scholarly journals 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation

2021 ◽  
Vol 6 (8) ◽  
pp. e006002
Author(s):  
Abigail H Neel ◽  
Svea Closser ◽  
Catherine Villanueva ◽  
Piyusha Majumdar ◽  
S D Gupta ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
System Level ◽  
Vaccine Hesitancy ◽  
High Coverage ◽  
Frontline Staff ◽  
Polio Vaccination ◽  
Worker Motivation ◽  
The Impact ◽  
Over Time

IntroductionThe debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time.MethodsWe constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication.ResultsPursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.ConclusionIt benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate. 

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 The impact of quarantine on Covid-19 infections

2021 ◽  
Vol 10 (s1) ◽  
Author(s):  
Pablo Marshall
Keyword(s):  
Health System ◽  
Infection Rate ◽  
District Level ◽  
Infection Model ◽  
Social Distancing ◽  
Proposed Model ◽  
Lower Infection ◽  
The Impact ◽  
Lower Infection Rate ◽  
Over Time

Abstract Objectives: Coronavirushas had profound effects on people’s lives and the economy of many countries, generating controversy between the need to establish quarantines and other social distancing measures to protect people’s health and the need to reactivate the economy. This study proposes and applies a modification of the SIR infection model to describe the evolution of coronavirus infections and to measure the effect of quarantine on the number of people infected. Methods: Two hypotheses, not necessarily mutually exclusive, are proposed for the impact of quarantines. According to the first hypothesis, quarantine reduces the infection rate, delaying new infections over time without modifying the total number of people infected at the end of the wave. The second hypothesis establishes that quarantine reduces the population infected in the wave. The two hypotheses are tested with data for a sample of 10 districts in Santiago, Chile. Results: The results of applying the methodology show that the proposed model describes well the evolution of infections at the district level. The data shows evidence in favor of the first hypothesis, quarantine reduces the infection rate; and not in favor of the second hypothesis, that quarantine reduces the population infected. Districts of higher socio-economic levels have a lower infection rate, and quarantine is more effective. Conclusions: Quarantine, in most districts, does not reduce the total number of people infected in the wave; it only reduces the rate at which they are infected. The reduction in the infection rate avoids peaks that may collapse the health system.

scholarly journals Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Keely Jordan ◽  
Todd P. Lewis ◽  
Bayard Roberts
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Point Of Care ◽  
System Level ◽  
System Quality ◽  
High Quality ◽  
Humanitarian Settings ◽  
Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

scholarly journals Empirically evaluating the impact of adjudicative tribunals in the health sector: context, challenges and opportunities

2011 ◽  
Vol 7 (2) ◽  
pp. 147-174
Author(s):  
Steven J. Hoffman ◽  
Lorne Sossin
Keyword(s):  
Health System ◽  
Health Sector ◽  
Cost Effective ◽  
System Level ◽  
Challenges And Opportunities ◽  
External Impact ◽  
Health System Governance ◽  
Evaluation Matrix ◽  
The Impact ◽  
Methodological Difficulties

AbstractAdjudicative tribunals are an integral part of health system governance, yet their real-world impact remains largely unknown. Most assessments focus on internal accountability and use anecdotal methodologies; few, studies if any, empirically evaluate their external impact and use these data to test effectiveness, track performance, inform service improvements and ultimately strengthen health systems. Given that such assessments would yield important benefits and have been conducted successfully in similar settings (e.g. specialist courts), their absence is likely attributable to complexity in the health system, methodological difficulties and the legal environment within which tribunals operate. We suggest practical steps for potential evaluators to conduct empirical impact evaluations along with an evaluation matrix template featuring possible target outcomes and corresponding surrogate endpoints, performance indicators and empirical methodologies. Several system-level strategies for supporting such assessments have also been suggested for academics, health system institutions, health planners and research funders. Action is necessary to ensure that policymakers do not continue operating without evidence but can rather pursue data-driven strategies that are more likely to achieve their health system goals in a cost-effective way.

scholarly journals How the ‘plates’ of a health system can shift, change and adjust during economic recessions. A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

2020 ◽  
Author(s):  
Giuliano Russo ◽  
Maria Luiza Levi Paim ◽  
Maria Teresa Seabra Soares de Britto e Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Ruth Helena de Souza Britto Ferreira de Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Health Systems ◽  
Low Income ◽  
Sao Paulo ◽  
São Paulo ◽  
Public And Private ◽  
Qualitative Interview Study ◽  
Economic Recessions ◽  
The Impact

Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

scholarly journals Conceptualizing resilience in health systems: results from 30 countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Karanikolos ◽  
A Maresso
Keyword(s):  
Health System ◽  
Health Systems ◽  
Analytical Framework ◽  
Three Dimensions ◽  
Necessary Condition ◽  
Eu Member States ◽  
Long Term Stability ◽  
The Matrix ◽  
Governance Tools ◽  
The Impact

Abstract The analytical framework used in the 2019 EU Country Health Profiles defines resilience as “health systems' capacity to absorb disturbance created by changing environments, sudden shocks or crises, and to adapt and respond effectively with the provision of needed services”. These challenges can be driven by changes or shocks in supply (economic shocks, growing shortages in available resources, technological innovations) or demand (demographic changes, public health threats like the Covid-19 pandemic). The Profiles analyse relevant policy measures to assess whether countries are well prepared to face health system shocks and strains. Methods The framework distinguishes three dimensions of resilience: Ensuring long-term stability of resources: the capacity to protect or generate adequate financial, physical and human resources, as well as information necessary to address a variety of major challenges.Responding efficiently: the ability to manage the health system with limited resources, through achieving efficiencies, while not sacrificing key priorities, benefits, access or entitlements.Strengthening governance: the capacity to steer the system in order to adapt it quickly to new objectives and priorities and to respond to major challenges through key governance tools. The profiles use a harmonised approach to analyse the degree of resilience in each country across these three dimensions through a range of quantitative and qualitative indicators. Results A matrix clusters the findings from the 30 Country Profiles in 2019 (pre Covid-19 outbreak) and identifies common resilience-related challenges and risks facing EU Member States. The matrix also captures examples of countries that are successfully deploying resilience-building policy strategies. Conclusions The evidence shows that resilience is a necessary condition for health systems to mitigate the impact of adversities, as well as respond effectively to both foreseen and unforeseen challenges. Panelists Josep Figueras, Moderator, European Observatory on Health Systems and Policies Federico Pratellesi, DG SANTE, European Commission Guillaume Dedet, Health Division, OECD, Paris, France Anna Maresso, European Observatory on Health Systems and Policies, University of Technology Berlin, Germany

scholarly journals Country-Wide Resilience Model for the Health System: A Case Study on Iran, under Coronavirus Outbreak

2021 ◽  
Author(s):  
Nazanin Pilevari ◽  
Mahyar Valeh Shiva
Keyword(s):  
Health System ◽  
Health Systems ◽  
Dynamic Capabilities ◽  
Health Information System ◽  
National Health System ◽  
Building Blocks ◽  
Interpretive Structural Modeling ◽  
System A ◽  
The Impact

Background: The outbreak of the COVID-19 virus has had many destructive impacts on socio-economic and health systems. The health systems of countries could be supportive in crisis management, but they also are affected by the impact of the crisis, consequently, their operational level has declined. This study pursued resilience in an overall national health system under pandemic stress. Methods: Based on WHO building blocks, by interviewing informants of the Ministry of Health and Medical Education, in Tehran-Iran, early 2021 a rich picture of the current situation depicted, the resilience model was extracted via a mixed method of Soft System Methodology (SSM) and total interpretive structural modeling (TISM). Dynamic capabilities were applied for the orchestration of the Iranian health system. Results: Particular functional and structural suggestions applicable for designing a ubiquitous resilience model for the country-wide health system are presented in this study. The variables of crisis sensing, opportunity seizing, and reconfiguration are the cornerstones of health system resilience. Conclusion: Well-suited health technology assessment (HTA) and health information system (HIS) play significant roles in the overall strengthening of the health system. All reforms for resilience will have a lasting result when the capabilities created by the resilience model are learned and reused in a dynamic cycle.

scholarly journals The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence

2019 ◽  
Vol 34 (8) ◽  
pp. 605-617 ◽  
Author(s):  
Seye Abimbola ◽  
Leonard Baatiema ◽  
Maryam Bigdeli
Keyword(s):  
Health System ◽  
Health Systems ◽  
Negative Impact ◽  
Contextual Factors ◽  
Evidence Synthesis ◽  
Implementation Strategies ◽  
Cochrane Library ◽  
Local Initiative ◽  
Middle Income ◽  
The Impact

Abstract One constant refrain in evaluations and reviews of decentralization is that the results are mixed. But given that decentralization is a complex intervention or phenomenon, what is more important is to generate evidence to inform implementation strategies. We therefore synthesized evidence from the literature to understand why, how and under what circumstances decentralization influences health system equity, efficiency and resilience. In doing this, we adopted the realist approach to evidence synthesis and included quantitative and qualitative studies in high-, low- and middle-income countries that assessed the the impact of decentralization on health systems. We searched the Medline and Embase databases via Ovid, and the Cochrane library of systematic reviews and included 51 studies with data from 25 countries. We identified three mechanisms through which decentralization impacts on health system equity, efficiency and resilience: ‘Voting with feet’ (reflecting how decentralization either exacerbates or assuages the existing patterns of inequities in the distribution of people, resources and outcomes in a jurisdiction); ‘Close to ground’ (reflecting how bringing governance closer to the people allows for use of local initiative, information, feedback, input and control); and ‘Watching the watchers’ (reflecting mutual accountability and support relations between multiple centres of governance which are multiplied by decentralization, involving governments at different levels and also community health committees and health boards). We also identified institutional, socio-economic and geographic contextual factors that influence each of these mechanisms. By moving beyond findings that the effects of decentralization on health systems and outcomes are mixed, this review presents mechanisms and contextual factors to which policymakers and implementers need to pay attention in their efforts to maximize the positive and minimize the negative impact of decentralized governance.

scholarly journals Health Sufficiency Indicators for Pandemic Monitoring

2021 ◽  
Vol 18 (10) ◽  
pp. 5358
Author(s):  
Javier M. Moguerza ◽  
Salvador Perelló Oliver ◽  
Isaac Martín de Diego ◽  
Víctor Aceña ◽  
Carmen Lancho ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Basic Information ◽  
Prevention Measures ◽  
Early Prevention ◽  
The World ◽  
Disease Spreading ◽  
The Impact ◽  
Spanish Health

The outbreak of the COVID-19 disease, spreading all around the world and causing a worldwide pandemic, has lead to the collapse of the health systems of the most affected countries. Due to the ease of transmission, early prevention measures are proved to be fundamental to control the pandemic and, hence, the saturation of the health systems. Given the difficulty of obtaining characteristics of these systems of different countries and regions, it is necessary to define indicators based on basic information that enable the assessment of the evolution of the impact of a disease in a health system along with fair comparisons among different ones. This present paper introduces the Health Sufficiency Indicator (HSI), in its accumulated and daily versions. This indicator measures the additional pressure that a health care system has to deal with due to a pandemic. Hence, it allows to evaluate the capacity of a health system to give response to the corresponding needs arising from a pandemic and to compare the evolution of the disease among different regions. In addition, the Potential Occupancy Ratio (POR) in both its hospital ward bed and ICU bed versions is here introduced to asses the impact of the pandemic in the capacity of hospitals. These indicators and other well-known ones are applied to track the evolution of the impact of the disease on the Spanish health system during the first wave of the pandemic, both on national and regional levels. An international comparison among the most affected countries is also performed.

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