The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
Browse
10 results
Search Results
Item Integrating healthcare financing for refugees into national health systems: findings from a rapid review of the literature(Elsevier, 2025-10-16) Bertone, Maria Paola; Palmer, Natasha; Witter, SophieAs the number of refugees increases and displacement becomes protracted, providing equitable healthcare in sustainable ways is increasingly challenging. The Global Compact for Refugees calls for greater inclusion of refugees in national health systems. However, evidence is limited on the most suitable approaches to achieve integration, including from a health financing perspective. This study reviewed normative and empirical literatures on health financing for refugees, reflecting on existing arrangements, and their level of integration with national health systems. A total of 52 documents were reviewed following a purposeful search of grey and published literature. Data were analysed according to core health financing sub-functions as defined by the WHO, specifically reflecting on pathways and approaches to integration for each. The analysis found that challenges remains in relation to funding for refugee healthcare, and areas of focus concern fair burden-sharing and engagement of development funders. Fund pooling proves to be a potential entry point for integration to reduce fragmentation in health financing through use of existing mechanisms (budgets or social health insurance schemes), despite challenges highlighted in the empirical literature. Fewer documents look at purchasing and benefit packages, and they highlight the importance of tailoring those to the specific needs of refugees. In relation to equity and efficiency, integration is often assumed to lead to improvements, but evidence is limited and issues related to the underlying weaknesses of the national health system might hamper the benefits of integration. Overall, the review findings support the development of hypotheses as to how best support health financing integration processes, and highlight areas for further research.Item The effectiveness of the Sierra Leone health sector’s response to COVID-19: a quantitative analysis(BioMed Central, 2025-03-12) Osborne, Augustus; Amara, Philip S.; M’Cormack-Hale, Fredline A.O.; Kanu, Mohamed; Kanu, Alhassan Fouard; Yillah, Regina Mamidy; Gooding, Kate; Witter, SophieBackground: The COVID-19 pandemic posed significant challenges to health systems globally, particularly in low-resource settings like Sierra Leone. Understanding the effectiveness of leadership, health workforce performance, community engagement, and service delivery during the pandemic is critical for strengthening future pandemic, preparedness and response. Methods: A cross-sectional study was conducted with 303 respondents, including stakeholders from the Ministry of Health, district health management teams, and community health workers. Data were collected using structured questionnaires and analyzed to assess perceptions of leadership, workforce performance, community participation, and disruptions to health services. Results: Leadership and governance were rated as “effective” or “very effective” by 58% of respondents, with key challenges including inadequate communication, delays in resource mobilization, and limited transparency. The health workforce demonstrated strong commitment (62%), but gaps in infection prevention and control training (48%) and shortages of personal protective equipment (39%) were significant barriers. Community engagement was moderately effective, with 54% rating it as “effective” or “very effective.” However, low trust in the health sector and misinformation hindered compliance with preventive measures. Maternal and child health services were the most disrupted, but innovative approaches such as telemedicine and mobile health units were adopted to mitigate service interruptions. Conclusion: Sierra Leone’s COVID-19 response highlighted both achievements and challenges. While leadership structures, workforce dedication, and community health worker contributions were notable strengths, gaps in communication, resource availability, and community trust limited the overall effectiveness of the response. Strengthening communication channels, investing in workforce training and resources, and enhancing community engagement strategies are critical for improving preparedness and response in future health emergencies.Item The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study(Elsevier, 2021-10-09) Arakelyan, Stella; Jailobaeva, Kanykey; Dakessian, Arek; Diaconu, Karin; Caperon, Lizzie; Strang, Alison; Bou-Orm, Ibrahim; Witter, Sophie; Ager, AlastairNon-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this cross-country multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n=102) and Group Model Building workshops (n=8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities’ responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.Item Experiences of a new cadre of midwives in Bangladesh: Findings from a mixed method study(BMC, 2020-10-06) Zaman, Rashid U.; Khaled, Adiba; Sabur, Muhammod Abdus; Islam, Shahidul; Ahmed, Shehlina; Varghese, Joe; Sherratt, Della; Witter, SophieBackground Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills.Item Understanding the resilience of health systems(Springer, 2020-02-26) Blanchet, Karl; Diaconu, Karin; Witter, Sophie; Bozorgmehr, Kayvan; Roberts, Bayard; Razum, Oliver; Biddle, LouiseGlobally, displacement is now at the highest level ever recorded with 68.5 million people being forcibly displaced due to violence, political instability or poor economic conditions. Migration towards neighbouring countries or more distant high-income settings in Europe is creating new challenges for national health systems. This chapter explores health systems resilience, i.e. the capacity of health systems to adapt and transform themselves in response to challenges. We offer reflections and a new conceptual framework on resilience based on systems thinking and complexity theories. The chapter also offers examples of migration-related challenges and resilience responses in health systems and policies in order to illustrate the utility and relevance of the developed conceptual framework for European and neighbouring health systems faced by population flows and conflict. Finally, we make recommendations for a new research agenda.Item Building cooperative learning to address alcohol and other drug abuse in Mpumalanga, South Africa: A participatory action research process(Taylor & Francis, 2020-03-02) Oladeinde, Oladapo; Mabetha, Denny; Twine, Rhian; Hove, Jennifer; van der Merwe, Maria; Byass, Peter; Witter, Sophie; Kahn, Kathleen; D'Ambruoso, Lucia; Wall, StigBackground: Alcohol and other drug (AOD) abuse is a major public health challenge disproportionately affecting marginalised communities. Involving communities in the development of responses can contribute to acceptable solutions.Item Understanding fragility: Implications for global health research and practice(Oxford University Press, 2019-12-10) Diaconu, Karin; Falconer, Jennifer; Vidal, Nicole L.; O'May, Fiona; Azasi, Esther; Elimian, Kelly; Bou-Orm, Ibrahim; Sarb, Cristina; Witter, Sophie; Ager, AlastairAdvances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience.Item Health system resilience in the face of crisis: Analysing the challenges, strategies and capacities for UNRWA in Syria(Oxford University Press, 2019-10-18) Jamal, Zeina; Alameddine, Mohamad; Diaconu, Karin; Lough, Graham; Witter, Sophie; Ager, Alastair; Fouad, Fouad M.Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.Item What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies(BioMed Central, 2019-01-21) Witter, Sophie; Anderson, Ian; Annear, Peter; Awosusi, Abiodun; Bhandari, Nitin N.; Brikci, Nouria; Binachon, Blandine; Chanturidze, Tata; Gilbert, Katherine; Jensen, Charity; Lievens, Tomas; McPake, Barbara; Raichowdhury, Snehashish; Jones, AlexBackground - All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems.Item Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria(Elsevier, 2018-10-21) Alameddine, Mohamad; Fouad, Fouad M.; Diaconu, Karin; Jamal, Zeina; Lough, Graham; Witter, Sophie; Ager, AlastairResilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We completed 62 semi-structured interviews (30 in Lebanon in November - December, 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. The study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.