Health System Needs to Establish Cardiac Surgery Centers

2021 ◽  
Author(s):  
Dominique Vervoort ◽  
Akash Premkumar ◽  
Hiba Ghandour ◽  
Jacques Kpodonu
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Diseases ◽  
Health System ◽  
Health Systems ◽  
Surgical Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Systems Perspective ◽  
Surgical Services ◽  
Surgery Center

AbstractCardiovascular diseases are the leading cause of mortality worldwide, responsible for nearly 18 million deaths each year. More than 80% of these take place in low- and middle-income countries (LMICs), where access to cardiac surgical services is scarce. Approximately 93% of the LMIC population, or six billion people worldwide, are estimated to lack access to safe, timely, and affordable cardiac surgical care as a result of workforce, infrastructure, financial, and quality barriers. Various models have been proposed and attempted to establish cardiac surgery centers in LMICs; however, only some have been successful in achieving sustainable local services. Here, we describe the workforce, infrastructure, financial, and political needs and considerations from a health systems perspective to establish a cardiac surgery center.

scholarly journals Decentralization and Regionalization: Redesigning Health Systems for High Quality Maternity Care Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

2020 ◽  
Author(s):  
Sanam Roder-DeWan
Keyword(s):  
Health System ◽  
Health Systems ◽  
Maternity Care ◽  
Quality Care ◽  
Surgical Care ◽  
Maternal Complications ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

The question of how to optimally design health systems in low- and middle-income countries (LMICs) for high quality care and survival requires context-specific evidence on which level of the health system is best positioned to deliver services. Given documented poor quality of care for surgical conditions in LMICs, evidence to support intentional health system design is urgently needed. Iverson and colleagues address this very important question. This commentary explores their findings with particular attention to how they apply to maternity care. Though surgical maternity care is a common healthcare need, maternal complications are often unpredictable and require immediate surgical attention in order to avert serious morbidity or mortality. A discussion of decentralization for maternity services must grapple with this tension and differentiate between facilities that can provide emergency surgical care and those that can not.

Challenges and possibilities of developing cardiac surgery in a peripheral hospital of low- and middle-income countries

Perfusion ◽  
2020 ◽  
Vol 36 (1) ◽  
pp. 38-43
Author(s):  
Kaushal K Tiwari ◽  
Julia Grapsa ◽  
Shankar Laudari ◽  
Michal Pazdernik ◽  
Dominique Vervoort
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Care ◽  
Capital City ◽  
World Population ◽  
Middle Income ◽  
Middle Income Countries ◽  
Peripheral Hospital ◽  
Challenges And Opportunities ◽  
Low And Middle Income

Objective: Over a million cardiac surgeries are performed every year around the globe. However, approximately 93% of world population living in low- and middle-income countries have no access to cardiac surgery. The incidence of rheumatic and congenital heart disease is high in Nepal, while only 2,500-3,000 cardiac surgeries are performed annually. The aim of our study is to analyze challenges and opportunities of establishing a cardiac surgery program in a peripheral hospital of Nepal. Methods: We analyzed our effort to establish a cardiac surgery program in a peripheral hospital in Nepal. Results: Out of 2,659 consulted and diagnosed patients, we performed 85 open-heart surgeries in 4 years. Mean age of patients was 38.35 ± 14.13 years. The majority of patients were male (62.4% of patients) with 65.9% suffering from rheumatic heart disease. Average intensive care unit stay and hospital stay were 2.32 ± 1.1 and 8.29 ± 2.75 days, respectively. No in-hospital mortality was observed. Conclusion: We conclude that developing cardiac surgical care in a peripheral hospital of a developing country is feasible with support from government, foreign colleagues, local teams, and non-governmental organizations. The availability of a regular cardiac surgery service in the periphery of the country makes such services more accessible for the patients and helps in reducing the long waiting lists and unmanageable workload in the established cardiac centers in the capital city.

scholarly journals Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement

2016 ◽  
Vol 3 ◽  
Author(s):  
J. Abdulmalik ◽  
L. Kola ◽  
O. Gureje
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Health System ◽  
Health Systems ◽  
Mental Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health System Governance ◽  
Low And Middle Income

IntroductionA health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it.MethodologyThis study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG.ResultsThe existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system.ConclusionThe identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

scholarly journals Decentralization and Regionalization of Surgical Care as a Critical Scale-up Strategy in Low- and Middle-Income Countries Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

2020 ◽  
Author(s):  
Jaymie A. Henry
Keyword(s):  
Scale Up ◽  
Surgical Care ◽  
Lessons Learned ◽  
Optimal Distribution ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Services ◽  
Obstetric Services ◽  
Surgical Conditions ◽  
Low And Middle Income

As global attention to improve the quality, safety and access to surgical care in low- and middle-income countries (LMICs) increases, the need for evidence-based strategies to reliably scale-up the quality and quantity of surgical services becomes ever more pertinent. Iversen et al discuss the optimal distribution of surgical services, whether through decentralization or regionalization, and propose a strategy that utilizes the dimensions of acuity, complexity and prevalence of surgical conditions to inform national priorities. Proposed expansion of this strategy to encompass levels of scale-up prioritization is discussed in this commentary. The decentralization of emergency obstetric services in LMICs shows promising results and should be further explored. The dearth of evidence of regionalization in LMICs, on the other hand, limits extrapolation of lessons learned. Nevertheless, principles from the successful regionalization of certain services such as trauma care in high-income countries (HICs) can be adapted to LMIC settings and can provide the backbone for innovation in service delivery and safety.

scholarly journals Conceptualizing the Organization of Surgical Services Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

2020 ◽  
Author(s):  
Sara A. Kreindler
Keyword(s):  
Surgical Care ◽  
Patient Acuity ◽  
Related Factors ◽  
Middle Income ◽  
Income Levels ◽  
Context Sensitive ◽  
Middle Income Countries ◽  
Surgical Services ◽  
Delivery Models ◽  
Special Relevance

According to Iverson and colleagues’ thoughtful analysis, decisions to decentralize or regionalize surgical services must take into account contextual realities that may impede the safe execution of certain delivery models in lowand middle-income countries (LMICs), and should be governed by procedure-related considerations (specifically, volume, patient acuity, and procedure complexity). This commentary suggests that, by shifting attention to the mechanisms whereby (de)centralization may exert beneficial impacts, it is possible to generate guidance applicable to countries across the socioeconomic spectrum. Four key mechanisms can be identified: decentralization (1) minimizes the need for patients to travel for care and, (2) obviates certain system-induced delays once patients present; centralization (3) facilitates the maintenance of a workforce with sufficient expertise to offer services safely, and (4) conserves resources by limiting the number of sites. The commentary elucidates how context- and procedurerelated factors determine the importance of each mechanism, allowing planners to prioritize among them. Although some context factors have special relevance to LMICs, most can also appear in high-income countries (HICs), and the procedure-related factors are universal. Thus, evidence from countries at all income levels might be fruitfully combined into an integrated body of context-sensitive guidance.

scholarly journals Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015–2020)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shegufta Shefa Sikder ◽  
Rakhi Ghoshal ◽  
Padma Bhate-Deosthali ◽  
Chandni Jaishwal ◽  
Nobhojit Roy
Keyword(s):  
Health System ◽  
Health Systems ◽  
Violence Against Women ◽  
Health Facilities ◽  
System Response ◽  
Provider Attitudes ◽  
Middle Income ◽  
Middle Income Countries ◽  
One Stop ◽  
Low And Middle Income

Abstract Background Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings. Methods We selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka. Results One-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge. Conclusion Significant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention.

scholarly journals Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Maya Semrau ◽  
Atalay Alem ◽  
Jose L. Ayuso-Mateos ◽  
Dan Chisholm ◽  
Oye Gureje ◽  
...  
Keyword(s):  
Mental Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Building Blocks ◽  
Health System Strengthening ◽  
Mental Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundThere is a large treatment gap for mental, neurological or substance use (MNS) disorders. The ‘Emerging mental health systems in low- and middle-income countries (LMICs)’ (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.AimsTo provide a set of proposed recommendations for mental health system strengthening in LMICs.MethodThe Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012–2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.ResultsThe proposed recommendations align closely with the World Health Organization's key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.ConclusionsThese recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.Declaration of interestNone.

scholarly journals Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-Income Countries: A Qualitative Evidence Synthesis

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Sandy Oliver ◽  
Sonja Merten ◽  
Wai Wai Han ◽  
Kaspar Wyss
Keyword(s):  
Health System ◽  
Conceptual Framework ◽  
Health Systems ◽  
Evidence Synthesis ◽  
A Priori ◽  
Qualitative Evidence Synthesis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Dynamic Attributes ◽  
Low And Middle Income

Background: A country’s health system faces pressure when hit by an unexpected shock, such as what we observe in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The concept of resilience is highly relevant in this context and is a prerequisite for a health system capable of withstanding future shocks. By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications. Methods: The review uses the best-fit framework synthesis approach. An a priori conceptual framework was selected and a coding framework created. A systematic search identified 4284 unique citations from electronic databases and reports by non-governmental organisations, 12 of which met the inclusion criteria. Data were extracted and coded against the pre-existing themes. Themes outside of the a priori framework were collated to form a refined list of themes. Then, all twelve studies were revisited using the new list of themes in the context of each study. Results: Ten themes were generated from the analysis. Five confirmed the a priori conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms. Conclusion: The refined conceptual model shows how the themes inter-connect. The foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience. This review prompts countries to consider building the foundations of resilience described here as a priority to better prepare for future shocks.

scholarly journals Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries

2020 ◽  
Vol 5 (6) ◽  
pp. e002375 ◽  
Author(s):  
Ché L Reddy ◽  
Alexander W Peters ◽  
Desmond Tanko Jumbam ◽  
Luke Caddell ◽  
Blake C Alkire ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Critical Role ◽  
Scale Up ◽  
Surgical Care ◽  
Healthcare Intervention ◽  
Strengthen Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Fiscal Space

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.

scholarly journals Effective methods for knowledge transfer to strengthen mental health systems in low- and middle-income countries

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Jose L. Ayuso-Mateos ◽  
Maria Miret ◽  
Pilar Lopez-Garcia ◽  
Atalay Alem ◽  
Dan Chisholm ◽  
...  
Keyword(s):  
Mental Health ◽  
Knowledge Transfer ◽  
Health System ◽  
Health Systems ◽  
Mental Healthcare ◽  
Health System Strengthening ◽  
Mental Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Background The Emerald project's focus is on how to strengthen mental health systems in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). This was done by generating evidence and capacity to enhance health system performance in delivering mental healthcare. A common problem in scaling-up interventions and strengthening mental health programmes in LMICs is how to transfer research evidence, such as the data collected in the Emerald project, into practice. Aims To describe how core elements of Emerald were implemented and aligned with the ultimate goal of strengthening mental health systems, as well as their short-term impact on practices, policies and programmes in the six partner countries. Method We focused on the involvement of policy planners, managers, patients and carers. Results Over 5 years of collaboration, the Emerald consortium has provided evidence and tools for the improvement of mental healthcare in the six LMICs involved in the project. We found that the knowledge transfer efforts had an impact on mental health service delivery and policy planning at the sites and countries involved in the project. Conclusions This approach may be valid beyond the mental health context, and may be effective for any initiative that aims at implementing evidence-based health policies for health system strengthening.

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