Browsing by Person "Loffreda, Giulia"

Now showing 1 - 20 of 22

A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon
(2020-03-30) Noubani, Aya; Diaconu, Karin; Ghandour, Lilian; El Koussa, Maria; Loffreda, Giulia; Saleh, Shadi
Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility.
An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries
(BMC, 2021-06-29) Jailobaeva, Kanykey; Falconer, Jennifer; Loffreda, Giulia; Arakelyan, Stella; Witter, Sophie; Ager, Alastair
Background: Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. Methods: This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. Results: In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios – receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. Conclusion: The growing threat of NCDs and their drivers are increasingly recognised. However, global actors’ policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.
Barriers and Opportunities for WHO ‘Best Buys’ Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review
(Maad Rayan Publishing Company, 2023-12-31) Loffreda, Giulia; Arakelyan, Stella; Bou-Orm, Ibrahim; Holmer, Hampus; Allen, Luke N.; Witter, Sophie; Ager, Alastair; Diaconu, Karin
Background: Improving the adoption and implementation of policies to curb noncommunicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policymakers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. Methods: We conducted a complex systematic review of articles discussing the adoption and implementation of WHO's ‘best buys' NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. Results: Our CLD highlights a central feedback loop encompassing three vital variables: 1) the ability to define, (re)shape and pass appropriate policy into law; 2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); 3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. Conclusion: To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.
Conflict as a macrodeterminant of non-communicable diseases: the experience of Libya.
(2022-10-01) Allen, Luke N; Aghilla, Mohamed; Kak, Mohini; Loffreda, Giulia; Wild, Cervantée Erice Koorey; Hatefi, Arian; Herbst, Christopher H; El Saeh, Haider
The dangers of “health washing” the fossil fuel industry [opinion]
(BMJ Publishing Group, 2023-04-19) Loffreda, Giulia; Osborne, Rhiannon; Arteaga-Cruz, Erika; Baum, Fran
Decision-making surrounding distress, depression and suicidal ideation: findings of a vignette study with primary health care practitioners in Lebanon [Working paper]
(Queen Margaret University, 2025-07) Noubani, Aya; Loffreda, Giulia; Diaconu, Karin; Muhheiddine, Dina; Horn, Rebecca; Saleh, Shadi
This working paper presents early findings from a vignette-based study exploring how primary health care (PHC) providers in Lebanon assess and respond to cases of mental ill-health, including distress, depression, and suicidal ideation. Sixty-one healthcare providers from PHC centers in Beirut and the Bekaa participated in the study using an interactive, web-based vignette tool that simulated patient cases. Each participant reviewed three vignettes varying by patient gender, nationality, and mental health severity. Providers assessed symptom severity, selected treatment options, and chose appropriate referrals. Although detailed findings are withheld to preserve the novelty of forthcoming peer-reviewed work, general trends suggest that provider decision-making varies based on professional role, patient profile, and regional context. The study underscores the potential of PHCCs to support early mental health intervention and the feasibility of vignette-based tools for research in fragile settings.
Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting
(BMC, 2021-01-11) Zablith, Nadine; Diaconu, Karin; Naja, Farah; El Koussa, Maria; Loffreda, Giulia; Bou-Orm, Ibrahim; Saleh, Shadi; National Institute for Health Research (NIHR)
Abstract: Background: Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. Methods: Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. Results: Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. Conclusion: Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.
Fragile, handle with care: Refining a key concept for global health and development
(BMJ Publishing Group, 2023-06-28) Diaconu, Karin; Witter, Sophie; Dakessian, Arek; Loffreda, Giulia; Ager, Alastair
Summary box In the development sphere, the term ‘fragile’ has generally been used as a pejorative label to represent ‘fragile and conflict-affected states’ with chronic governance challenges. Beginning with the formulation of the OECD’s multidimensional framing of fragility, a broader use of the term is emerging, which is of potential utility in the field of global health. Evidence from a series of studies addressing non-communicable disease and mental health provision—both of which require continuity of care and long-term investments into health service delivery and capacity—informs a ‘fragility for health’ framework consistent with this evolving understanding of fragility. This framework identifies two domains that warrant more intense, politically sensitive study: political economy and financing for health services delivery and community engagement in shaping systems for health. Consideration of these domains will critically inform health interventions in contexts of fragility.
Health justice in fragile and shock-prone settings: from theory to practice towards building resilient health systems
(BMJ, 2025-09-10) Loffreda, Giulia; Regmi, Shophika; Khalil, Joanna; La, Thazin; Idriss, Ayesha; Raven, Joanna; Witter, Sophie; Mansour, Wesam
Health justice is an emerging imperative in global health and health policy and systems research, particularly in fragile and shock-prone settings where inequities are deepened by political instability, conflict and structural violence. This practice paper explores how the ReBUILD for Resilience consortium has sought to operationalise health justice as a guiding principle and embedded practice in four diverse contexts: Myanmar, Nepal, Lebanon and Sierra Leone. Drawing from political philosophy, public health ethics and the capability approach, we outline a framework that positions health justice not only as an aspiration but also as an actionable, community-rooted agenda that centres equity, power redistribution and inclusive governance. Through participatory action research, political economy analysis and embedded learning sites, the ReBUILD teams engaged with communities and health system actors to co-create interventions that respond to local needs while addressing entrenched exclusion and marginalisation. Country experiences demonstrate both the potential and challenges of advancing health justice: from establishing inclusive Municipal Health Committees and revitalising health facility governance to promoting leadership among marginalised groups such as people with disabilities and displaced populations. This paper reflects on tensions around facilitation, participation and positionality and acknowledges the broader political economy, subnational, national and transnational, that shapes opportunities for transformation. We argue that health justice must be pursued through politically astute, reflexive and participatory research approaches, grounded in long-term relationships and a commitment to amplifying community voices. While the road is complex and contested, the pursuit of health justice is essential for building more equitable, inclusive and resilient health systems in the face of protracted crises and global inequities.
How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks.
(2022-11-29) Gooding, Kate; Bertone, Maria Paola; Loffreda, Giulia; Witter, Sophie
Discussions of health system resilience and emergency management often highlight the importance of coordination and partnership across government and with other stakeholders. However, both coordination and partnership have been identified as areas requiring further research. This paper identifies characteristics and enablers of effective coordination for emergency preparedness and response, drawing on experience from different countries with a range of shocks, including floods, drought, and COVID-19. The paper synthesises evidence from a set of reports related to research, evaluation and technical assistance projects, bringing together evidence from 11 countries in sub-Saharan Africa and South Asia. Methods for the original reports included primary data collection through interviews, focus groups and workshop discussions, analysis of secondary data, and document review. Reports were synthesised using a coding framework, and quality of evidence was considered for reliability of the findings. The reports highlighted the role played by coordination and partnership in preparedness and response, and identified four key areas that characterise and enable effective coordination. First, coordination needs to be inclusive, bringing together different government sectors and levels, and stakeholders such as development agencies, universities, the private sector, local leaders and civil society, with equitable gender representation. Second, structural aspects of coordination bodies are important, including availability of coordination structures and regular meeting fora; clear roles, mandates and sufficient authority; the value of building on existing coordination mechanisms; and ongoing functioning of coordination bodies, before and after crises. Third, organisations responsible for coordination require sufficient capacity, including staff, funding, communication infrastructure and other resources, and learning from previous emergencies. Fourth, effective coordination is supported by high-level political leadership and incentives for collaboration. Country experience also highlighted interactions between these components, and with the wider health system and governance architecture, pointing to the need to consider coordination as part of a complex adaptive system. COVID-19 and other shocks have highlighted the importance of effective coordination and partnership across government and with other stakeholders. Using country experience, the paper identifies a set of recommendations to strengthen coordination for health system resilience and emergency management. [Abstract copyright: © 2022. The Author(s).]
Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica
(Public Library of Science, 2023-04-19) Loffreda, Giulia; Chikovani, Ivdity; Mocumbi, Ana O.; Asmar, Michele Kosremelli; Blanco, Laura C.; Grant, Liz; Ager, Alastair
While scientific research supporting mitigation of further global temperature rise remains a major priority, CoP26 and CoP27 saw increased recognition of the importance of research that informs adaptation to irreversible changes in climate and the increasing threats of extreme weather events. Such work is inevitably and appropriately contextual, but efforts to generalise principles that inform local strategies for adaptation and resilience are likely crucial. Systems approaches are particularly promising in this regard. This study adopted a system dynamics framing to consider linkages between climate change and population health across four low- and middle-income country settings with a view to identifying priority inter-sectoral adaptation measures in each. On the basis of a focused literature review in each setting, we developed preliminary causal loop diagrams (CLD) addressing dynamics operating in Mozambique, Lebanon, Costa Rica, and Georgia. Participatory workshops in each setting convened technical experts from different disciplines to review and refine this causal loop analysis, and identify key drivers and leverage points for adaptation strategy. While analyses reflected the unique dynamics of each setting, common leverage points were identified across sites. These comprised: i) early warning/preparedness regarding extreme events (thus mitigating risk exposure); ii) adapted agricultural practices (to sustain food security and community livelihoods in changing environmental conditions); iii) urban planning (to strengthen the quality of housing and infrastructure and thus reduce population exposure to risks); iv) health systems resilience (to maintain access to quality healthcare for treatment of disease associated with increased risk exposure and other conditions for which access may be disrupted by extreme events); and v) social security (supporting the livelihoods of vulnerable communities and enabling their access to public services, including healthcare). System dynamics modelling methods can provide a valuable mechanism for convening actors across multiple sectors to consider the development of adaptation strategies.
Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica
(Institute for Global Health and Development: Queen Margaret University, Edinburgh, 2021-10) Loffreda, Giulia; Grant, Liz; Ager, Alastair; Chikovani, Idvity; Mocumbi, Ana Olga; Asmar, Michele; Blanco, Laura Cristina
Dataset for this paper is available at: https://eresearch.qmu.ac.uk/handle/20.500.12289/12889
Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica
(2021-10) Loffreda, Giulia; Grant, Liz; Ager, Alastair; Chikovani, Idvity; Mocumbi, Ana Olga; Asmar, Michele; Blanco, Laura Cristina
Dataset for: Loffreda, G., Grant, L., Ager, A., Chikovani, I., Mocumbi, A.O., Asmar, M. and Blanco, L.C. (2021) Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica. Edinburgh: Institute for Global Health and Development, Queen Margaret University. https://eresearch.qmu.ac.uk/handle/20.500.12289/11605
Navigating power in policy adoption: the political economy of noncommunicable diseases in Sierra Leone
(Elsevier, 2025-10-06) Loffreda, Giulia; Senesi, Reynold; Diaconu, Karin; Idriss, Ayesha; Witter, Sophie
Non-communicable diseases (NCDs) represent a rising health burden globally, yet low- and middle-income countries (LMICs), particularly fragile states, face persistent barriers to NCD prevention and control policy adoption and implementation. This qualitative case study examines the factors influencing NCD policy adoption in Sierra Leone, a country that, in recent years, has focused on tackling these conditions. Drawing on 20 key informant interviews and 39 policy documents and media analysis, the study highlights the interplay of global health norms, commercial determinants, and local capacities. Findings reveal how international frameworks like WHO’s ‘best buys’ provide essential guidance but often fail to accommodate local socio-political realities. The analysis underscores how multisectoral coalitions, power dynamics, and commercial interests shape outcomes of policy adoption, while chronic underfunding and donor-driven priorities further complicate governance. Recommendations emphasize the importance of context-sensitive strategies that integrate local knowledge systems, strengthen leadership, and embed implementation research. Ultimately, fostering adaptive, accountable, and well-resourced health systems, supported by global solidarity and coordinated governance reforms, is essential to achieving sustainable NCD responses, particularly in an era marked by fractured multilateralism and weakened collective action, where strengthening local capacities and political commitment becomes even more critical.
Non-communicable disease policy implementation in Libya: A mixed methods assessment
(Public Library of Science, 2022-11-10) Allen, Luke N.; Wild, Cervantée E. K.; Loffreda, Giulia; Kak, Mohini; Aghilla, Mohamed; Emahbes, Taher; Bonyani, Atousa; Hatefi, Arian; Herbst, Christopher; El Saeh, Haider M.
The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya’s NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya’s complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.
Political economy analysis of Universal health coverage and health financing reforms in low- and middle-income countries: The role of stakeholder engagement in the research process
(BMC, 2021-12-11) Loffreda, Giulia; Bello, Kéfilath; Kiendrébéogo, Joël Arthur; Selenou, Isidore; Ag Ahmed, Mohamed Ali; Dossou, Jean Paul; Witter, Sophie; Bertone, Maria Paola
Background: Progress towards Universal Health Coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond ‘study subjects’ as potential co-creators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods: We reviewed the literature to describe if, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardised search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of authors of the included studies to complement the information retrieved. Results: 50 articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, focusing on sensitive issues and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, co-production of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions: Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensure relevance, usability, and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.
Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms
(BioMed Central, 2023-12-18) Bou-Orm, Ibrahim; Loffreda, Giulia; Diaconu, Karin; Witter, Sophie; deVos, Pol
Introduction: Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. Methods: This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. Results: Lebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. Conclusion: Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.
Readiness to deliver person‐focused care in a fragile situation: The case of Mental Health Services in Lebanon
(BMC, 2021-03-02) Noubani, Aya; Diaconu, Karin; Loffreda, Giulia; Saleh, Shadi
Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.
Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda
(Elsevier, 2025-09-12) Olabi, Amina; Palmer, Natasha; Bertone, Maria Paola; Loffreda, Giulia; Bou-Orm, Ibrahim; Sempé, Lucas; Vera Espinoza, Marcia; Dakessian, Arek; Kadetz, Paul; Ager, Alastair; Witter, Sophie
This paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.
Social determinants and mental health needs of Palestine refugees and UNRWA responses in Gaza during the COVID-19 pandemic: a qualitative assessment
(BioMed Central, 2022-12-08) Jamal, Zeina; ElKhatib, Zoheir; AlBaik, Shatha; Horino, Masako; Waleed, Mohammed; Fawaz, Farah; Loffreda, Giulia; Seita, Akihiro; Witter, Sophie; Diaconu, Karin
Background: Due to pre-existing difficulties, refugees are especially susceptible to the negative effects of the pandemic; nonetheless, the pandemic’s effect on this group is still unclear. The purpose of this study was to determine the effects of the COVID-19 pandemic on the mental health of Palestine refugees in Gaza by identifying the role of social determinants. During the pandemic, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) enacted a number of policies and measures. The purpose of this research was to assess their efficacy and acceptability. Methods: This qualitative study took place between August and November 2020. Twenty-nine key-informant interviews were conducted remotely with UNRWA Headquarters, field and clinical staff in Gaza and with community members, aged ≥18 years and residing in Rafah and Jabalia camps. We sought informed consent verbally or via email. Data was coded based on the framework for social determinants of mental health. Results: Interview results indicated that the relationship might be unidirectional, with COVID-19 causing the degradation of living conditions and vice versa, with living conditions exacerbating the COVID-19 situation by facilitating virus transmission. In other instances, the association between mental health determinants and COVID-19 might be bidirectional. In terms of experiencing violence and anxieties, women, children, and daily-paid employees were significantly more disadvantaged than other groups in the community. UNRWA modified its service delivery techniques in order to continue providing essential services. In general, UNRWA’s strategies throughout the pandemic were deemed beneficial, but insufficient to meet the needs of Gazans. Conclusion: The pandemic highlights the need to go beyond disease treatment and prevention to address social determinants to improve refugees’ health and reduce their susceptibility to future shocks. UNRWA has rapidly implemented telemedicine and mental telehealth services, making it imperative to assess the efficacy of these novel approaches to provide care at a distance. A long-term option may be to employ a hybrid strategy, which combines online and in-person therapy.