scholarly journals Understanding factors impacting global priority of emergency care: a qualitative policy analysis

2021 ◽  
Vol 6 (12) ◽  
pp. e006681
Author(s):  
Portia I Chipendo ◽  
Yusra R Shawar ◽  
Jeremy Shiffman ◽  
Junaid Abdul Razzak
Keyword(s):  
Emergency Care ◽  
Governance Structure ◽  
Problem Definition ◽  
Policy Framework ◽  
Coalition Building ◽  
Care Practice ◽  
Middle Income ◽  
Political Ethnography ◽  
Global Priority ◽  
Policy Windows

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates.MethodsWe conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes.ResultsWe identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network’s commitment to the issue, the emerging leadership and the existence of policy windows.ConclusionTo improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies.

scholarly journals Role of Dentistry in Global Health: Challenges and Research Priorities

2021 ◽  
pp. 002203452199201
Author(s):  
F.N. Hugo ◽  
N.J. Kassebaum ◽  
W. Marcenes ◽  
E. Bernabé
Keyword(s):  
Oral Health ◽  
Global Health ◽  
Quality Care ◽  
Research Priorities ◽  
Optimal Strategies ◽  
Problem Definition ◽  
Coalition Building ◽  
Multidisciplinary Teams ◽  
System Reform ◽  
Middle Income

Despite some improvements in the oral health of populations globally, major problems remain all over the planet, most notably among underprivileged communities of low- and middle-income countries but also in high-income countries. Furthermore, essential oral health care has been a privilege, instead of a right, for most individuals. The release of the Lancet issue on oral health in July 2019 built up some momentum and put oral conditions and dental services in the limelight. Yet, much work is still needed to bridge the gap between dental research and global health and get oral health recognized as a population health priority worldwide. Using the framework proposed by Shiffman, we argue that a global health network for oral health must be harnessed to influence global health policy and drive health system reform. We have identified challenges around 4 key areas (problem definition, positioning, coalition building, and governance) from our experience working in the global health arena and with collaborators in multidisciplinary teams. These challenges are outlined here to validate them externally but also to call the attention of interested players inside and outside dentistry. How well our profession addresses these challenges will shape our performance during the Sustainable Development Goals era and beyond. This analysis is followed by a discussion of fundamental gaps in knowledge, particularly in 3 areas of oral health action: 1) epidemiology and health information systems; 2) collection, harmonization, and rigorous assessment of evidence for prevention, equity, and treatment; and 3) optimal strategies for delivering essential quality care to all who need it without financial hardship.

scholarly journals Closing the Equity Gap of Access to Emergency Departments of Private Hospitals in Thailand

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Paibul Suriyawongpaisal ◽  
Pongsakorn Atiksawedparit ◽  
Samrit Srithamrongsawad ◽  
Thanita Thongtan
Keyword(s):  
Emergency Care ◽  
Private Hospital ◽  
Financial Incentive ◽  
Gender Disparity ◽  
Lessons Learned ◽  
Care Seeking ◽  
Health Coverage ◽  
Private Hospitals ◽  
Middle Income ◽  
Strategic Policies

Background. Previous policy implementation in 2012 to incentivize private hospitals in Thailand, a country with universal health coverage, to provide free-of-charge emergency care using DRG-based payment resulted in an equity gap of access and copayment. To bridge the gap, strategic policies involving financial and legal interventions were implemented in 2017. This study aims to assess whether this new approach would be able to fill the gap. Methods. We analyzed an administrative dataset of over 20,206 patients visiting private hospital EDs from April 2017 to October 2017 requested for the preauthorization of access to emergency care in the first 72 hours free of charge. The association between types of insurance and the approval status was explored using logistic regression equation adjusting for age, modes of access, systolic blood pressure, respiratory rate, and Glasgow coma scores. Results and Discussion. The strategic policies implementation resulted in reversing ED payer mix from the most privileged scheme, having the major share of ED visit, to the least privileged scheme. The data showed an increasing trend of ED visits to private hospitals indicates the acceptance of the financial incentive. Obvious differences in degrees of urgency between authorized and unauthorized patients suggested the role of preauthorization as a barrier to the noncritical patient visiting the ED. Furthermore, our study depicted the gender disparity between authorized and unauthorized patients which might indicate a delay in care seeking among critical female patients. Lessons learned for policymakers in low-and-middle income countries attempting to close the equity gap of access to private hospital EDs are discussed.

scholarly journals Determinants of mortgage price affordability: a study of Ghana

2018 ◽  
Vol 11 (4) ◽  
pp. 734-751 ◽  
Author(s):  
DeGraft Owusu-Manu ◽  
David John Edwards ◽  
Erika Anneli Pärn ◽  
Richard Ohene Asiedu ◽  
Alex Aboagye
Keyword(s):  
Market Failure ◽  
Urban Housing ◽  
Mortgage Market ◽  
Policy Framework ◽  
African Countries ◽  
Middle Income ◽  
Content Type ◽  
Developmental Factors ◽  
Research Findings ◽  
Survey Results

Purpose While mortgage markets have gradually emerged in many African countries, substantial barriers still hinder their growth and expansion. Affordability has been widely cited as a prominent issue that doggedly remains at the core of urban housing problems. Hence, this paper aims to investigate the determinants of mortgage price affordability. Design/methodology/approach Data were gathered using semi-structured questionnaires obtained from a sample drawn from three major West African mortgage financing institutions. Respondents rated the variables using a five-point Likert item rating. The survey results were analysed using exploratory factor analysis. Findings In total, 11 variables that influence mortgage affordability were categorised within five principal components, namely, economic factors, financial factors, property characteristics, developmental factors and geographical factors. Practical implications The results provide insightful guidance to policymakers and practitioners on how to mitigate affordability issues within Ghana’s fledgling mortgage market. Failure to address the mortgage price affordability conundrum will place enormous pressure upon social housing and rental accommodation. Originality/value The research findings expand existing frontiers of knowledge by investigating and reporting upon the determinants of mortgage price affordability. The work also engenders wider debate on the need to establish mortgage packages targeted at low-to-middle-income earners. The culmination of analysis and debate will provide a robust basis for developing a future housing policy framework.

scholarly journals Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems

2019 ◽  
Vol 4 (Suppl 6) ◽  
pp. e001265 ◽  
Author(s):  
Rachel T Moresky ◽  
Junaid Razzak ◽  
Teri Reynolds ◽  
Lee A Wallis ◽  
Benjamin W Wachira ◽  
...  
Keyword(s):  
Health Systems ◽  
Emergency Care ◽  
Low Income ◽  
Communicable Diseases ◽  
Middle Income ◽  
Care Research ◽  
Middle Income Countries ◽  
Emergency Care Systems ◽  
Care Systems ◽  
Research Questions

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.

PP158 The Art Of Collaboration In Guideline Development

2018 ◽  
Vol 34 (S1) ◽  
pp. 128-128
Author(s):  
Carmen Moga ◽  
Ann Scott
Keyword(s):  
Guideline Development ◽  
Multidisciplinary Care ◽  
Governance Structure ◽  
Steering Committee ◽  
Care Practice ◽  
Stakeholder Collaboration ◽  
Effective Decision Making ◽  
Practice Knowledge ◽  
Multi Stakeholder ◽  
Clinical Queries

Introduction:Developing clinical practice guidelines (CPGs) is a collaborative, multi-stakeholder enterprise. Over the last 13 years, health technology assessment (HTA) researchers from the Institute of Health Economics (IHE) partnered in a unique manner with provincial clinicians and stakeholders to develop and update CPGs using an innovative adaptation method. The complexities, intricacies, and attributes for success are presented, with emphasis on the role played by HTA resources.Methods:A governance structure (Advisory Committee, Steering Committee, Guideline Development Group) was designed to provide adequate oversight and quick, effective decision making, facilitate progress of the activities, and provide a mechanism for involving a wide variety of participants in the guideline development processes—stakeholders who represent policy, multidisciplinary care practice, knowledge translation, and research.Results:The HTA researchers served various functions and played multiple translation roles in the guideline development process: acting as a hub for connecting researchers with government to address relevant policy questions; liaising with committees to translate clinical queries into searchable questions for information specialists; preparing background documents and compiling discussion materials to expedite review by committees; connecting committees with external stakeholders such as the provincial CPG program; and bringing lay advisors into the final review process. Elements for success included effective communication, development and use of consistent methods, reliance on the highest quality of research evidence, willingness to contribute and share expertise, awareness of other initiatives and projects, transparency and openness, efficiency, flexibility, respect, enthusiasm, commitment, and patience.Conclusions:The development of CPGs requires the establishment of sophisticated multi-stakeholder collaboration and time. HTA agencies are well positioned to be an effective translation hub connecting the various stakeholders by virtue of their inherent ability to communicate in the language of policy makers, clinicians, and patients, so that all participants understand enough to add their voice to the process.

scholarly journals Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study

2019 ◽  
Vol 54 (5) ◽  
pp. 1802419 ◽  
Author(s):  
Cristina Ardura-Garcia ◽  
Erick Arias ◽  
Paola Hurtado ◽  
Laura J. Bonnett ◽  
Carlos Sandoval ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Emergency Care ◽  
Protective Factor ◽  
Assessment Tool ◽  
Cox Regression ◽  
Emergency Rooms ◽  
Middle Income ◽  
Middle Income Countries ◽  
Asthma Attack ◽  
Younger Age

Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5–15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months’ follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79–0.96 per year), previous asthma diagnosis (2.2, 1.2–3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1–1.5), food triggers (2.0, 1.1–3.6) and eczema diagnosis (4.2, 1.02–17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50–0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.

scholarly journals Developing metrics for emergency care research in low- and middle-income countries

2016 ◽  
Vol 6 (3) ◽  
pp. 116-124 ◽  
Author(s):  
Samer Abujaber ◽  
Cindy Y. Chang ◽  
Teri A. Reynolds ◽  
Hani Mowafi ◽  
Ziad Obermeyer
Keyword(s):  
Emergency Care ◽  
Middle Income ◽  
Care Research ◽  
Middle Income Countries ◽  
Low And Middle Income
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