scholarly journals Targeted anti-corruption in LMICs: developmental governance and health systems research

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Hutchinson
Keyword(s):  
Health System ◽  
Health Systems ◽  
Health Workers ◽  
Middle Income ◽  
Impact Action ◽  
Delivery Of Care ◽  
Accountability Measures ◽  
Systems Research ◽  
Context Specific ◽  
Traditional Approaches

Abstract Traditional approaches to anti-corruption have relied upon broad-based legal change and the introduction transparency and accountability measures. The evidence to date shows that these have been unsuccessful in reducing corruption in health and other sectors in low and middle income countries. Traditional approaches often assume that corruption is driven by individual greed, immorality or opportunism caused by a lack of accountability measures and that once corruption is rendered visible that there will be a channel through which it can be acted upon. In many LMICs, however, corruption and rule breaking is widespread and much better understood as a systemic problem. In these settings, health workers often break rules to solve the problems of working in overstretched, underfunded health systems. In these settings, policy often does not match the realities of an underfunded health system, and so sticking to the rules can have harm career progression or the ability to care for ones family. New approaches to anti-corruption based on Mushtaq Khan's idea of developmental governance take these context specific factors into account and look for targeted, feasible and high impact action that can create improvements of rule abiding behaviour that benefit the health system and the delivery of care. This presentation examines how it can be applied to the health system and the adaptations that it makes in the ways that we work on anti-corruption in health. It examines the ways in which policy can be changed so that groups of actors in the system are be incentivised to engage in abiding behaviour as they recognize that it is in their interests to do so.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Conflict affected, parallel health systems: challenges to collaboration between ethnic and government health systems in Kayin State, Myanmar

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Colette Pang Biesty ◽  
Aung Ja Brang ◽  
Barry Munslow
Keyword(s):  
Health System ◽  
Health Systems ◽  
Health Workers ◽  
Health Providers ◽  
Peace Accord ◽  
Government Health ◽  
Peace Processes ◽  
Post Conflict ◽  
Observation Methods ◽  
Minority Ethnic Groups

Abstract Background Myanmar has had a long history of civil wars with its minority ethnic groups and is yet to see a sustainable peace accord. The conflicts have had a significant impact on health in Myanmar, with ethnic populations experiencing inequitable health outcomes. Consequently, to meet the health needs of ethnic people, Ethnic Health Organisations and Community-Based Health Organisations (EHO/CBHOs) created their own health system. The EHO/CBHO and Government health systems, provided by the Myanmar Ministry of Health and Sports (MoHS), remain parallel, despite both stakeholders discussing unification of the health systems within the context of ongoing but unresolved peace processes. EHO/CBHOs discuss the ‘convergence’ of health systems, whilst the MoHS discuss the integration of health providers under their National Health Plan. Methods A qualitative study design was used to explore the challenges to collaboration between EHO/CBHOs and the MoHS in Kayin state, Myanmar. Twelve health workers from different levels of the Karen EHO/CBHO health system were interviewed. Semi-structured, in-depth interviews were digitally recorded, transcribed, and coded. Data was analysed thematically using the Framework method. Topic guides evolved in an iterative process, as themes emerged inductively from the transcripts. A literature review and observation methods were also utilised to increase validity of the data. Results The challenges to collaboration were identified in the following five themes: (1) the current situation is not ‘post conflict’ (2) a lack of trust (3) centralised nature of the MoHS (4) lack of EHO/CBHO health worker accreditation (5) the NHP is not implemented in some ethnic areas. Conclusions Ultimately, all five challenges to collaboration stem from the lack of peace in Myanmar. The health systems cannot be ‘converged or ‘integrated’ until there is a peace accord which is acceptable to all actors. EHO/CBHOs want a federal political system, where the health system is devolved, equitable and accessible to all ethnic people. External donors should understand this context and remain neutral by supporting all health actors in a conflict sensitive manner.

scholarly journals Measuring the efficiency of health systems in Asia: a data envelopment analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e022155 ◽  
Author(s):  
Sayem Ahmed ◽  
Md Zahid Hasan ◽  
Mary MacLennan ◽  
Farzana Dorin ◽  
Mohammad Wahid Ahmed ◽  
...  
Keyword(s):  
Data Envelopment Analysis ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
Income Group ◽  
Data Envelopment ◽  
System Efficiency ◽  
Asian Countries ◽  
Middle Income ◽  
Health System Efficiency

ObjectiveThis study aims to estimate the technical efficiency of health systems in Asia.SettingsThe study was conducted in Asian countries.MethodsWe applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.ResultsThe main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.ConclusionThe results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.

Understanding Public Health Informatics in Context of Health in Low and Middle-Income Countries

2017 ◽  
Author(s):  
Sundeep Sahay ◽  
T Sundararaman ◽  
Jørn Braa
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Health Informatics ◽  
Information Needs ◽  
Clinical Information ◽  
Population Based ◽  
Public Health Informatics ◽  
Middle Income ◽  
Context Specific ◽  
Health Programmes

This chapter places public health informatics within a public health context. An understanding of PHI must be built on the perspective of public health as the health of populations. In LMICs it is closely related to an understanding of the primary healthcare approach, and the role and functions of public health systems, including the measurement of health status and equity, the effective coverage of different health programmes, and the utilization of different health services. This requires an understanding of the social and environmental determinants of healthcare, which need relevant data from other sectors as well. The architecture and development of public health informatics varies across nations and is path-dependent and context-specific. Many have evolved as monitoring support to externally financed vertical programmes, some as support for comprehensive primary health programmes and some from support systems for health insurance. The current information needs of health systems, transcends their respective origins, and requires both individual-based clinical information and aggregate population-based data.

scholarly journals OC 8586 INSTITUTIONAL RESEARCH CAPACITY BUILDING FOR MULTI-DISCIPLINARY HEALTH RESEARCH TO SUPPORT THE HEALTH SYSTEM REBUILDING PHASE IN SIERRA LEONE

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A15.1-A15
Author(s):  
Wurie Haja
Keyword(s):  
Health System ◽  
Capacity Building ◽  
Sierra Leone ◽  
Health Systems ◽  
Health Research ◽  
Capacity Development ◽  
Research Capacity ◽  
Research Centre ◽  
Institutional Research ◽  
Systems Research

BackgroundThe EDCTP-funded project ‘Institutional capacity development for multi-disciplinary health research to support the health system rebuilding phase in Sierra Leone’ (RECAP-SL) created a solid platform on which sustainable research capacity can be built at the College of Medicine and Allied Health Sciences (COMAHS) at the University of Sierra Leone. This in turn will support the much-needed evidence-based health systems reconstruction phase in Sierra Leone and support the evolution of the research landscape at COMAHS.Methods and resultsWe established a research centre at COMAHS and conducted a research needs assessment. This informed the development of short- and long-term action plans to support sustainable institutional research capacity development and enabled the development of a four-year research strategy. These plans also served as a guide for subsequent research partnerships in terms of capacity building efforts to address identified challenges.We also focused on training four research fellows and developed a wider student engagement platform to help cultivate a research culture. The research fellows will support other researchers at COMAHS, thus promoting sustainability of the research centre. Continued professional development opportunities for the fellows are also being actively sought, to develop them up to doctoral level, which addresses one of the gaps identified in the capacity assessment report.ConclusionTo support sustainability, capacity building efforts are being designed to ensure that these gains are maintained over time, with international and national research partners and funders recognising the importance of further developing local research capacity. Through a multi-pronged approach, health systems research capacity has been strengthened in Sierra Leone. This will support the generation of evidence that will inform building sustainable health systems fit for responding cohesively to outbreaks and for delivering services across the country, especially for the most disadvantaged populations.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

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 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.

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