The UK Fleming Fund: Developing AMR surveillance capacity in low- and middle-income countries

Abstract Background In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion. Conclusion The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.

Download Full-text

Reflections on the UK legacy of health inequities research, from the perspective of low- and middle-income countries (LMICs)

Health Inequalities ◽

10.1093/acprof:oso/9780198703358.003.0005 ◽

2015 ◽

pp. 69-80

Author(s):

Johanna Hanefeld

Keyword(s):

Health Inequities ◽

Middle Income ◽

Middle Income Countries ◽

The Uk ◽

Low And Middle Income

Download Full-text

Quality-of-life in dementia: Assessment in low-and-middle income countries

10.31219/osf.io/w8kue ◽

2017 ◽

Author(s):

Kia-Chong Chua ◽

Jan R. Böhnke ◽

Martin Prince ◽

Sube Banerjee

Keyword(s):

Measurement Invariance ◽

Core Component ◽

Middle Income ◽

Middle Income Countries ◽

People With Dementia ◽

Dementia Research ◽

American Spanish ◽

The Uk ◽

Low And Middle Income

The global burden of dementia is disproportionately higher in low-and-middle income countries yet systematic assessments of health-related quality-of-life (HRQL) mostly rely on measures developed in the UK/US. A recent systematic review of dementia-specific HRQL measures concluded that none could be recommended without further linguistic validation. Using a unique dataset from the 10/66 Dementia Research Group, we conducted one of the first in-depth studies to investigate the measurement invariance of dementia-specific HRQL measures for low-and-middle income countries. HRQL of people with dementia was assessed by self-report (DEMQOL) and informant-report (DEMQOL-Proxy) in a community memory clinic in the UK and population cohort surveys of the 10/66 Dementia Research Group in the Dominican Republic, Mexico, Cuba, Peru and Venezuela. Measurement invariance between the UK English and Ibero-American Spanish versions was investigated using multiple-group confirmatory bifactor modelling. Our findings showed that UK and Latin America older adults differ in how they respond to “positive emotion” items in the DEMQOL and DEMQOL-Proxy. The remaining items of DEMQOL and DEMQOL-Proxy showed no major difference in conceptual meaning, sensitivity to individual differences, and standards of difficulty between the UK English and Ibero-American Spanish versions. Furthermore, we found that the core components of self- and informant appraisal of HRQL may differ. Negative emotion may be a core component in self-appraisal of HRQL whereas social functioning may be a core component in how informants appraise HRQL of people with dementia. Measurement invariance of translated HRQL assessment warrant continued investigation, particularly in low-and-middle income countries, where the societal and fiscal impact of dementia needs urgent attention.

Download Full-text

Taking the path less trodden: UK psychiatrists working in low- and middle-income countries

Psychiatric Bulletin ◽

10.1192/pb.bp.107.018465 ◽

2008 ◽

Vol 32 (11) ◽

pp. 431-435

Author(s):

Helen McColl ◽

Rebecca Syed Sheriff ◽

Charlotte Hanlon

Keyword(s):

Developing Countries ◽

Collaborative Work ◽

The Political ◽

Political Climate ◽

Middle Income ◽

Middle Income Countries ◽

Health Partnerships ◽

The Individual ◽

The Uk ◽

Low And Middle Income

SummaryUK-based psychiatrists have the opportunity to work in low- and middle-income countries. the political climate is supportive, as evidenced by the recent Crisp report on ‘Global Health Partnerships: the UK Contribution to Health in Developing Countries’, and the Royal College of Psychiatrists volunteer scheme. However, many psychiatrists are unaware of ways in which they might contribute. In this article, we give examples of the diverse ways in which UK-based psychiatrists are already engaged in collaborative work overseas. We discuss some of the mutual benefits that such partnerships can bring and highlight the under-recognised benefits to the UK, both to the individual and to the National Health Service.

Download Full-text

NHS links: achievements of a scheme between one London mental health trust and Uganda

Psychiatric Bulletin ◽

10.1192/pb.bp.108.019406 ◽

2009 ◽

Vol 33 (7) ◽

pp. 265-269 ◽

Cited By ~ 2

Author(s):

Dave Baillie ◽

Jed Boardman ◽

Tom Onen ◽

Cerdic Hall ◽

Maia Gedde ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Short Term ◽

Middle Income ◽

Middle Income Countries ◽

Educational Partnership ◽

The Uk ◽

Health Trust ◽

Low And Middle Income

SummaryThis paper describes a link between a mental health trust (the East London Foundation Trust (ELFT)) in the UK and mental health services in Uganda which has developed since 2004. the aim of the link was to help support the development of mental health services in Uganda by establishing an educational partnership. During the first 3 years, nine staff from ELFT and nine staff from Butabika, from a variety of disciplines, have made short-term exchange visits. Evaluation of the link has demonstrated that benefits have been experienced in both London and Uganda. Such links can provide one way of strategically supporting and strengthening existing health services in low- and middle-income countries.

Download Full-text

Current Concepts Imaging in COVID-19 and the Challenges for Low and Middle Income Countries

Journal of Global Radiology ◽

10.7191/jgr.2020.1106 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Jeffrey Mendel ◽

Justine Lee ◽

David Rosman

Keyword(s):

Public Health ◽

Infectious Diseases ◽

Imaging Findings ◽

Middle Income ◽

Middle Income Countries ◽

The Past ◽

Current State ◽

Global Pandemic ◽

The Uk ◽

Low And Middle Income

With nearly 3,800,000 cases and 270,000 deaths reported worldwide, COVID-19 is a global pandemic unlike any we have seen in our lifetimes (1). As early as 1995, the WHO was warning of a global infectious disease crisis, citing 30 new infectious diseases emerging in the past 20 years, loss of antibiotic effectiveness, low rates of immunization, poverty, and inadequate investment in public health contributing to the more than 17 million people dying each year from infectious diseases, principally in Low and Middle Income countries (LMIC) (2). Unlike previous infectious diseases, at the time of this writing over 63% of the total reported cases of COVID-19 are in 6 High Income Countries (HIC): USA, Italy, Spain, France, Germany and the UK. Information concerning the imaging findings in COVID-19 has been rapidly disseminated from the centers first affected by the pandemic. This article attempts to summarize the current state of knowledge regarding the imaging findings in COVID-19, focusing on pulmonary findings, and offer recommendation for the use of imaging for diagnosis and surveillance of COVID-19, particularly in LMIC.

Download Full-text

An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries

Globalization and Health ◽

10.1186/s12992-021-00713-4 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Kanykey Jailobaeva ◽

Jennifer Falconer ◽

Giulia Loffreda ◽

Stella Arakelyan ◽

Sophie Witter ◽

...

Keyword(s):

Global Health ◽

Poverty Reduction ◽

Noncommunicable Disease ◽

Health Priorities ◽

Noncommunicable Diseases ◽

Limited Attention ◽

Middle Income ◽

Middle Income Countries ◽

The Uk ◽

Low And Middle Income

Abstract Background Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. Methods This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. Results In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios – receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. Conclusion The growing threat of NCDs and their drivers are increasingly recognised. However, global actors’ policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.

Download Full-text