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Langlois EV, Mancuso A, Elias V, Reveiz L. Embedding implementation research to enhance health policy and systems: a multi-country analysis from ten settings in Latin America and the Caribbean. Health Res Policy Syst 2019; 17:85. [PMID: 31615511 PMCID: PMC6794825 DOI: 10.1186/s12961-019-0484-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background Progress towards universal health coverage requires health policies and systems that are informed by contextualised and actionable research. Many challenges impede the uptake of evidence to enhance health policy implementation and the coverage, quality, efficiency and equity of health systems. To address this need, we developed an innovative model of implementation research embedded in real-world policy and programme cycles and led directly by policy-makers and health systems decision-makers. The approach was tested in ten settings in Latin America and the Caribbean, supported under a common funding and capacity strengthening initiative. The present study aims to analyse ten embedded implementation research projects in order to identify barriers and facilitators to embedding research into policy and practice as well as to assess the programme, policy and systems improvements and the cross-cutting lessons in conducting research embedded in real-world policy and systems decision-making. Methods The multi-country analysis is based on the triangulation of data collected via three methods, namely (1) document review, (2) an electronic questionnaire and (3) in-depth interviews with decision-makers. Data from the document review was charted and narratively synthesised. Data from the questionnaire was used to assess three characteristics of the decision-maker’s participation in embedded research, namely (1) level of engagement in different stages of research; (2) extent to which their capacities to conduct and use research were developed; and (3) the level of confidence in undertaking implementation research activities. Interview data was analysed using a thematic approach. Results The main barriers to effective delivery or scale-up of health interventions identified in the research projects were inadequate financing, fragmentation of healthcare services and information systems, limited capacity of health system stakeholders, insufficient time, cultural factors, and a lack of information. Decision-makers’ experience in embedded research showed strong engagement in protocol development, moderate engagement in data collection and low engagement in data analysis. The in-depth interviews identified 17 facilitators and 8 barriers to embedding research into policy and systems. The principal facilitating factors were actionability of findings, relevance of research and engagement of decision-makers, whereas the main barriers were time and political processes. In Argentina, the research led to the development of new monitoring indicators to improve the implementation of the perinatal health policy, while in Chile, empirical findings supported the establishment of a training programme on reproductive rights, targeted to municipal health facilities. Conclusions This multi-country analysis contributes to the evidence base for the embedded research approach to support health policy and systems decisions-making. Embedding research into policy and practice stimulates the relevance and applicability of research, while promoting decision-makers’ engagement and likelihood to use research evidence in policy-making and health systems strengthening.
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Affiliation(s)
- Etienne V Langlois
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization (WHO), 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Arielle Mancuso
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization (WHO), 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Vanessa Elias
- Pan American Health Organization (PAHO), 525 23rd Street NW, Washington, DC, United States of America
| | - Ludovic Reveiz
- Pan American Health Organization (PAHO), 525 23rd Street NW, Washington, DC, United States of America
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Abstract
This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of “managed care” on care quality are its tight constraints on physicians’ professional autonomy; a large reliance on the physicians’ material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.
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Affiliation(s)
- Jean-Pierre Unger
- 1 Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | - Pierre De Paepe
- 1 Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
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Ormsby GM. Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach. Int J Health Plann Manage 2019; 34:e1356-e1375. [PMID: 30977559 DOI: 10.1002/hpm.2784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/11/2022] Open
Abstract
This formative research process aimed to develop an Eye Health Strategic Planning and Evaluation Framework and indicator Checklist. The research process utilized a multi-phased multiple methods approach including literature review, initial expert review (n = 27), findings from a Cambodian Avoidable Blindness Initiative demonstration project (2009-2012), observation and analysis of four rural sites of the Indian LV Prasad Eye Institute Pyramid Model (n = 21), and finally, a critique by Cambodian government eye health professionals/staff (n = 15), health center staff and community representatives (n = 77) and patients (n = 62). Results from three Cambodian population-based surveys (KAP n = 599, patient follow-up n = 354, and RAAB 4650) also informed the development of the Framework and the Checklist. The Framework domains include: situation analysis, determinants of accessibility, service delivery systems, operation systems, networks and linkages, outcomes, and impact. Domains were subdivided into 59 components. The Checklist consists of 253 indicator items. The Eye Health Strategic Planning and Evaluation Framework and the Checklist can assist policy makers, program planners, and evaluators to develop a comprehensive whole of systems approach to eye health care to improve coverage and utilization of services.
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Affiliation(s)
- Gail M Ormsby
- Research, Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Queensland, Australia.,Adjunct Lecturer, Lifestyle Research Centre, Avondale College of Higher Education, New South Wales, Australia
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De Brún A, McAuliffe E. Recruitment of Healthcare Staff to Social Network Studies: A Case Study Exploring Experiences, Challenges, and Considerations. Int J Environ Res Public Health 2018; 15:E2778. [PMID: 30544531 DOI: 10.3390/ijerph15122778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022]
Abstract
Social network analysis (SNA) is a term that describes a set of methodologies to understand and depict social relations or ties. SNA is different from other research methods in several ways that have important ethical implications, as well as specific considerations for study design. Recruitment of participants and attrition during the study, where there are several data collection time points, pose significant challenges. Furthermore, there are implications of non-participation in studies, whereby gaps in network maps may result in an inaccurate representation of how a network is working and this, in turn, means the results may be of lesser value in terms of informing policy and practice. Given the widely noted challenge of recruiting healthcare staff to research, this paper adopts a case study approach to discussing considerations for researchers, as well as offering recommendations and insights from our own research and from the published literature about how to tackle these issues. This paper examines data sourcing, decision-making about defining the network for data collection, and ethical considerations and their implications for the recruitment of healthcare staff to social network studies. We use a case study example exploring leadership in a hospital group network to illustrate techniques and challenges in the recruitment of healthcare staff.
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Bazzano AN, Wharton MK, Monnette A, Nauman E, Price-Haywood E, Glover C, Dominick P, Malone P, Hu G, Shi L. Barriers and Facilitators in Implementing Non-Face-to-Face Chronic Care Management in an Elderly Population with Diabetes: A Qualitative Study of Physician and Health System Perspectives. J Clin Med 2018; 7:E451. [PMID: 30463310 DOI: 10.3390/jcm7110451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected from interviews with physicians, health system administrators, and other healthcare staff about chronic care management for elderly people with diabetes co-morbid with other chronic conditions in light of new programs intended to reduce barriers by incentivizing care encounters that take place through telephone and electronic communications (non-face-to-face care). Results indicate that health system personnel view non-face-to-face care as potentially providing value for patients and addressing systemic needs, yet challenging to implement in practice. Barriers and facilitators to this approach for managing diabetes and chronic care management for its complications are presented, with consideration to different types of health systems, and recommendations are provided for implementation.
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Theobald S, Morgan R, Hawkins K, Ssali S, George A, Molyneux S. The importance of gender analysis in research for health systems strengthening. Health Policy Plan 2018; 32:v1-v3. [PMID: 29244107 PMCID: PMC5886229 DOI: 10.1093/heapol/czx163] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems; illustrate how gender power relations affect access to important resources; and demonstrate that gender norms, poverty and patriarchy interplay to limit women’s choices and chances both within household interactions and within the health sector. Health systems researchers have a responsibility to promote the incorporation of gender analyses into their studies in order to inform more strategic, effective and equitable health systems interventions, programmes, and policies. Responding to gender inequitable systems, institutions, and services in this sector requires an ‘all hands-on deck’ approach. We cannot claim to take a ‘people-centred approach’ to health systems if the status quo continues.
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Affiliation(s)
- Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore MD, 21202, USA
| | - Kate Hawkins
- Pamoja Communications Ltd., 81 Ewhurst Road, Brighton, BN2 4AL
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, P.O.BOX 7062, Kampala, Uganda
| | - Asha George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville 7535, South Africa
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, PO Box 230, Kilifi 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, UK.,Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, UK
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Lee EH, Olsen CH, Koehlmoos T, Masuoka P, Stewart A, Bennett JW, Mancuso J. A cross-sectional study of malaria endemicity and health system readiness to deliver services in Kenya, Namibia and Senegal. Health Policy Plan 2018; 32:iii75-iii87. [PMID: 29149315 DOI: 10.1093/heapol/czx114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/13/2022] Open
Abstract
Despite good progress towards elimination, malaria continues to contribute substantially to the sub-Saharan African disease burden. Sustaining previous gains requires continued readiness to deliver malaria services in response to actual disease burden, which in turn contributes to health systems strengthening. This study investigates a health system innovation. We examined whether malaria prevalence, or endemicity, is a driver of health facility readiness to deliver malaria services. To estimate this association, we geo-linked cross-sectional facility survey data to endemicity data for Kenya, Namibia and Senegal. We tested the validity and reliability of the primary study outcome, the malaria service readiness index and mapped service readiness components in a geographic information system. We conducted a weighted multivariable linear regression analysis of the relationship between endemicity and malaria service readiness, stratified for urban or rural facility location. As endemicity increased in rural areas, there was a concurrent, modest increase in service readiness at the facility level [β: 0.028; (95% CI 0.008, 0.047)], whereas no relationship existed in urban settings. Private-for-profit facilities were generally less prepared than public [β: -0.102; (95% CI - 0.154, -0.050)]. Most facilities had the necessary supplies to diagnose malaria, yet availability of malaria guidelines and adequately trained staff as well as medicines and commodities varied. Findings require cautious interpretation outside the study sample, which was a more limited subset of the original surveys' sampling schemes. Our approach and findings may be used by national malaria programs to identify low performing facilities in malarious areas for targeted service delivery interventions. This study demonstrates use of existing data sources to evaluate health system performance and to identify within- and cross-country variations for targeted interventions.
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Affiliation(s)
- Elizabeth H Lee
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA.,Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Cara H Olsen
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Tracey Koehlmoos
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Penny Masuoka
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 100, Bethesda, MD 20817, USA.,Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Ann Stewart
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jason W Bennett
- Division of Tropical Public Health, The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.,Multidrug Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910, USA
| | - James Mancuso
- United States Army Medical Directorate - Kenya, Nyanza, Kenya
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Abstract
Research funders from high-income countries have an ethical obligation to support health research in low and middle-income countries that promotes justice in global health. Conceptual work from bioethics proposes funders should do so through their design of grants programs, investments, and grants management. That work has begun to specify the content of funders' ethical responsibility with regards to health systems research, but it has thus far not been informed by their practice. As a first step to bridge that gap, this paper focuses on health systems research funders' design of grants programs. It aims to test the content of funders' proposed ethical responsibility against recent empirical work describing how they design their health systems research grants programs to help address global health disparities. Based on that analysis, recommendations are made for how to better articulate the content of health systems research funders' obligation. Such recommendations may be pertinent to funders of other types of international research. The paper also provides an initial picture of how well health systems research grants programs' designs may align with the ideals of global health justice.
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Affiliation(s)
- Bridget Pratt
- a Nossal Institute for Global Health and Centre for Health Equity, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Adnan A Hyder
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Johns Hopkins Berman Institute of Bioethics , Baltimore , MD , USA
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Bailie R, Bailie J, Larkins S, Broughton E. Editorial: Continuous Quality Improvement (CQI)-Advancing Understanding of Design, Application, Impact, and Evaluation of CQI Approaches. Front Public Health 2017; 5:306. [PMID: 29218305 PMCID: PMC5703697 DOI: 10.3389/fpubh.2017.00306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ross Bailie
- The University of Sydney, The University Centre for Rural Health, Lismore, NSW, Australia
| | - Jodie Bailie
- The University of Sydney, The University Centre for Rural Health, Lismore, NSW, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, Townsville, QLD, Australia
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Pratt B, Hyder AA. Linking Participatory Action Research on Health Systems to Justice in Global Health: A Case Study of the Maternal and Neonatal Implementation for Equitable Health Systems Project in Rural Uganda. J Empir Res Hum Res Ethics 2017; 13:74-87. [PMID: 29160115 DOI: 10.1177/1556264617741022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An ethical framework called "research for health justice" provides initial guidance on how to link health systems research in low- and middle-income countries to health equity. To further develop the largely conceptual framework, we tested its guidance against the experience of the Maternal and Neonatal Implementation for Equitable Health Systems (Manifest) project, which was performed in rural Uganda by researchers from Makerere University. We conducted 21 in-depth interviews with investigators and research implementers, directly observed study sites, and reviewed study-related documents. Our analysis identifies where alignment exists between the framework's guidance and the Manifest project, providing initial lessons on how that was achieved. It also identifies where nonalignment occurred and gaps in the framework's guidance. Suggestions are then made for revising and expanding "research for health justice."
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Affiliation(s)
- Bridget Pratt
- 1 University of Melbourne, Melbourne, Victoria, Australia.,2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adnan A Hyder
- 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,3 Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
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Chughtai S, Blanchet K. Systems thinking in public health: a bibliographic contribution to a meta-narrative review. Health Policy Plan 2017; 32:585-594. [PMID: 28062516 DOI: 10.1093/heapol/czw159] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/13/2022] Open
Abstract
Background Research across the formal, natural and social sciences has greatly expanded our knowledge about complex systems in recent decades, informing a broadly inclusive, cross-disciplinary conceptual framework referred to as Systems Thinking (ST). Its use in public health is rapidly increasing, although there remains a poor understanding of how these ideas have been imported, adapted and elaborated by public health research networks worldwide. Method This review employed a mixed methods approach to narrate the development of ST in public health. Tabulated results from a literature search of the Web of Science Core Collection database were used to perform a bibliometric analysis and literature review. Annual publication counts and citation scores were used to analyse trends and identify popular and potential 'landmark' publications. Citation network and co-authorship network diagrams were analysed to identify groups of articles and researchers in various network roles. Results Our search string related to 763 publications. Filtering excluded 208 publications while citation tracing identified 2 texts. The final 557 publications were analysed, revealing a near-exponential growth in literature over recent years. Half of all articles were published after 2010 with almost a fifth (17.8%) published in 2014. Bibliographic analysis identified five distinct citation and co-authorship groups homophilous by common geography, research focus, inspiration or institutional affiliation. As a loosely related set of sciences, many public health researchers have developed different aspects of ST based on their underlying perspective. Early studies were inspired by Management-related literature, while later groups adopted a broadly inclusive understanding which incorporated related Systems sciences and approaches. Conclusion ST is an increasingly popular subject of discussion within public health although its understanding and approaches remain unclear. Briefly tracing the introduction and development of these ideas and author groups in public health literature may provide clarity and opportunities for further learning, research and development.
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Affiliation(s)
- Saad Chughtai
- Health Policy, Planning, Finance (LSHTM/LSE). ApaJee Trust, Nowshera, KPK, Pakistan
| | - Karl Blanchet
- Karl Blanchet, Department of Global Health and Development, London School of Hygiene & Tropical Medicine
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Brooks C, D'Ambruoso L, Kazimierczak K, Ngobeni S, Twine R, Tollman S, Kahn K, Byass P. Introducing visual participatory methods to develop local knowledge on HIV in rural South Africa. BMJ Glob Health 2017; 2:e000231. [PMID: 29071128 PMCID: PMC5640027 DOI: 10.1136/bmjgh-2016-000231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/02/2016] [Revised: 06/08/2017] [Accepted: 07/02/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION South Africa is a country faced with complex health and social inequalities, in which HIV/AIDS has had devastating impacts. The study aimed to gain insights into the perspectives of rural communities on HIV-related mortality. METHODS A participatory action research (PAR) process, inclusive of a visual participatory method (Photovoice), was initiated to elicit and organise local knowledge and to identify priorities for action in a rural subdistrict underpinned by the Agincourt Health and Socio-Demographic Surveillance System (HDSS). We convened three village-based discussion groups, presented HDSS data on HIV-related mortality, elicited subjective perspectives on HIV/AIDS, systematised these into collective accounts and identified priorities for action. Framework analysis was performed on narrative and visual data, and practice theory was used to interpret the findings. FINDINGS A range of social and health systems factors were identified as causes and contributors of HIV mortality. These included alcohol use/abuse, gender inequalities, stigma around disclosure of HIV status, problems with informal care, poor sanitation, harmful traditional practices, delays in treatment, problems with medications and problematic staff-patient relationships. To address these issues, developing youth facilities in communities, improving employment opportunities, timely treatment and extending community outreach for health education and health promotion were identified. DISCUSSION Addressing social practices of blame, stigma and mistrust around HIV-related mortality may be a useful focus for policy and planning. Research that engages communities and authorities to coproduce evidence can capture these practices, improve communication and build trust. CONCLUSION Actions to reduce HIV should go beyond individual agency and structural forces to focus on how social practices embody these elements. Initiating PAR inclusive of visual methods can build shared understandings of disease burdens in social and health systems contexts. This can develop shared accountability and improve staff-patient relationships, which, over time, may address the issues identified, here related to stigma and blame.
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Affiliation(s)
- Chloe Brooks
- Department for International Development, London, UK.,Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Lucia D'Ambruoso
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Kathleen Kahn
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH: An International Network for the Demographic Evaluation of Populations and Their Health, Accra, Ghana
| | - Peter Byass
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bozorgmehr K, Goosen S, Mohsenpour A, Kuehne A, Razum O, Kunst AE. How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries. Int J Environ Res Public Health 2017; 14:E894. [PMID: 28786927 DOI: 10.3390/ijerph14080894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 11/02/2022]
Abstract
Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson's rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0-97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson's rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component "data sources and availability" was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future.
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Pratt B, Hyder AA. Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research. Dev World Bioeth 2016; 18:76-90. [PMID: 27878976 DOI: 10.1111/dewb.12136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries (LMICs) that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity. Semi-structured in-depth interviews were performed with 16 grants officers working for 11 funders and organisations that support health systems research: the Alliance for Health Policy and Systems Research, Comic Relief, Doris Duke Foundation, European Commission, International Development Research Centre, Norwegian Agency for Development Cooperation, Research Council of Norway, Rockefeller Foundation, UK Department of International Development, UK Medical Research Council, and Wellcome Trust. Thematic analysis of the data demonstrates their funding schemes promote health systems research with (up to) five key features that advance health equity: being conducted with worst-off populations, focusing on research topics that advance equitable health systems, having LMIC ownership of the research agenda, strengthening LMIC research capacity, and having an impact on health disparities. The different types of incentives that encouraged proposed projects to have these features are identified and classified by their strength (strong, moderate, weak). It is suggested that research funders ought to create and maintain funding schemes with strong incentives for the features identified above in order to more effectively help reduce global health disparities.
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