Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice

2019 ◽  
Vol 34 (8) ◽  
pp. 618-624
Author(s):  
Anatole Manzi ◽  
Alyssa Ierardo ◽  
Jean Claude Mugunga ◽  
Cate Oswald ◽  
Patrick Ulysse ◽  
...  
Keyword(s):  
Global Health ◽  
Health System ◽  
Low Income ◽  
Program Implementation ◽  
Quality Care ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Global Movement ◽  
Active Implementation

Abstract The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

scholarly journals Nurses' Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Low Income ◽  
Quality Care ◽  
Low Income Countries ◽  
Small Island ◽  
Skill Mix ◽  
Timor Leste

Abstract Background Research on quality of care revealed nurse-to-patient ratio and skill mix served as key elements in quality of care. However, those studies were done in countries where nursing workforce had reasonable proportion of professional nurses with bachelor degrees. Findings of these researches may overlook challenges in health system as well as the nature of nursing service in small island low-income countries that has a huge proportion of auxiliary nurses. Working in under-sourced places, nurses in Timor-Leste might have different viewpoints on what aspect contribute to quality of care. Methods Focus group discussions (FGDs) were done in 2017, in three districts that included staff nurses and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method. Results Two themes were emerged from the FGDs data: “patients as the center of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also covered the importance of employing nurses’ value system in order to uphold quality of care. The second theme included quality care milieu amplifying distinctive factors facing health system in under-resources places. Problems related with facility infrastructure, equipment and supplies, financing, management, and staffing were narrated. While an inadequacy or a deficiency of these factors implies the country’s struggles to maintain a functioning health care facility, it incapacitated nurses to improve quality of care. Conclusions Compared to nurses in countries with better skill mix, nurses in under-resources places and small island low-income countries face different challenging situations that go beyond nursing realm, forcing nurses to describe quality care uniquely. Findings from this study provide evidence that it is urgent to develop policies of human resources for health (HRH) within the context of the health policies that contributes to professional management of the largest cadre, thus strengthens their ability to improve patient care service.

scholarly journals Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017

2021 ◽  
Vol 6 (4) ◽  
pp. e004858
Author(s):  
Modhurima Moitra ◽  
Ian Cogswell ◽  
Emilie Maddison ◽  
Kyle Simpson ◽  
Hayley Stutzman ◽  
...  
Keyword(s):  
Low Income ◽  
Development Assistance ◽  
Health Spending ◽  
Recipient Country ◽  
Health Systems Strengthening ◽  
Low Income Countries ◽  
Middle Income ◽  
Development Assistance For Health ◽  
Country Characteristics ◽  
Health Accounts

IntroductionIn 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.MethodsWe extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.ResultsFactors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).ConclusionSubstantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

scholarly journals The contribution of Dutch doctors in Global Health and Tropical Medicine to research in global health in low- and middle-income countries: an exploration of the evidence

2019 ◽  
Vol 50 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Rob Mooij ◽  
Esther MJ Jurgens ◽  
Jeroen van Dillen ◽  
Jelle Stekelenburg
Keyword(s):  
Global Health ◽  
Low Income ◽  
Tropical Medicine ◽  
Low Income Countries ◽  
Global Health Research ◽  
Medical Doctors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Phd Thesis ◽  
Low And Middle Income

Results from medical research from high-income countries may not apply to low- and middle-income countries. Some expatriate physicians combine clinical duties with research. We present global health research conducted by Dutch medical doctors in Global Health and Tropical Medicine in low- and middle-income countries and explore the value of their research. We included all research conducted in the last 30 years by medical doctors in Global Health and Tropical Medicine in a low- and middle-income country, resulting in a PhD thesis. Articles and co-authors were found through Medline. More than half of the 18 identified PhD theses concerned maternal health and obstetrics, and the majority of the research was conducted in low-income countries, mostly in rural hospitals. Over 70 local co-authors were involved. Different aspects of these studies are discussed.

Global Health Perspective in Sarcomas and Other Rare Cancers

2018 ◽  
pp. 916-924 ◽  
Author(s):  
Vaia Florou ◽  
Antonio G. Nascimento ◽  
Ashish Gulia ◽  
Gilberto de Lima Lopes
Keyword(s):  
Radiation Therapy ◽  
Global Health ◽  
Low Income ◽  
Multidisciplinary Approach ◽  
Low Income Countries ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Management Guidelines ◽  
Systemic Treatments ◽  
Poor Outcomes

Sarcomas, rare and heterogenous malignancies that comprise less than 1% of all cancers, have poor outcomes in the metastatic and refractory setting. Their management requires a multidisciplinary approach that consists of medical and surgical oncologists, radiation oncologists, and pathologists as well as ancillary support. In addition to systemic treatments, most patients will require surgical resection and radiation therapy, which mandates the use of the latest technologies and specialized expertise. Management guidelines have been developed in high-income countries, but their applicability in low-income countries, where resources may be limited, remains a challenge. In this article, we propose the best possible evidence-based practices specifically for income-constrained settings to overcome this challenge. In addition, we review the different methods that can be used in low-income countries to access new and expensive treatments, which often times carry prohibitive costs for these areas.

scholarly journals Out-of-Pocket Expenditures on Health: A Global Stocktake

2020 ◽  
Vol 35 (2) ◽  
pp. 123-157 ◽  
Author(s):  
Adam Wagstaff ◽  
Patrick Eozenou ◽  
Marc Smitz
Keyword(s):  
Health System ◽  
Low Income ◽  
Poverty Line ◽  
Low Income Countries ◽  
Two Measures ◽  
Per Capita ◽  
Summary Measures ◽  
The Rich ◽  
Catastrophic Expenditures ◽  
Highly Correlated

Abstract This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.

Sign in / Sign up

Export Citation Format

Share Document