The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
Browse
7 results
Search Results
Item Risks and Resilience Amongst Rural Honduran Children(Springer, 2025-09-20) Viola, Lorian VThis study utilized a socioecological systems framework to examine the interplay of risk and resilience factors among children in middle childhood residing in a rural community in Honduras. In such contexts marked by structural disadvantage, a nuanced understanding of resilience is essential for mitigating the effects of adversity and fostering children’s potential. Utilizing an exploratory mixed-methods design, the research was conducted in three sequential phases. In the first phase (focus groups, N = 4), participants identified 12 context-specific childhood adversities and six associated signs of vulnerability. The second phase (risk screening, N = 175) found that children frequently encountered multiple, co-occurring risks, such as prolonged parental absence. In the third phase (survey, N = 84), resilience was assessed using the Child and Youth Resilience Measure (CYRM-28), revealing that among children experiencing co-occurring risks, resilience was primarily relational in nature, with social networks providing essential protective resources. Logistic regression analyses identified four key protective factors within children’s social ecologies: three at the household level (consistent adult presence in the home and the regular availability of time and resources for academic tasks) and one at the community level (perceived safety during school commutes). Although the study’s relatively small sample size limits the generalizability of the findings, the results highlight the critical role of multisystemic influences in fostering positive outcomes for children exposed to high levels of adversity.Item Identifying vulnerabilities in essential health services: Analysing the effects of system shocks on childhood vaccination delivery in Lebanon(Elsevier, 2024-08-28) Ismail, Sharif A.; Tomoaia-Cotisel, Andrada; Noubani, Aya; Fouad, Fouad M.; Trogrlić, Robert Šakić; Bell, Sadie; Blanchet, Karl; Borghi, JosephineShocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting.Item Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal(BioMed Central, 2024-04-04) Regmi, Shophika; Bertone, Maria Paola; Shrestha, Prabita; Sapkota, Suprich; Arjyal, Abriti; Martineau, Tim; Raven, Joanna; Witter, Sophie; Baral, SushilIntroduction: The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. Methods: We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. Results: In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. Conclusions: The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.Item Evolution and lessons from an integrated service delivery network in North West Syria(BioMed Central, 2023-03-24) Witter, Sophie; Diaconu, Karin; Bou-Orm, Ibrahim; Jamal, Zeina; Shroff, Zubin Cyrus; Mahmoud, Abdulbaki; Daher, Mahmoud; Varma, VinodBackground: Northwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings. Methods: This mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated. Results: The study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps. Conclusion: This study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.Item 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, SophieDiscussions 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).]Item Living with transience in high-risk humanitarian spaces: Gendered experiences of international staff and policy implications for building resilience(Wiley, 2020-08-10) Strohmeier, Hannah; Panter-Brick, CatherineBeing deployed in crisis zones is perilous business. To-date, little is known regarding how humanitarian workers relate social and professional goals to lived experiences of high-risk environments. In South Sudan, ranked as the most dangerous country for aid workers globally, we interviewed international humanitarian staff (n=20) to examine, using thematic and interpretative phenomenological analysis, their sense of place, wellbeing, and vocation. Subjectivities of humanitarian spaces hinged upon negotiating physical hardships and social relationships: Juba was described both as a "prison" and "party hot spot." For expatriate staff, making sense of spatial, social, and professional transience was sharply gendered and rooted in subjectivities of risk-taking, crisis-managing, and career-building. We highlight two policy measures to address the implications of transience for human wellbeing and organizational effectiveness. Efforts to support teams and structure work environments, altering the humanitarian and vocational bubble, will help build resilience at the heart of humanitarian systems.Item Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: Impacts, challenges, and strategies in the field(BioMed Central, 2020-06-23) Panter-Brick, Catherine; Eggerman, Mark; Ager, Alastair; Hadfield, Kristin; Dajani, Rana; This research was funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme (https://www.elrha.org/project/yale-psychosocial-call2/) for a total GPB 295,131 in 2015–17 (grant #14045). Elrha aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises (elrha.org/r2hc). The R2HC programme is funded equally by the Wellcome Trust and the UK Government.Background: Evidence of ‘what works’ in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them.