scholarly journals The Health Systems of Low- and Middle-Income Countries

Public Health ◽  
2020 ◽  
Author(s):  
Anne Mills
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Political Science ◽  
20Th Century ◽  
Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

“Health system” is a term generally considered to be relatively recent. It is defined as all organizations, institutions, and resources that produce actions whose primary purpose is to improve health, whether these be targeted at individuals (such as health-care delivery) or populations (such as public health measures). Health-care and public health institutions have a long history, but the notion of an organized “health system” is a relatively recent development (dating from the mid-20th century). In low- and middle-income countries (LMICs), Western medicine was often introduced by former colonial authorities through the construction of public hospitals, health centers, and training schools, with church authorities also making a major contribution. As in high-income countries, there was a gradual process over the latter half 20th century to construct an organized and coordinated national health system. However, health systems became a key focus of international attention only in the late 1990s, when it became apparent that achieving the health-related Millennium Development Goals (e.g., reduction of child and maternal mortality; control of HIV, TB, and malaria) was threatened less by the availability of technical solutions and more by the ability of health systems to put them into practice. More recently, the Ebola epidemic in West Africa highlighted the critical importance of health systems in ensuring health security. In response to the increased awareness of the role of health systems, significant attention has been paid to defining the health system and its goals, categorizing its elements, assessing problems and testing solutions, and seeking to identify the relationship between different health system configurations and overall performance. Over time, specific issues within the general area of health systems have received special attention, including achieving universal health coverage (where the whole population of a country has access to health care and protection against its costs), the role of primary health care, the relative merits of different ways of financing a health system, the relative roles of public and private health sectors, and the appropriate mix of different types of health worker. Many disciplines can contribute to improved understanding of health systems, including economics, sociology, anthropology, history, political science, and management science. Until recently, the discipline of economics has tended to dominate the study of health systems. However, with the emergence of health policy and systems research as an important area of study, other disciplines have been making growing contributions, especially political science and the behavioral sciences concerned with the behavior of both individuals and organizations.

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.

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 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.

scholarly journals Time for a renewed focus on the role of cleaners in achieving safe health care in low- and middle-income countries

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Julie Storr ◽  
Claire Kilpatrick ◽  
Karen Lee
Keyword(s):  
Health Care ◽  
Current Data ◽  
Health Care Facilities ◽  
Infection Prevention And Control ◽  
Discussion Paper ◽  
Quality Health Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractWater, sanitation and hygiene, collectively known as WASH, is an enabler of infection prevention and control (IPC), both of which contribute to safe, quality health care and the prevention of spread of antimicrobial resistance (AMR). This discussion paper considers the importance placed on the role of hygiene, including cleaning and those who clean, in health care facilities, within the context of existing data, guidelines and initiatives. Informed by this, the paper presents five areas for consideration that have the potential to strengthen and further demonstrate the value of this important cadre of staff and their role in clean, safe healthcare, particularly in low- and middle-income countries. The considerations centre around actions to overcome the current data gaps, including the paucity of national data on environmental cleaning and the training of cleaners; strengthening the implementation of norms and standards; combining global and national advocacy efforts; revisiting investment; and addressing research gaps on the issue. The need to act, in line with WHO and UNICEF recommendations to address this overlooked and undercompensated workforce and to elevate their status as important contributors to IPC, WASH and AMR is a pressing one.

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