A Bottleneck Analysis of Care and Feeding of the Small and Sick Newborn in Malawi: Findings and Proposed Solutions (P11-100-19)

Abstract Objectives The objectives of this bottleneck analysis are to 1) Diagnose bottlenecks at the health facility and health system levels in the provision of care and feeding of the small and sick newborn (SSNB) within the context of the Baby Friendly Hospital Initiative (BFHI) in Malawi, 2) Provide recommendations to address the identified bottlenecks. Methods The Every Newborn Action Plan (ENAP) bottleneck analysis tool was adapted to provide an increased focus on care and feeding of the SSNB. Using the adapted bottleneck analysis tool, we conducted facility-based observations and interviews with clinical and supervisory staff at eight hospitals to assess for bottlenecks at the facility level. To identify health system bottlenecks, interviews were conducted with key district- and national-level Ministry of Health personnel, and a desk review of key national nutrition and child health policies and guidelines was conducted. Information collected from interviews and extracted from national policies and guidelines were collated and analyzed for the presence/absence of significant bottlenecks. Results Significant bottlenecks were similar across the eight hospitals and included: unskilled staff in feeding concerns of the SSNB; overburdened and understaffed hospitals; lack of feeding cups for infants who are unable to suckle; limited space in the maternity ward for mothers and other caregivers to be present and feed their infant; no job aids or supportive supervision protocols or guidelines around care of the SSNB; no national policies in place to ensure monitoring of care of the SSNB. Key actions to address the identified bottlenecks are presented — including task shifting, improving mechanisms for monitoring care of SSNBs, and capacity-building of health providers — with consideration around how they could be implemented through Malawi's existing and scaled Baby-Friendly Hospital Initiative platform. Conclusions This assessment revealed the need to strengthen the provision of care and feeding of the SSNB. Addressing gaps in each of the six ENAP building blocks will be critical for improving newborn nutrition and health outcomes, and Malawi's already existing BFHI platform could provide an ideal platform for addressing the identified bottlenecks. Funding Sources United States Agency for International Development (USAID).

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Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03800-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fariba Mirbaha-Hashemi ◽

Batool Tayefi ◽

Zahra Rampisheh ◽

Arash Tehrani-Banihashemi ◽

Mozhdeh Ramezani ◽

...

Keyword(s):

Action Plan ◽

Scale Up ◽

Newborn Care ◽

Building Blocks ◽

Neonatal Care ◽

Patient Transfer ◽

Analysis Tool ◽

System Building ◽

Bottleneck Analysis ◽

Health System Building Blocks

Abstract Background Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.

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Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

Globalization and Health ◽

10.1186/s12992-021-00676-6 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Antonio Bernabé-Ortiz ◽

Jessica H. Zafra-Tanaka ◽

Miguel Moscoso-Porras ◽

Rangarajan Sampath ◽

Beatrice Vetter ◽

...

Keyword(s):

Health System ◽

New Technologies ◽

Action Plan ◽

Building Blocks ◽

Communicable Diseases ◽

Noncommunicable Disease ◽

World Health ◽

Noncommunicable Diseases ◽

Diagnostic Tools ◽

Monitoring Tools

AbstractA key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

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Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020)

PLoS ONE ◽

10.1371/journal.pone.0259189 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259189

Author(s):

Sonia Vivian de Jezus ◽

Adriana Ilha da Silva ◽

Ricardo Alexandre Arcêncio ◽

Nahari de Faria Marcos Terena ◽

Jair dos Santos Pinheiro ◽

...

Keyword(s):

Mixed Methods ◽

Health System ◽

Ethnic Group ◽

Multiple Correspondence Analysis ◽

Action Plan ◽

Local Level ◽

Healthcare Providers ◽

Mixed Methods Study ◽

Local Action ◽

Provision Of Care

Background The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation. Objective Analyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil. Method A mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data. Results 106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.

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Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment

BMC Health Services Research ◽

10.1186/s12913-019-4672-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Abubeker Kedir Usman ◽

◽

Eskinder Wolka ◽

Yared Tadesse ◽

Abraham Tariku ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Health System ◽

Building Blocks ◽

World Health ◽

Qualitative Assessment ◽

Middle Income ◽

Middle Income Countries ◽

Sick Newborn ◽

Health Organization

Abstract Background Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to support health care facilities in the care provided to preterm, low birth weight, and sick newborns in different regions of Ethiopia. Methods A qualitative assessment using in-depth interviews with health facility leaders was conducted in health facilities in 3 regions of Ethiopia from December 2017 to February 2018. The interview guide was developed using a modified version of the World Health Organization health system building blocks. Results Across the public health system, adequate and reliable space, power, and water were problematic. Human resource issues (training, staffing, and retention) were critical to being able to properly care for preterm, low birth weight, and sick newborns. Problems with functional equipment and equipment distribution systems were widespread. Funds were lacking to support preterm, low birth weight, and sick newborn needs in facilities. Data collection practices, data quality, and data utilization were all problematic. There were gaps in the availability of guidelines and protocols, specifically targeting preterm, low birth weight, and sick newborn care. Key facilitators, information disseminators, and influencers identified in the study were the Health Development Army, community and religious leaders, and mothers and families who had had positive experiences or outcomes of care. Conclusions The Ethiopian health system has opportunities across all 7 World Health Organization health system building blocks to strengthen readiness to support health facilities to provide quality care and improve outcomes for preterm, low birth weight, and sick newborns.

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European experience in transition to circular economy

Economic Analysis Theory and Practice ◽

10.24891/ea.19.4.598 ◽

2020 ◽

Vol 19 (4) ◽

pp. 598-617 ◽

Cited By ~ 1

Author(s):

S.V. Ratner

Keyword(s):

European Union ◽

Circular Economy ◽

Raw Materials ◽

Action Plan ◽

National Level ◽

The European Union ◽

Scientific Methods ◽

European Experience ◽

General Scientific ◽

The Eu

Subject. The article considers the concept of circular economy, which has originated relatively recently in the academic literature, and is now increasingly recognized in many countries at the national level. In the European Union, the transition to circular economy is viewed as an opportunity to improve competitiveness of the European Union, protect businesses from resource shortages and fluctuating prices for raw materials and supplies, and a way to increase employment and innovation. Objectives. The aim of the study is to analyze the incentives developed by the European Commission for moving to circular economy, and to assess their effectiveness on the basis of statistical analysis. Methods. I employ general scientific methods of research. Results. The analysis of the EU Action Plan for the Circular Economy enabled to conclude that the results of the recent research in circular economy barriers, eco-innovation, technology and infrastructure were successfully integrated into the framework of this document. Understanding the root causes holding back the circular economy development and the balanced combination of economic and administrative incentives strengthened the Action Plan, and it contributed to the circular economy development in the EU. Conclusions. The measures to stimulate the development of the circular economy proposed in the European Action Plan can be viewed as a prototype for designing similar strategies in other countries, including Russia. Meanwhile, a more detailed analysis of barriers to the circular economy at the level of individual countries and regions is needed.

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22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1092 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Health System ◽

Health Systems ◽

Building Blocks ◽

The State ◽

Lessons Learned ◽

Three Dimensions ◽

Health System Strengthening ◽

New Work ◽

State Of Health ◽

The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

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Health system gaps in cardiovascular disease prevention and management in Nepal

BMC Health Services Research ◽

10.1186/s12913-021-06681-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Archana Shrestha ◽

Rashmi Maharjan ◽

Biraj Man Karmacharya ◽

Swornim Bajracharya ◽

Niharika Jha ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

National Health ◽

Task Force ◽

Health Spending ◽

Building Blocks ◽

Critical System ◽

Government Organizations ◽

The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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Preparedness for Mitigating Noncommunicable Diseases in Gaindakot Municipality, Nepal: Perspectives of Key informants

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37567 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1320-1324

Author(s):

Narayan Sapkota ◽

Damaru Prasad Paneru

Keyword(s):

Health System ◽

Health Workforce ◽

Prevention And Control ◽

Local Level ◽

Building Blocks ◽

Health System Strengthening ◽

High Morbidity ◽

Major Public Health Problem ◽

Screening Services ◽

And Control

Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level. Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal. Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis. Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level. Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.

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European smart specialization for Ukrainian regional development: path from creation to implementation

Problems and Perspectives in Management ◽

10.21511/ppm.17(2).2019.29 ◽

2019 ◽

Vol 17 (2) ◽

pp. 376-391 ◽

Cited By ~ 1

Author(s):

Yevheniia Polishchuk ◽

Alla Ivashchenko ◽

Igor Britchenko ◽

Pavel Machashchik ◽

Serhiy Shkarlet

Keyword(s):

Direct Action ◽

Action Plan ◽

National Level ◽

Regional Distribution ◽

Structural Funds ◽

Organizational Mechanism ◽

Weak Points ◽

Characteristic Features ◽

Smart Specialization ◽

The Eu

The focus of the research is to develop recommendations of smart specialization (SS) for Ukrainian policymakers using European approaches. The authors revealed that the main SS projects are presented in such sectors as agri-food, industrial modernization and energy. More than 12 EU countries were the plot for conducted analysis of SS, as a result of which the level of activity of each country was determined. The creation of consortiums, including SMEs, associations, universities and other participants, disclosed the successful way of SS realization. The structure of SME’s innovative potential in Ukraine was identified underlining their main characteristic features like types of innovations and innovative activity, differentiation according to enterprise size, their regional distribution. The authors explored lack of innovations on regional and national level and significant territorial disparities, which could be eliminated through policy implementation of regional SS. The existing legislative norms for possibility of SS implementation in Ukraine were analyzed due to correspondence with the EU ones. The analysis provides the opportunity to consider them only as general framework documents without any action plans and sectoral prioritization at all. The weak points of these law documents are emphasized. As a result of research, the authors developed recommendations presented by direct action plan for Ukrainian policymakers, which include such activities as underlining key priorities (especially ICT applicability in every SS project) and their correspondence with the EU ones; eliminating regional imbalances by focusing on innovation development and reorientation of some regions according to SS priorities; respecting regional existing capacities; providing organizational mechanism for cooperation of stakeholders and financial mechanism for SS support through the EU structural funds.

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Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

Global Health Research and Policy ◽

10.1186/s41256-021-00212-4 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Zarni Htun ◽

Yingxi Zhao ◽

Hannah Gilbert ◽

Chunling Lu

Keyword(s):

Civil Society ◽

Qualitative Study ◽

Health System ◽

Global Fund ◽

Scale Up ◽

Building Blocks ◽

Key Informants ◽

The Impact ◽

Hiv Aids

Abstract Background The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). Methods We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. Results We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. Conclusion There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

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