scholarly journals Governing multisectoral action for health in low-income and middle-income countries: an agenda for the way forward

2018 ◽  
Vol 3 (Suppl 4) ◽  
pp. e000890 ◽  
Author(s):  
Kumanan Rasanathan ◽  
Vincent Atkins ◽  
Charles Mwansambo ◽  
Agnès Soucat ◽  
Sara Bennett
Keyword(s):  
Low Income ◽  
Implementation Research ◽  
Conflicts Of Interest ◽  
Health Sector ◽  
Middle Income ◽  
Policy Makers ◽  
Implementation Processes ◽  
Existing Structures ◽  
Middle Income Countries ◽  
The Way

Drawing on experiences reviewed in the accompanying supplement and other literature, we present an agenda for the way forward for policy-makers, managers, civil society and development partners to govern multisectoral action for health in low-income and middle-income countries and consider how such an agenda might be realised. We propose the following key strategies: understand the key actors and political ecosystem, including type of multisectoral action required and mapping incentives, interests and hierarchies; frame the issue in the most strategic manner; define clear roles with specific sets of interventions according to sector; use existing structures unless there is a compelling reason not to do so; pay explicit attention to the roles of non-state sectors; address conflicts of interest and manage tradeoffs; distribute leadership; develop financing and monitoring systems to encourage collaboration; strengthen implementation processes and capacity; and support mutual learning and implementation research. To support countries to strengthen governance for multisectoral action, the global community can assist by further developing technical tools and convening peer learning by policy-makers (particularly from beyond the health sector), supporting knowledge management and sharing of experiences in multisectoral action beyond health, developing an agenda for and execution of implementation research and, finally, driving multilateral and bilateral development partners to transcend their own silos and work in a more multisectoral manner.

scholarly journals How is implementation research applied to advance health in low-income and middle-income countries?

2019 ◽  
Vol 4 (2) ◽  
pp. e001257 ◽  
Author(s):  
Olakunle Alonge ◽  
Daniela Cristina Rodriguez ◽  
Neal Brandes ◽  
Elvin Geng ◽  
Ludovic Reveiz ◽  
...  
Keyword(s):  
Low Income ◽  
Implementation Research ◽  
Large Scale ◽  
Scale Up ◽  
Middle Income ◽  
Policy Makers ◽  
Is Implementation ◽  
Middle Income Countries ◽  
Ir Studies ◽  
Learning And Change

This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.

scholarly journals Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017

2019 ◽  
Vol 4 (2) ◽  
pp. e001248
Author(s):  
Helen Saxenian ◽  
Nahad Sadr-Azodi ◽  
Miloud Kaddar ◽  
Kamel Senouci
Keyword(s):  
Economic Growth ◽  
Middle East ◽  
North Africa ◽  
Low Income ◽  
Health Sector ◽  
Cost Effective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Fiscal Space

Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region’s population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria–pertussis–tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization.

scholarly journals Identifying health policy and systems research priorities on multisectoral collaboration for health in low-income and middle-income countries

2018 ◽  
Vol 3 (Suppl 4) ◽  
pp. e000970 ◽  
Author(s):  
Douglas Glandon ◽  
Ankita Meghani ◽  
Nasreen Jessani ◽  
Mary Qiu ◽  
Sara Bennett
Keyword(s):  
Low Income ◽  
Health Sector ◽  
Research Priorities ◽  
Implementation Strategies ◽  
Health Coverage ◽  
Middle Income ◽  
The Sustainable Development ◽  
Middle Income Countries ◽  
Systems Research ◽  
Review Articles

IntroductionWhile efforts to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) have reinvigorated interest in multisectoral collaborations (MSCs) among the global health and development community, there remains a plethora of questions about how best to conceptualise, plan, implement, evaluate and sustain MSCs. The objective of this paper is to present research priorities on MSC for health from researchers and policymakers around the globe, with an emphasis on low-income and middle-income countries.MethodsThe authors identified 30 priority research questions from two sources: (1) 38 review articles on MSC for health, and (2) interviews and focus groups with a total of 81 policymakers, including government officials (largely from ministries of health and state/provincial departments of health, but also offices of planning, public service, social development, the prime minister and others), large multilateral or bilateral organisations, and non-governmental organisations. In a third phase, questions were refined and ranked by a diverse group of researchers from around the globe using an online voting platform.ResultsThe top-ranked questions focused predominantly on pragmatic questions, such as how best to structure, implement and sustain MSCs, as well as how to build stakeholder capacity and community partnerships. Despite substantial variation between review articles, policymakers’ reflections and online ranking by researchers, two topics emerged as research priorities for all three: (1) leadership, partnership and governance structures for MSCs; and (2) MSC implementation strategies and mechanisms. The review articles underscored the need for more guidance on appropriate study designs and methods for investigating MSCs, which may be a prerequisite for other identified research priorities.ConclusionThese findings could inform efforts within and beyond the health sector to better align research objectives and funding with the evidence needs of policymakers grappling with questions about how best to leverage MSCs to achieve UHC and the SDGs.

scholarly journals Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. e001560
Author(s):  
Carinne Brody ◽  
Say Sok ◽  
Sovannary Tuot ◽  
Marija Pantelic ◽  
Enrique Restoy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hiv Prevention ◽  
Low Income ◽  
Equal Rights ◽  
Middle Income ◽  
Policy Makers ◽  
Combination Prevention ◽  
Middle Income Countries ◽  
Registration Number ◽  
Prevention Programmes

IntroductionThis systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes.MethodsAn electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised.ResultsThis review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome.ConclusionThese findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes.PROSPERO registration numberCRD42018106909

scholarly journals Product Space Perspective on Structural Change in Morocco

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Israel Osorio Rodarte ◽  
Hans Lofgren
Keyword(s):  
Low Income ◽  
Product Space ◽  
High Growth ◽  
High Tech ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Moderate Growth ◽  
Manufactured Products ◽  
Space Approach

AbstractDrawing on international trade data, this paper uses the product space approach to analyze changes in Morocco’s goods exports in 1990–2010 and future export priorities. The level and moderate growth of Morocco’s gross domestic product match the predictions of product space analysis, informed by changes in the income potential of Morocco’s export basket, reflecting relatively strong capabilities in products with a relatively low potential to contribute to income growth and diversification. Morocco’s peripheral position in the product space points to the difficulty of diversification into more sophisticated products. Encouraging changes since 1990 include the development of a revealed comparative advantage in medium- and high-tech manufactures. However, the number of goods involved is relatively small and this transformation has not sufficed to raise per capita growth to the average for middle-income countries. Among sectors, high growth is likely for phosphate-based fertilizer exports. However, phosphates are hampered by low income and diversification potentials. Along with various other manufactured products, electronics and the automotive industry are promising sectors that may offer more lasting positive contributions. Beyond goods, policy makers should also consider the potential contributions of service exports, which in recent years have enjoyed rapid growth.

scholarly journals A patient–clinician James Lind Alliance partnership to identify research priorities for hyperemesis gravidarum

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041254
Author(s):  
Caitlin R Dean ◽  
Hyke Bierma ◽  
Ria Clarke ◽  
Brian Cleary ◽  
Patricia Ellis ◽  
...  
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Hyperemesis Gravidarum ◽  
Research Priorities ◽  
Developed Countries ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
James Lind Alliance ◽  
Research Questions

ObjectiveThere are many uncertainties surrounding the aetiology, treatment and sequelae of hyperemesis gravidarum (HG). Prioritising research questions could reduce research waste, helping researchers and funders direct attention to those questions which most urgently need addressing. The HG priority setting partnership (PSP) was established to identify and rank the top 25 priority research questions important to both patients and clinicians.MethodsFollowing the James Lind Alliance (JLA) methodology, an HG PSP steering group was established. Stakeholders representing patients, carers and multidisciplinary professionals completed an online survey to gather uncertainties. Eligible uncertainties related to HG. Uncertainties on nausea and vomiting of pregnancy and those on complementary treatments were not eligible. Questions were verified against the evidence. Two rounds of prioritisation included an online ranking survey and a 1-hour consensus workshop.Results1009 participants (938 patients/carers, 118 professionals with overlap between categories) submitted 2899 questions. Questions originated from participants in 26 different countries, and people from 32 countries took part in the first prioritisation stage. 66 unique questions emerged, which were evidence checked according to the agreed protocol. 65 true uncertainties were narrowed via an online ranking survey to 26 unranked uncertainties. The consensus workshop was attended by 19 international patients and clinicians who reached consensus on the top 10 questions for international researchers to address. More patients than professionals took part in the surveys but were equally distributed during the consensus workshop. Participants from low-income and middle-income countries noted that the priorities may be different in their settings.ConclusionsBy following the JLA method, a prioritised list of uncertainties relevant to both HG patients and their clinicians has been identified which can inform the international HG research agenda, funders and policy-makers. While it is possible to conduct an international PSP, results from developed countries may not be as relevant in low-income and middle-income countries.

scholarly journals Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050766
Author(s):  
Chinwe Onuegbu ◽  
Maxwell Larweh ◽  
Jenny Harlock ◽  
Frances Griffiths
Keyword(s):  
Systematic Review ◽  
Social Networks ◽  
Low Income ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Illness Experiences ◽  
Urban Settlements ◽  
Lay Consultation ◽  
Informal Urban Settlements

ObjectivesLay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs.DesignMixed-method systematic review.Data sourcesSix key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles.Eligibility criteriaPapers that described discussions with lay informal social network members during symptoms or illness experiences.Data analysis and synthesisQuality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies.Results13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice.ConclusionLay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours.PROSPERO registration numberCRD42020205196.

Human Resources for Mental Health in Low and Middle Income Countries

2018 ◽  
pp. 354-374
Author(s):  
Sheikh Mohammed Shariful Islam ◽  
Reshman Tabassum ◽  
Paolo C Colet ◽  
Jonas Preposi Cruz ◽  
Sukhen Dey ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Human Resources ◽  
Low Income ◽  
Low Income Countries ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Low And Middle Income

Mental disorders are a major public health challenge globally, contributing to 40% of the global burden of disease. Nevertheless, it remains highly neglected by health planners and policy makers, particularly in low and middle income countries (LMIC). Bangladesh, one of the low-income countries, suffers from a severe shortage of appropriately trained and an adequate number of human resources to provide mental health care. The authors reviewed available evidence on the dynamics of mental health services in LMIC like Bangladesh, with a view to help develop appropriate policies on human resources. This chapter critically examines the current situation of human resources for mental health in Bangladesh, and explores ways to further strengthen human resources so as to enhance mental health services in the country.

scholarly journals Recruitment of consultant psychiatrists from low- and middle-income countries

2004 ◽  
Vol 1 (6) ◽  
pp. 15-18 ◽  
Author(s):  
David Ndetei ◽  
Salman Karim ◽  
Malik Mubbashar
Keyword(s):  
Low Income ◽  
Health Sector ◽  
World Health ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Fellowship Programme ◽  
Health Organization ◽  
Rich Countries ◽  
Low And Middle Income

The UK's 2-year International Fellowship Programme for consultant doctors has inadvertently highlighted the long-standing issues of the costs and benefits of such recruitment for the countries of origin, and of whether it is ethical for rich countries to recruit health personnel not only from other rich countries but also from low- and middle-income countries. The ‘brain drain’ from poor to rich countries has been recognised for decades; it occurs in the health sector as well as other sectors, such as education, science and engineering. It has had serious ramifications for the health service infrastructure in low-income countries, where poverty, morbidity, disability and mortality are increasing rather than decreasing, and it is a matter of serious concern for both the World Health Organization and the International Monetary Fund (Carrington & Detragiache, 1998; Lee, 2003).

scholarly journals Allocating resources to support universal health coverage: policy processes and implementation in Malawi

2020 ◽  
Vol 5 (8) ◽  
pp. e002766 ◽  
Author(s):  
Pakwanja Twea ◽  
Gerald Manthalu ◽  
Sakshi Mohan
Keyword(s):  
Resource Allocation ◽  
Low Income ◽  
Health Sector ◽  
Health Resources ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Distribution Of Resources ◽  
The Government ◽  
Limited Health

Optimising the use of limited health resources in low-income and middle-income countries towards the maximisation of health outcomes requires efficient distribution of resources across health services and geographical areas. While technical research exists on how efficiencies can be achieved in resource allocation, there is limited guidance on the policy processes required to convert these technical inputs into practicable solutions. In this article, we discuss Malawi’s experience in 2019 of revising its resource allocation formula (RAF) for the geographical distribution of the government health sector budget to the decentralised units in-charge of delivering primary and secondary healthcare. The policy process to revise the RAF in Malawi was initiated by district assemblies seeking a more equitable distribution of government resources, with the Ministry of Health and Population (MOHP) leading the technical and deliberative work. This article discusses all the steps undertaken by MOHP, Malawi to date as well as the steps necessary looking forward to legally establish the newly developed RAF and to start implementing it. We highlight the practical and political considerations in ensuring the acceptability and implementation feasibility of a revised RAF. It is hoped that this discussion will serve as guidance to other countries undergoing a revision of their resource allocation frameworks.

Sign in / Sign up

Export Citation Format

Share Document