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10 years of the Syrian conflict: A time to act and not merely to remember [Comment]
(Elsevier, 2021-03-12) Jabbour, Samer; Leaning, Jennifer; Nuwayhid, Iman; Ager, Alastair; Cammett, Melani; Dewachi, Omar; Fouad, Fouad M.; Giacaman, Rita; Sapir, Debarati Guha; Hage, Ghassan; Majed, Ziad; Nasser, Rabie; Sparrow, Annie; Spiegel, Paul; Tarakji, Ahmad; Whitson, Sarah Leah; Yassin, Nasser
100 key research questions for the post-2015 development agenda
(ODI, 2015-12-13) Oldekop, Johan A.; Fontana, Lorenza B.; Grugel, Jean; Roughton, Nicole; Adu-Ampong, Emmanuel A.; Bird, Gemma K.; Dorgan, Alex; Vera Espinoza, Marcia; Wallin, Sara; Hammett, Daniel; Agbarakwe, Esther; Agrawal, Arun; Asylbekova, Nurgul; Azkoul, Clarissa; Bardsley, Craig; Bebbington, Anthony J.; Carvalho, Savio; Chopra, Deepta; Christopoulos, Stamatios; Crewe, Emma; Dop, Marie-Claude; Fischer, Joern; Gerretsen, Daan; Glennie, Jonathan; Gois, William; Gondwe, Mtinkheni; Harrison, Lizz A.; Hujo, Katja; Keen, Mark; Laserna, Roberto; Miggiano, Luca; Mistry, Sarah; Morgan, Rosemary J.; Raftree, Linda L.; Rhind, Duncan; Rodrigues, Thiago; Roschnik, Sonia; Senkubuge, Flavia; Thornton, Ian; Trace, Simon; Ore, Teresa; Valdés, René Mauricio; Vira, Bhaskar; Yeates, Nicola; Sutherland, William J.
The Sustainable Development Goals (SDGs) herald a new phase for international development. This article presents the results of a consultative exercise to collaboratively identify 100 research questions of critical importance for the post-2015 international development agenda. The final shortlist is grouped into nine thematic areas and was selected by 21 representatives of international and non-governmental organisations and consultancies, and 14 academics with diverse disciplinary expertise from an initial pool of 704 questions submitted by 110 organisations based in 34 countries. The shortlist includes questions addressing long-standing problems, new challenges and broader issues related to development policies, practices and institutions. Collectively, these questions are relevant for future development-related research priorities of governmental and non-governmental organisations worldwide and could act as focal points for transdisciplinary research collaborations.
34 Gender Difference in the Association between Handgrip Strength and Cognitive Performance of Older Adults in Rural Malaysia
(Oxford University Press, 2019-12-20) Moffat, Emily; Stephan, Blossom CM; Allotey, Pascale; Reidpath, Daniel
Introduction Handgrip strength is an easy and safe measurement to evaluate the physical functioning of older adults. Lower hand grip strength is associated with cognitive decline, and can be used as an effective method for early detection of cognitive impairment. Objective This study aimed to evaluate the gender differences in association between hand grip strength and cognitive performance among older adults in rural Malaysia Methods This was a cross-sectional study done among 200 community dwelling older adults (100 men and 100 women) aged ≥ 50 years. The study was embedded in the ongoing longitudinal study of South East Asia Community Observatory (SEACO) in Segamat district of Johor, Malaysia. Data was collected by trained data collectors during home visits. Cognitive performance was assessed using Mini Mental State Examination (MMSE). Hand grip strength was measured using digital grip dynamometer. Results The mean age of study participants was 61.5 years (SD= 8.4). Women had lower mean hand grip strength (19.8, SD=5.6) compared to men (33.4, SD= 8.2). The mean MMSE score for women and men were 23 (SD= 4.5) and 25.1(SD=3) respectively. Cognitive impairment was detected in 26% of men and 21% of women. Hand grip strength showed positive association with MMSE score, among women (ß coefficient= 0.302, p<0.001), but not among men (p= 0.077). Hand grip strength was significantly association with MMSE score among women (ß coefficient=0.162, 95% CI = 0.026- 0.298; p=0.02) after controlling for age, level of education and body mass index. Conclusion The study shows that lower hand grip strength is associated with poor cognitive performance among women, while hand grip strength is not associated with cognitive performance among men.
4 Cuadras a la Redonda. Diagnóstico y perspectivas de las radios comunitarias de la Región Metropolitana
(Instituto de la Comunicación e Imagen, Universidad de Chile, 2005) Rodríguez, Raúl; Vera Espinoza, Marcia
La radio comunitaria es un instrumento democratizador de las comunicaciones, en el proceso de generar relaciones que fortalezcan la identidad de lo propio, del entorno, el barrio o la comuna. Constituye, por tanto, una dimensión importante en el ejercicio del Derecho a la Comunicación y la Libertad de Expresión. El presente trabajo compila investigaciones exploratorias referidas a la acción local de las radios comunitarias, la ley de mínima cobertura y la evaluación de las radios comunitarias de Santiago, entre otras.
A cluster randomised trial to evaluate the effect of optimising TB/HIV integration on patient level outcomes: The merge- trial protocol
(Elsevier, 2014-10) Kufa, T.; Hippner, P.; Charalambous, S.; Kielmann, Karina; Vassall, A.; Churchyard, G.; Grant, Alison D.; Fielding, K.
Introduction We describe the design of the MERGE trial, a cluster randomised trial, to evaluate the effect of an intervention to optimise TB/HIV service integration on mortality, morbidity and retention in care among newly-diagnosed HIV-positive patients and newly-diagnosed TB patients. Design Eighteen primary care clinics were randomised to either intervention or standard of care arms. The intervention comprised activities designed to optimise TB and HIV service integration and supported by two new staff cadres-a TB/HIV integration officer and a TB screening officer-for 24 months. A process evaluation to understand how the intervention was perceived and implemented at the clinics was conducted as part of the trial. Newly-diagnosed HIV-positive patients and newly-diagnosed TB patients were enrolled into the study and followed up through telephonic interviews and case note abstractions at six monthly intervals for up to 18 months in order to measure outcomes. The primary outcomes were incidence of hospitalisations or death among newly diagnosed TB patients, incidence of hospitalisation or death among newly diagnosed HIV-positive patients and retention in care among HIV-positive TB patients. Secondary outcomes of the study included measures of cost-effectiveness. Discussion Methodological challenges of the trial such as implementation of a complex multi-faceted health systems intervention, the measurement of integration at baseline and at the end of the study and an evolving standard of care with respect to TB and HIV are discussed. The trial will contribute to understanding whether TB/HIV service integration affects patient outcomes.
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.
A comparison of health-related quality of life using the World Health Organization Quality of Life-BREF and 5-Level EuroQol-5 Dimensions in the Malaysian population.
(2025-03-31) Liem, Andrian; Chih, Hui Jun; Velaithan, Vithya; Norman, Richard; Reidpath, Daniel; Su, Tin Tin
This study aimed to describe and compare health-related quality of life (QoL) as measured by the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and the EuroQol-5 Dimensions (EQ-5D) among the Malaysian population, examining differences by sociodemographic characteristics including age, income, sex, ethnicity, educational level, and occupation. This cross-sectional study used data from 19,402 individuals collected as part of a health and demographic surveillance system survey conducted in the Segamat district of Malaysia in 2018-2019. Descriptive statistics and measures of central tendency were produced. Differences in QoL among demographic sub-groups were examined using the t-test and analysis of variance, while the correlations between the WHOQoL-BREF and EQ-5D were evaluated using Pearson correlation coefficients. Based on complete case analysis (n=19,129), the average scores for the 4 WHOQoL-BREF domains were 28.2 (physical), 24.1 (psychological), 12.0 (social relationships), and 30.4 (environment). The percentages of participants not in full health for each EQ-5D dimension were 12.8% (mobility), 3.1% (self-care), 6.9% (usual activities), 20.9% (pain/discomfort), and 6.8% (anxiety/depression). Correlations between the 4 WHOQoL-BREF domains and the 5 EQ-5D dimensions were relatively weak, ranging from -0.06 (social relationships with self-care and pain/discomfort; p<0.001) to -0.42 (physical with mobility; p<0.001). Although health-related QoL as measured by the WHOQoL-BREF and the EQ-5D are correlated, these 2 measures should not be considered interchangeable. The choice between them should be guided by the specific research questions and the intended use of the data.
A Jordanian case study: the implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
(2008) Horn, Rebecca; Strang, Alison
This case study describes the use of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings in Jordan. The fieldwork was carried out 17-27 August 2008 in Jordan and involved discussions with representatives of humanitarian organisations and UN agencies in Amman and Zarqa. This paper describes the ways in which the guidelines have been disseminated in Jordan and how they have 'added value' within the context of the Iraqi refugee crisis in Jordan. It also describes the factors that have hindered the full implementation of the guidelines.
A Kenyan case study: implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings
(2008) Horn, Rebecca; Strang, Alison
This case study describes the use of the IASC Guidelines on Mental Health and Psychosocial Support in Kenya. The fieldwork was carried out 14-25 July 2008, and involved discussions with representatives of humanitarian organisations, UN agencies and government departments in Nairobi, Eldoret and Nakuru. It describes the ways in which the guidelines have been disseminated in Kenya, how they have 'added value' in that context, as well as the factors that have hindered the full implementation of the guidelines in Kenya.
A multi-country phase 2 study to evaluate the suitcase lab for rapid detection of SARS-CoV-2 in seven Sub-Saharan African countries: Lessons from the field
(Elsevier, 2023-03-03) Ceruti, Arianna; Dia, Ndongo; Bakarey, Adeleye Solomon; Ssekitoleko, Judah; Andriamandimby, Soa Fy; Malwengo-Kasongo, Padra; Ahmed, Rasheeda H.A.; Kobialka, Rea Maja; Heraud, Jean Michel; Diagne, Moussa Moise; Dione, Marie Henriette Dior; Dieng, Idrissa; Faye, Martin; Faye, Ousmane; Rafisandratantsoa, Jean Théophile; Ravalohery, Jean-Pierre; Raharinandrasana, Claudio; Randriambolamanantsoa, Tsiry H.; Razanajatovo, Norosoa; Razanatovo, Iony; Rabarison, Joelinotahina H.; Dussart, Phillipe; Kyei-Tuffuor, Louis; Agbanyo, Abigail; Adewumi, Olubusuyi Moses; Fowotade, Adeola; Raifu, Muideen Kolawole; Okitale-Talunda, Patient; Kashitu-Mujinga, Gracia; Mbelu-Kabongo, Christelle; Ahuka-Mundeke, Steve; Makaka-Mutondo, Anguy; Abdalla, Enas M.; Idris, Sanaa M.; Elmagzoub, Wisal A.; Ali, Rahma H.; Nour, Eman O.M.; Ebraheem, Rasha S.M.; Ahmed, Huda H.H.; Abdalla, Hamadelniel E.; Elnegoumi, Musab; Mukhtar, Izdihar; Adam, Muatsim A.M.; Mohamed, Nuha Y.I.; Bedri, Shahinaz A.; Hamdan, Hamdan Mustafa; Kisekka, Magid; Mpumwiire, Monica; Aloyo, Sharley Melissa; Wandera, Joanita Nabwire; Agaba, Andrew; Kamulegeya, Rogers; Kiprotich, Hosea; Kateete, David Patrick; Kadetz, Paul; Truyen, Uwe; Eltom, Kamal H.; Sakuntabhai, Anavaj; Okuni, Julius Boniface; Makiala-Mandanda, Sheila; Lacoste, Vincent; Ademowo, George Olusegun; Frimpong, Michael; Sall, Amadou Alpha; Weidmann, Manfred; Wahed, Ahmed Abd El
Background : The COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings. Objectives : To validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries. Study design : In this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 minutes. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied. Results : Four sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay). Conclusion : Overall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.
A new look: professionalization of NGOs in Kyrgyzstan
(Taylor & Francis, 2014-09-12) Jailobaeva, Kanykey
Non-governmental organizations (NGOs) in post-Soviet Kyrgyzstan have become visible players in the social and political scene. However, despite being portrayed as professional organizations in the literature, the professionalization of NGOs in Kyrgyzstan has been understudied. This article aims to rectify this gap. It presents and discusses the findings of a study analysing NGOs from an organizational perspective using semi-structured interviews with 45 NGOs, self-administered questionnaires with their leaders and employees, and observation of their working environment. The key conclusion is that the NGO sector can be described as semi-professional. NGOs use different tactics to achieve efficiency and effectiveness. However, they face such challenges as limited funding, high staff turnover and poor coordination. The article provides an account of the NGO sector by mapping it into professional and non-professional groups that can serve as a new benchmark for better understanding NGOs in Kyrgyzstan.
A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health
(BioMed Central, 2024-10-21) Ager, Alastair; Hermosilla, Sabrina; Schafer, Alison; Kestel, Dévora
Background: There is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative. Methods: This study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework. Results: Documentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees. Conclusions: The role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.
A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis
(Public Library of Science, 2024-02-12) Abredu, Juliet; Dwumfour, Catherine K.; Alipitio, Boo; Alordey, Mawusi; Dzomeku, Veronica Millicent; Witter, Sophie
The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of ‘free’ delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the ‘free’ delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.
A Study of the Emotional and Psychological Well-being of Refugees in Kakuma Refugee Camp, Kenya
(2010) Horn, Rebecca
A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings
(International Society of Global Health, 2023-10-13) Chan, Kit Yee; Srivastava, Noori; Wang, Zhicheng; Xia, Xiaoqian; Huang, Zhangziyue; Poon, Adrienne N; Reidpath, Daniel
Abstract Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
A theory-based evaluation of the Leadership for Universal Health Coverage Programme: insights for multisectoral leadership development in global health.
(2022-09-29) Witter, Sophie; Brikci, Nouria; Scherer, David
Leadership to manage the complex political and technical challenges of moving towards universal health coverage (UHC) is widely recognized as critical, but there are few studies which evaluate how to expand capacities in this area. This article aims to fill some of this gap by presenting the methods and findings of an evaluation of the Leadership for UHC (L4UHC) programme in 2019-2020. Given the complexity of the intervention and environment, we adopted a theory-driven evaluation approach that allowed us to understand the role of the programme, amongst other factors. Data from a range of sources and tools were compared with a programme theory of change, with analysis structured using an evaluation matrix organized according to the Organisation for Economic Co-operation and Development-Development Assistance Committee (OECD-DAC) criteria. Data sources included key informant (KI) interviews (89 in total); surveys of the 80 workshop participants; a range of secondary data sources; case studies in two countries; and observation of activities and modules by the evaluator. Participants and KIs at the global and country levels reported high relevance of the programme and a lack of alternatives aiming at similar goals. In relation to effectiveness, at the individual level, there was an increase in some competencies, particularly for those with less experience at the baseline. Less change was observed in commitment to UHC as that started at a relatively high level. Understanding of UHC complexity grew, particularly for those coming from a non-health background. Connections across institutional divides for team members in-country increased, although variably across the countries, but the programme has not as yet had a major impact on national coalitions for UHC. Impacts on health policy and practice outcomes were evident in two out of seven countries. We examined factors favouring success and explanatory factors. We identified positive but no negative unintended effects. While noting methodological constraints, the theory-based evaluation approach is found suitable for assessing and learning lessons from complex global programmes. We conclude that L4UHC is an important addition to the global and national health ecosystem, addressing a relevant need with some strong results, and also highlight challenges which can inform other programmes with similar objectives. [Abstract copyright: © 2022. The Author(s).]
A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012
(2014-07-23) Bertone, Maria Paola; Samai, Mohamed; Edem-Hotah, Joseph; Witter, Sophie
Background: It is recognized that decisions taken in the early recovery period may affect the development of health systems. Additionally, some suggest that the immediate post-conflict period may allow for the opening of a political 'window of opportunity' for reform. For these reasons, it is useful to reflect on the policy space that exists in this period, by what it is shaped, how decisions are made, and what are their long-term implications. Examining the policy trajectory and its determinants can be helpful to explore the specific features of the post-conflict policy-making environment. With this aim, the study looks at the development of policies on human resources for health (HRH) in Sierra Leone over the decade after the conflict (2002-2012). Methods. Multiple sources were used to collect qualitative data on the period between 2002 and 2012: a stakeholder mapping workshop, a document review and a series of key informant interviews. The analysis draws from political economy and policy analysis tools, focusing on the drivers of reform, the processes, the contextual features, and the actors and agendas. Findings. Our findings identify three stages of policy-making. At first characterized by political uncertainty, incremental policies and stop-gap measures, the context substantially changed in 2009. The launch of the Free Health Care Initiative provided to be an instrumental event and catalyst for health system, and HRH, reform. However, after the launch of the initiative, the pace of HRH decision-making again slowed down. Conclusions: Our study identifies the key drivers of HRH policy trajectory in Sierra Leone: (i) the political situation, at first uncertain and later on more defined; (ii) the availability of funding and the stances of agencies providing such funds; (iii) the sense of need for radical change - which is perhaps the only element related to the post-conflict setting. It also emerges that a 'windows of opportunity' for reform did not open in the immediate post-conflict, but rather 8 years later when the Free Health Care Initiative was announced, thus making it difficult to link it directly to the features of the post-conflict policy-making environment. 2014 Bertone et al.; licensee BioMed Central Ltd.
About face: How the People’s Republic of China harnessed health to leverage soft power on the world stage
(Frontiers, 2022-02-03) Kadetz, Paul; Stanley-Baker, Michael; Wang, Mei
In the fifteen year period from 1964–1979, The People’s Republic of China engaged in an unprecedented number of domestic and international health campaigns that were utilized for China’s entrance onto the world stage. From Mao Zedong’s vision of a new form of medicine via the unification of Chinese medicines and biomedicine to the adoption of a Chinese model of healthcare integration and primary healthcare by the World Health Organization in the Declaration of Alma Ata, the PRC entered the world stage through its health exports and its distinctive adaptation of modernity to serve domestic, and often foreign policy goals. These exports include Sino-African health diplomacy; the globalization of Traditional Chinese Medicine, and in particular the global utilization and scientific recognition of the antimalarial artemisinin derived from the Chinese herb Qinghao; and a model of primary and rural universal healthcare utilizing community health workers that garnered multilateral support. However, the face of benevolence displayed on the world stage was often contradicted by what was occurring domestically, behind the scenes, with the marked state enforcement of many of these same health campaigns in front of the backdrop of the cultural revolution. This paper examines if, and how, the West may have orientalized and romanticized China’s healthcare exports. Furthermore, we analyze the World Health Organization’s adoption and global promotion of a model for universal healthcare using healthcare integration that was only able to be achieved through the often brutal enforcement of the state, whilst rejecting grass-roots movements enacted during the same period, such as the practitioner-led integration of Ayurvedic medicine in India.
Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn.
(Wiley-Blackwell, 2010-08) Witter, Sophie; Richard, Fabienne; De Brouwere, Vincent
Summary The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and comprehensive emergency obstetric care facilities. To promote the uptake of quality care, there are two possible approaches: influencing the demand and/or the supply of care. Five lessons emerged from experiences. First, it is difficult to obtain robust evidence of the effects of a particular intervention in a context, where they are always associated with other interventions. Second, the interventions tend to have relatively modest short-term impacts, when they address only part of the health system. Third, the long-term effects of an intervention on the whole health system are uncertain. Fourth, because newborn health is intimately linked with maternal health, it is of paramount importance to organise the continuum of care between mother and newborn. Finally, the transfer of experiences is delicate, and an intervention package that has proved to have a positive effect in one setting may have very different effects in other settings. L'accs aux services de sant maternelle et prinatale: leons tires d'exemples russies et moins russies de l'amlioration de l'accs un accouchement et des soins srs pour le nouveau-n L'immense majorit des 6,3 millions de dcs prinataux et du demi-million de dcs maternels surviennent dans les pays en dveloppement et sont vitables. Cependant, la plupart des interventions visant rduire la mortalit prinatale et maternelle ont besoin d'un systme de soins de sant offrant des prestations de soins prnataux appropris et de qualit, y compris des services complets de soins obsttriques d'urgence de base. Afin de promouvoir l'adoption de soins de qualit, il y a deux approches possibles: influencer la demande et/ou l'offre de soins. Cinq leons ont t dgages de certaines expriences. D'abord, il est difficile d'obtenir des preuves solides des effets d'une intervention particulire dans un contexte o_ ils sont toujours associs d'autres interventions. Deuximement, les interventions ont tendance avoir des impactes relativement modestes court terme quand elles ne visent qu'une partie du systme de sant. Troisimement, les effets long terme d'une intervention sur l'ensemble du systme de sant sont incertains. Quatrimement, comme la sant du nouveau-n est intimement lie celle de la mre, il est d'une importance primordiale d'organiser la continuit des soins entre la mre et le nouveau-n. Enfin, le transfert d'expriences est dlicat et une trousse d'intervention qui s'est avre positive dans un contexte peut avoir des effets trs diffrents dans d'autres contextes. Punto de vista Acceso a servicios maternos y perinatales: lecciones de ejemplos exitosos y menos exitosos en la mejora del acceso a un parto seguro y cuidados neonatales La gran mayor_a de las 6.3 millones de muertes perinatales y el medio mill_n de muertes maternas suceden en pa_ses en v_as de desarrollo y son inevitables. Sin embargo, la mayor_a de las intervenciones que buscan reducir las muertes maternas y perinatales requieren de un sistema sanitario que ofrezca unos cuidados prenatales apropiados y unos cuidados de calidad durante el parto, incluyendo el acceso a instalaciones obsttricas bsicas y de emergencia. A la hora de promover la mejora del servicio hay dos posibilidades: influenciar la demanda y/o la oferta de cuidados. Se obtuvieron cinco lecciones como resultado de las diferentes experiencias. Primero, es dif_cil obtener una evidencia robusta de los efectos que tiene una intervenci_n en particular dentro de un contexto en el cual siempre hay otras intervenciones asociadas. Segundo, las intervenciones tienden a tener impactos con ventanas de tiempo relativamente cortas cuando solo han sido dirigidas hacia una parte del sistema sanitario. Tercero, los efectos a largo plazo de una intervenci_n, sobre todo en el sistema de salud, son inciertos. Cuarto, puesto que la salud neonatal est_ntimamente ligada a la salud materna, es muy importante ligar los cuidados continuos de la madre y del neonato. Finalmente, la transferencia de experiencias es delicada y un tipo de intervenci_n que ha tenido un efecto positivo en un lugar puede tener efectos muy diferentes en otro.
Accessing palliative care for multiple sclerosis: A qualitative study of a neglected neurological disease
(Elsevier, 2019-10) Cheong, Wing Loong; Mohan, Devi; Warren, Narelle; Reidpath, Daniel
Background Despite the global consensus on the importance of palliative care for patients with multiple sclerosis (MS), many patients in developing countries do not receive palliative care. Improving access to palliative care for MS requires a contextual understanding of how palliative care is perceived by patients and health professionals, the existing care pathways, and barriers to the provision of palliative care. Objective This study aims to examine and contrast the perceptions of MS patients, neurologists, and palliative care physicians towards providing palliative care for patients with MS in Malaysia. Methods 12 MS patients, 5 neurologists, and 5 palliative care physicians participated in this qualitative study. Each participant took part in a semi-structured interview. The interviews were transcribed verbatim, and analysed using an iterative thematic analysis approach. Results Patients and neurologists mostly associated palliative care with the end-of-life and struggled to understand the need for palliative care in MS. Another barrier was the lack of understanding about the palliative care needs of MS patients. Palliative care physicians also identified the scarcity of resources and their lack of experience with MS as barriers. The current referral-based care pathway itself was found to be a barrier to the provision of palliative care. Conclusions MS patients in Malaysia face several barriers in accessing palliative care. Overcoming these barriers will require improving the shared understanding of palliative care and its role in MS. The existing care pathway also needs to be reformed to ensure that it improves access to palliative care for MS patients.