scholarly journals Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka

2019 ◽  
Vol 4 (1) ◽  
pp. e001134 ◽  
Author(s):  
Abi Beane ◽  
Ambepitiyawaduge Pubudu De Silva ◽  
Priyantha Lakmini Athapattu ◽  
Saroj Jayasinghe ◽  
Anuja Unnathie Abayadeera ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Acute Care ◽  
Low Income ◽  
National Level ◽  
Digital Information ◽  
Collaborative Approach ◽  
Frontline Staff ◽  
Middle Income ◽  
Team Members ◽  
Similar Work

Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north–south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work.

scholarly journals CHALLENGES ON URBAN AGEING IN HIGH DENSITY SETTLEMENTS: Relationship of built-environment attributes and lifestyle of elderly in Western province, Sri Lanka

2021 ◽  
Author(s):  
N.N. Jayaratne ◽  
◽  
I. Rajapaksha ◽  
Keyword(s):  
Sri Lanka ◽  
Built Environment ◽  
Case Studies ◽  
Low Income ◽  
Population Aging ◽  
Age Groups ◽  
Assessment Method ◽  
Middle Income ◽  
Age Related ◽  
Health Related

Urbanization and population aging are two key phenomena in the twenty-first century that concerns the elders living in cities, especially those in low- and middle-income countries like Sri Lanka. In such a setting, understanding the responsiveness of the built environment for active aging is crucial. However, even the few available studies are prioritized on health rather than the built environment attributes. Therefore, this study aims to assess the built environment attributes related to elders, for the first time, in developing countries like Sri Lanka. The assessment method composes of two case studies in Colombo, Sri Lanka with a questionnaire survey, an axial map, and a frequency analysis using the SPSS software. The case studies comprise of a middle-income and a low-income settlement both with high population density. The analysis results explicitly informed that, in comparison, the middle-income settlement is more adversely affected by the built environment response related to health and social relationships. This finding is further supported by the prominence in health-related issues of loneliness (ρ-value .042) and lack of freedom (ρ-value .014) in the middle-income settlement. The built environment attributes were ranked based on their significance in correlation with the Quality-of-Life measures and the individual age-related characteristics. This was further developed for an appraisal that assesses health-related aspects of built environment response for vulnerable age groups like elders. The findings and the appraisal could support the future decision-making process of the National health budget and future urban design interventions since Sri Lanka has the highest South Asian aging population.

scholarly journals Inclusion of diabetic retinopathy screening strategies in national-level diabetes care planning in low-income and middle-income settings: protocol for a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038647
Author(s):  
Katie Curran ◽  
Prabhath Piyasena ◽  
Nathan Congdon ◽  
Lisa Duke ◽  
Belma Malanda ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Scoping Review ◽  
Low Income ◽  
Communicable Disease ◽  
Grey Literature ◽  
National Level ◽  
Service Planning ◽  
Health Concern ◽  
Cochrane Library ◽  
Middle Income

IntroductionThe diabetes mellitus (DM) epidemic is a major public health concern globally, with the highest-burden in low-income and middle-income countries (LMICs). Diabetic retinopathy (DR) is a microvascular complication of diabetes, and if left untreated can lead to visual impairment and blindness. Epidemiological studies suggest that the incidence of sight-threatening DR is decreasing in high-income countries due to improved treatments and management of DM; however, these trends are not replicated in LMICs. In this paper, we outline a scoping review protocol that aims to identify which LMICs have included DR in their national DM, non-communicable disease or prevention of blindness plans. The scoping review also aims to assess gaps when implementing national DR screening programmes in LMICs.Methods and analysisThis scoping review will follow the Arksey and O’Malley (2005) methodology and the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Review guidelines. A comprehensive search of peer-reviewed and grey literature will be conducted from October 1989 (St. Vincent Declaration) to February 2020. Studies will be identified from electronic databases; Medline, Embase and CENTRAL (Cochrane Library). To identify further relevant articles, a hand search will be conducted using the reference lists of included studies. Two reviewers will independently screen records for relevant data and disagreements about eligibility will be resolved through consensus or arbitration by a third reviewer. A quantitative analysis will be performed to highlight key findings and thematic analysis will be used to identify emerging themes and subthemes from included studies. The key themes will highlight countries progress in terms of national-level DR service planning and screening implementation.Ethics and disseminationNo ethical approval is required because the scoping review methodology aims to synthesise information from publicly available resources. The results will be disseminated through conference presentations and peer-reviewed publication.

scholarly journals Epidemic Spread and Its Management Through Governance and Leadership Response Influencing the Arising Challenges Around COVID-19 in Pakistan—A Lesson Learnt for Low Income Countries With Limited Resource

2020 ◽  
Vol 8 ◽  
Author(s):  
Ahsan Nawaz ◽  
Xing Su ◽  
Muhammad Qasim Barkat ◽  
Sana Asghar ◽  
Ali Asad ◽  
...  
Keyword(s):  
Low Income ◽  
Preventive Measures ◽  
National Level ◽  
Limited Resource ◽  
Low Income Countries ◽  
Strict Adherence ◽  
Similar Work ◽  
The Usa ◽  
The Government ◽  
Global Statistics

The coronavirus disease (COVID-19) was first reported in China (Wuhan) at the end of 2019. It has rapidly spread over 216 countries, including the USA, UK, Europe, Russia, and many Asian countries. It has affected more than 4.5 million people, and around 0.3 million deaths have been reported globally. Many preventive measures have been adopted worldwide to mitigate its spread. The government of Pakistan has also taken many preventive measures to combat the COVID-19 outbreak, such as rapid response by governance, continuous monitoring of the pandemic spread in the affected areas, and integration of resources from multiple sectors, including health, education, defense, and media. According to global statistics, the number of COVID-19 cases in the country remained remarkably lower than the expected number for the first 169 days, as compared to other countries. A total of 286,674 confirmed cases, including 16,475 active, 6,139 deaths, and 264,060 (92%) recoveries were reported. The study finds that strict adherence to national policies, effective governance, and unity at the national level resulted in better outcomes. Hence, the preventive measures, rapid responses, and strategies adopted for combating the challenges could be adopted as a learning tool for other countries having similar work environments and financial constraints. This paper can help and guide governance/public actions in response to the possible rebound of coronavirus this fall/winter.

scholarly journals Establishment of a road traffic trauma registry for northern Sri Lanka

2020 ◽  
Vol 5 (1) ◽  
pp. e001818 ◽  
Author(s):  
Thayasivam Gobyshanger ◽  
Alison M Bales ◽  
Claire Hardman ◽  
Mary McCarthy
Keyword(s):  
Sri Lanka ◽  
Low Income ◽  
Trauma Registry ◽  
Road Traffic ◽  
Prehospital Care ◽  
Public Health Problem ◽  
Global Public Health ◽  
Middle Income ◽  
Road Traffic Crashes ◽  
Middle Income Countries

Road traffic injuries are a neglected global public health problem. Over 1.25 million people are killed each year, and middle-income countries, which are motorising rapidly, are the hardest hit. Sri Lanka is dealing with an injury-related healthcare crisis, with a recent 85% increase in road traffic fatality rates. Road traffic crashes now account for 25 000 injuries annually and 10 deaths daily. Development of a trauma registry is the foundation for injury control, care and prevention. Five northern Sri Lankan provinces collaborated with Jaffna Teaching Hospital to develop a local electronic registry. The Centre for Clinical Excellence and Research was established to provide organisational leadership, hardware and software were purchased, and data collectors trained. Initial data collection was modified after implementation challenges were resolved. Between 1 June 2017 and 30 September 2017, 1708 injured patients were entered into the registry. Among these patients, 62% were male, 76% were aged 21–50, 71.3% were motorcyclists and 34% were in a collision with another motorcyclist. There were frequent collisions with uncontrolled livestock (12%) and with fixed objects (14%), and most patients were transported by private vehicles without prehospital care. Head (n=315) and lower extremity (n=497) injuries predominated. Establishment of a trauma registry in low-income and middle-income countries is a significant challenge and requires invested local leadership; the most challenging issue is ongoing funding. However, this pilot registry provides a valuable foundation, identifying unique injury mechanisms, establishing priorities for prevention and patient care, and introducing the concept of an organised system to this region.

scholarly journals The State of the World’s Midwifery 2021 report: findings to drive global policy and practice

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrea Nove ◽  
Petra ten Hoope-Bender ◽  
Martin Boyce ◽  
Sarah Bar-Zeev ◽  
Luc de Bernis ◽  
...  
Keyword(s):  
East Asia ◽  
Low Income ◽  
Eastern Mediterranean ◽  
National Level ◽  
Policy Implications ◽  
Low Income Countries ◽  
South East Asia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Income Groups

AbstractThe third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory environments tend to be strong. Upper-middle-income countries also tend to have strong policy environments. LICs and lower-middle-income countries tend to have a broader scope of practice for midwives, and many also have midwives in leadership positions within national government. Key regional variations include: major midwife shortages in Africa and South-East Asia but more promising signs of growth in South-East Asia than in Africa; a strong focus in Africa on professional midwives (rather than associate professionals: the norm in many South-East Asian countries); heavy reliance on medical doctors rather than midwives in the Americas and Eastern Mediterranean regions and parts of the Western Pacific; and a strong educational and regulatory environment in Europe but a lack of midwife leaders at national level. SoWMy 2021 provides stakeholders with the latest data and information to inform their efforts to build back better and fairer after COVID-19. This paper provides a number of policy responses to SoWMy 2021 that are tailored to different contexts, and suggests a variety of issues to consider in these contexts. These suggestions are supported by the inclusion of all countries in the report, because it is clear which countries have strong SRMNAH workforces and enabling environments and can be viewed as exemplars within regions and income groups.

Development Outcomes of Old and New Sources of International Development Finance in Sri Lanka

2017 ◽  
Vol 33 (4) ◽  
pp. 488-516
Author(s):  
Muttukrishna Sarvananthan
Keyword(s):  
Sri Lanka ◽  
International Development ◽  
Civil Wars ◽  
Low Income ◽  
Income Country ◽  
Middle Income ◽  
Development Finance ◽  
Low Income Country ◽  
Capita Income Growth ◽  
Development Outcomes

This research article compares and contrasts development outcomes of ‘traditional’ or ‘old’ and ‘emerging’ or ‘new’ sources of international development finance in Sri Lanka during the ceasefire time (2002–2005) when it depended on former sources and the post-civil war period (2009–2012) when it depended heavily on the latter sources. It also compares and contrasts the development outcomes in Sri Lanka (a lower middle income country), which depended heavily on the ‘emerging’ or ‘new’ sources of international development finance, and Nepal (a low income country), which depended on ‘traditional’ or ‘old’ sources of international development finance, during the first five years after the end of their respective civil wars. Although the causality is difficult to establish, the data presented herein demonstrates that while GDP growth and per capita income growth have been greater under the new international development finance regime in Sri Lanka, positive changes in the rates of inflation, unemployment, and poverty have been greater under the old international development finance regimes in Sri Lanka and Nepal.

scholarly journals Interprofessional work in operating rooms: a qualitative study from Sri Lanka

2021 ◽  
Author(s):  
Vathsala Jayasuriya-Illesinghe ◽  
Sepali Guruge ◽  
Bawantha Gamage ◽  
Sherry Espin
Keyword(s):  
Sri Lanka ◽  
Interprofessional Collaboration ◽  
Contextual Factors ◽  
Operating Rooms ◽  
Team Members ◽  
Interprofessional Teamwork ◽  
Similar Work ◽  
Surgical Errors ◽  
Relational Factors ◽  
And Gender

Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

scholarly journals Interprofessional work in operating rooms: a qualitative study from Sri Lanka

2021 ◽  
Author(s):  
Vathsala Jayasuriya-Illesinghe ◽  
Sepali Guruge ◽  
Bawantha Gamage ◽  
Sherry Espin
Keyword(s):  
Sri Lanka ◽  
Interprofessional Collaboration ◽  
Contextual Factors ◽  
Operating Rooms ◽  
Team Members ◽  
Interprofessional Teamwork ◽  
Similar Work ◽  
Surgical Errors ◽  
Relational Factors ◽  
And Gender

Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

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