The Institute for Global Health and Development
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Item Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: A systematic review(Elsevier, 2020-12-09) Rass, Ella; Lokot, Michelle; Brown, Felicity L; Fuhr, Daniela C; Asmar, Michèle Kosremelli; Smith, James; McKee, Martin; Bou-Orm, Ibrahim; Yeretzian, Joumana Stephan; Roberts, BayardBackground Community participation in health responses in humanitarian crises is increasingly promoted by humanitarian actors to support adoption of measures that are relevant and effective to local needs. Our aim was to understand the role of community participation in humanitarian health responses for conflict-affected populations (including forcibly displaced populations) in low- and middle-income countries and the barriers and facilitators to community participation in healthcare responses. Methods Using a systematic review methodology, following the PRISMA protocol, we searched four bibliographic databases for publications reporting peer-reviewed primary research. Studies were selected if they reported how conflict-affected populations were involved in healthcare responses in low- and middle-income settings, and associated changes in healthcare responses or health outcomes. We applied descriptive thematic synthesis and assessed study quality using study design-specific appraisal tools. Results Of 18,247 records identified through the database searching, 18 studies met our inclusion criteria. Various types of community participation were observed, with participation mostly involved in implementing interventions rather than framing problems or designing solutions. Most studies on community participation focused on changes in health services (access, utilisation, quality), community acceptability and awareness, and ownership and sustainability. Key barriers and facilitators to community participation included political will at national and local level, ongoing armed conflict, financial and economic factors, socio-cultural dynamics of communities, design of humanitarian responses, health system factors, and health knowledge and beliefs. Included studies were of mixed quality and the overall strength of evidence was weak. More generally there was limited critical engagement with concepts of participation. Conclusion This review highlights the need for more research on more meaningful community participation in healthcare responses in conflict-affected communities, particularly in framing problems and creating solutions. More robust research is also required linking community participation with longer-term individual and health system outcomes, and that critically engages in constructs of community participation.Item 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, MeiIn 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.Item Understanding the health needs of internally displaced persons: A scoping review(Elsevier, 2021-10-29) Cantor, David James; Swartz, Jina; Bayard, Roberts; Abbara, Aula; Ager, Alastair; Bhutta, Zulfiqar A.; Blanchet, Karl; Bunte, Derebe Madoro; Chukwuorji, JohnBosco Chika; Daoud, Nihaya; Ekezie, Winifred; Jimenez-Damary, Cecilia; Jobanputra, Kiran; Makhashvili, Nino; Rayes, Diana; Restrepo-Espinosa, Maria Helena; Rodriguez-Morales, Alfonso J.; Bukola, Salami; Smith, JamesWe seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDPs health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.Item Evidencias actuales en las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud en la población cubana(Editorial Ciencias Médicas, 2014-05) Álvarez Pérez, Adolfo G.; Luis Gonzalvez, Isabel P.; Maldonado Cantillo, Geominia; Romero Placeres, Manuel; Bonet‐Gorbea, Mariano; Lage Davila, Carlos; De Vos, Pol; Van der Stuyft, PatrickLos determinantes sociales de la salud son las condiciones sociales en las cuales las personas que conforman una población determinada nacen, viven y trabajan. El presente artículo tiene el objetivo de documentar las evidencias actuales sobre las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud de la población cubana. Desde una perspectiva estructural las variables de servicios de salud muestran diferencias entre territorios, asociadas básicamente a la existencia de un sistema de salud único con cobertura y acceso universal para toda la población. Se observan mayores diferenciales en el comportamiento de los llamados “determinantes no médicos”, como densidad poblacional, producción y circulación económica, mostrando estas diferencias un patrón geográfico. También se observan diferenciales en el comportamiento de la mortalidad materna y la hipertensión arterial entre territorios y en el tiempo. La productividad económica y las condiciones de vida están poco relacionadas con otros indicadores de resultados. Ante lo anteriormente expuesto se presenta una propuesta metodológica para el estudio y manejo de los determinantes sociales de la salud. Se requieren espacios de estudio de los determinantes sociales a nivel local, mediante técnicas multivariadas cuyos resultados aporten insumos para el diseño de intervenciones integrales basadas en los enfoques de planificación estratégica, acción intersectorial y participación social. Se impone insertar en la práctica del sistema de salud cubano un enfoque dirigido a trabajar más con los determinantes sociales de la salud, para lo cual se propone un modelo para el estudio e intervención local.Item Choices for spending government revenue: New African oil, gas, and mining economies. WIDER Working Paper 2017/150(United Nations University, World Institute for Development Economics Research, 2017-07) Witter, Sophie; Jakobsen, MajaThis paper examines a broad range of opportunities for addressing the pressing human development needs of low-income countries by using new oil, gas, and mineral discoveries. It assesses how much of an impact can be made on the funding gaps for health and education by new oil and gas revenues, and what other uses of those revenues are likely to arise. The paper argues that there is a strong case for investing natural resources revenues in social sectors, as they provide an opportunity to help to close the financing gaps in the African countries examined. However, the paper also highlights that the political economy risks of this revenue stream are higher than for other types of revenues. Finally, it illustrates how a simple diagnostic framework can be used to help to guide social sector investment decisions in the light of new natural resources revenues.Item Understanding Integration: A Conceptual Framework(2008-06) Ager, Alastair; Strang, AlisonIntegration has become both a key policy objective related to the resettlement of refugees and other migrants, and a matter of significant public discussion. Coherent policy development and productive public debate are, however, both threatened by the fact that the concept of integration is used with widely differing meanings. Based on review of attempted definitions of the term, related literature and primary fieldwork in settings of refugee settlement in the UK, the paper identifies elements central to perceptions of what constitutes 'successful' integration. Key domains of integration are proposed related to four overall themes: achievement and access across the sectors of employment, housing, education and health; assumptions and practice regarding citizenship and rights; processes of social connection within and between groups within the community; and structural barriers to such connection related to language, culture and the local environment. A framework linking these domains is presented as a tool to foster debate and definition regarding normative conceptions of integration in resettlement settings. The Author [2008]. Published by Oxford University Press. All rights reserved.