Repository logo
 

The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

Browse

Subject: search.filters.subject.Global Health

Search Results

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    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).]
  • No Thumbnail Available
    Item
    Problematizing the “global” in global health: An assessment of the global discourse of safety
    (Springer, 2015-09-30) Kadetz, Paul
    The practice of global health assumes that there are no differences between what is decided at a global level of policy making and what is implemented at a given local level. However, this research reveals a marked disconnect between the normative assumptions and understandings of global health and their appropriateness for local level implementation. The normative discourse of safety, embedded in global health, provides a case example by which to critically examine the importance of recognizing the differences between global and local understandings of health. The lack of a hegemonic understanding of safety and the dangers and risks that are generated when imposing foreign understandings of safety onto local levels, serve to problematize the ethnocentric assumptions embedded in the discourse of global health.
  • Thumbnail Image
    Item
    Identifying key influences on antibiotic use in China: A systematic scoping review and narrative synthesis
    (BMJ, 2022-03-24) Coope, Caroline; Schneider, Annegret; Zhang, Tingting; Kadetz, Paul; Feng, Rui; Lambert, Helen; Wang, DeBin; Oliver, Isabel; Michie, Susan; Cabral, Christie
    Introduction: The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. Methods: Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). Results: Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. Conclusions: Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
  • Thumbnail Image
    Item
    Understanding the resilience of health systems
    (Springer, 2020-02-26) Blanchet, Karl; Diaconu, Karin; Witter, Sophie; Bozorgmehr, Kayvan; Roberts, Bayard; Razum, Oliver; Biddle, Louise
    Globally, 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.