scholarly journals ‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036285
Author(s):  
Olivia Biermann ◽  
Salla Atkins ◽  
Knut Lönnroth ◽  
Maxine Caws ◽  
Kerri Viney
Keyword(s):  
Stakeholder Engagement ◽  
Policy Development ◽  
Case Finding ◽  
World Health ◽  
Framework Analysis ◽  
Tuberculosis Case ◽  
Systematic Screening ◽  
Non Profit ◽  
Key Stakeholders ◽  
Health Organization

ObjectiveTo explore experts’ views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes.DesignThis is an exploratory study based on semistructured expert interviews. Framework analysis was applied.ParticipantsThe study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide.ResultsThis study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental stakeholders in ACF policy development. Such key stakeholders also influence ACF policy implementation, in addition to available systems and processes in a given health system, and implementers’ motivation and incentives. According to the interviewees, the World Health Organization (WHO) guidelines for systematic screening face the innate challenge of providing guidance to countries across the broad area of ACF in terms of target groups, settings and screening algorithms. The guidelines could be improved by focusing on what should be done rather than what can be done in ACF, and by providing howto examples. Leadership, integration into health systems and long-term financing are key for ACF to be sustainable.ConclusionsWe provide new insights into ACF policy processes globally, particularly regarding facilitators for and barriers to ACF policy development, evidence need and use, and donor organisations’ influence. According to expert participants, national and global ACF policy development and implementation can be improved by broadening stakeholder engagement. Meanwhile, using diverse evidence to inform ACF policy development and implementation could mitigate the ‘power plays plus push’ that might otherwise disrupt and mislead these policy processes.

scholarly journals Factors influencing active tuberculosis case-finding policy development and implementation: a scoping review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031284 ◽  
Author(s):  
Olivia Biermann ◽  
Knut Lönnroth ◽  
Maxine Caws ◽  
Kerri Viney
Keyword(s):  
Health System ◽  
Influencing Factors ◽  
Scoping Review ◽  
Policy Development ◽  
Case Finding ◽  
System Capacity ◽  
World Health ◽  
Eligibility Criteria ◽  
Tuberculosis Case ◽  
Factors Influencing

ObjectiveTo explore antecedents, components and influencing factors on active case-finding (ACF) policy development and implementation.DesignScoping review, searching MEDLINE, Web of Science, the Cochrane Database of Systematic Reviews and the World Health Organization (WHO) Library from January 1968 to January 2018. We excluded studies focusing on latent tuberculosis (TB) infection, passive case-finding, childhood TB and studies about effectiveness, yield, accuracy and impact without descriptions of how this evidence has/could influence ACF policy or implementation. We included any type of study written in English, and conducted frequency and thematic analyses.ResultsSeventy-three articles fulfilled our eligibility criteria. Most (67%) were published after 2010. The studies were conducted in all WHO regions, but primarily in Africa (22%), Europe (23%) and the Western-Pacific region (12%). Forty-one percent of the studies were classified as quantitative, followed by reviews (22%) and qualitative studies (12%). Most articles focused on ACF for tuberculosis contacts (25%) or migrants (32%). Fourteen percent of the articles described community-based screening of high-risk populations. Fifty-nine percent of studies reported influencing factors for ACF implementation; mostly linked to the health system (eg, resources) and the community/individual (eg, social determinants of health). Only two articles highlighted factors influencing ACF policy development (eg, politics). Six articles described WHO’s ACF-related recommendations as important antecedent for ACF. Key components of successful ACF implementation include health system capacity, mechanisms for integration, education and collaboration for ACF.ConclusionWe identified some main themes regarding the antecedents, components and influencing factors for ACF policy development and implementation. While we know much about facilitators and barriers for ACF policy implementation, we know less abouthowto strengthen those facilitators andhowto overcome those barriers. A major knowledge gap remains when it comes to understanding which contextual factors influence ACF policy development. Research is required to understand, inform and improve ACF policy development and implementation.

scholarly journals Antibiotic Pipeline Coordinators

2018 ◽  
Vol 46 (S1) ◽  
pp. 25-31 ◽  
Author(s):  
Enrico Baraldi ◽  
Olof Lindahl ◽  
Miloje Savic ◽  
David Findlay ◽  
Christine Årdal
Keyword(s):  
Research And Development ◽  
World Health ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Priority List ◽  
Non Profit ◽  
Global Priority ◽  
The World ◽  
New Antibiotics ◽  
Health Organization

The World Health Organization (WHO) has published a global priority list of antibiotic-resistant bacteria to guide research and development (R&D) of new antibiotics. Every pathogen on this list requires R&D activity, but some are more attractive for private sector investments, as evidenced by the current antibacterial pipeline. A “pipeline coordinator” is a governmental/non-profit organization that closely tracks the antibacterial pipeline and actively supports R&D across all priority pathogens employing new financing tools.

scholarly journals Nurses’ and midwives’ perspectives on participation in national policy development, review and reforms in Ghana: A qualitative study

2021 ◽  
Author(s):  
Angela Kwartemaa Acheampong ◽  
Lillian Akorfa Ohene ◽  
Isabella Naana Akyaa Asante ◽  
Josephine Kyei ◽  
Gladys Dzansi ◽  
...  
Keyword(s):  
Health Policy ◽  
Staff Development ◽  
Policy Development ◽  
National Policy ◽  
World Health ◽  
Health Coverage ◽  
Policy Reforms ◽  
Individual Interviews ◽  
Health Organization ◽  
Nurses And Midwives

Abstract Background: The World Health Organization has admonished member countries to strive towards achieving universal health coverage (UHC) through actionable health policies and strategies. Nurses and midwives have instrumental roles in achieving UHC via health policy development and implementation. However, there is a paucity of empirical data on nurses and midwives’ participation in policy development in Ghana. The current study explored nurses and midwives’ participation in policy development, reviews and reforms in Ghana.Methods: A qualitative descriptive exploratory design was adopted for this study. One-on-one individual interviews were conducted after 30 participants were purposefully selected. Data was audiotaped with permission, transcribed and analyzed inductively using the content analysis procedures. Results: Two main themes emerged from the data: participation in policy development and perspectives on policy reviews and reforms. The findings showed that during health policy development and reviews, nurses in Ghana were overlooked and unacknowledged. Policy reforms regarding bridging the pre-service preparation gap, staff development and motivation mechanisms and influence on admission into nursing schools were raisedConclusion: The authors concluded that nurses and midwives are crucial members of the healthcare systems and their inputs in policy development and reviews would improve health delivery in Ghana.

scholarly journals Monitoring the implementation of a Municipal Policy on Complementary and Integrative Practices: the main challenges

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Carmencita Ignatti ◽  
Eunice Nakamura
Keyword(s):  
Health Service ◽  
Policy Development ◽  
Participant Observation ◽  
Doctoral Program ◽  
Ethnographic Study ◽  
World Health ◽  
Municipal Policy ◽  
The World ◽  
Institutional Aspects ◽  
Health Organization

Abstract This paper is an excerpt of an ethnographic study conducted within a doctoral program in a Complementary and Integrative Practices referral unit located in Peruíbe-SP, Brazil. It presents an analysis of the implementation of a Municipal Policy on Complementary and Integrative Practices (MPCIP), including participant observation of meetings held with workers and managers, field diaries, documents from the Brazilian Ministry of Health and the World Health Organization, legislation, and reports of those involved. The analysis was based on hermeneutic interpretation (GEERTZ, 1989), and the main challenges faced during the process are presented. Even though the format of the MPCIP in Peruíbe meets national and international requirements, it only warranted legal-institutional aspects. Despite advancements in policy development, there remain political and operational challenges to its implementation and expansion, which shall be overcome to fully implement Complementary and Integrative Practices in the city’s health service.

scholarly journals Introducing risk inequality metrics in tuberculosis policy development

2018 ◽  
Author(s):  
M. Gabriela M. Gomes ◽  
Juliane F. Oliveira ◽  
Adelmo Bertolde ◽  
Tuan Anh Nguyen ◽  
Ethel L. Maciel ◽  
...  
Keyword(s):  
Policy Development ◽  
Data Interpretation ◽  
World Health ◽  
Individual Risk ◽  
Control Programs ◽  
Force Of Infection ◽  
Cohort Selection ◽  
National Tuberculosis ◽  
Health Organization ◽  
And Control

Global stakeholders including the World Health Organization rely on predictive models for developing strategies and setting targets for tuberculosis care and control programs. Failure to account for variation in individual risk leads to substantial biases that impair data interpretation and policy decisions1,2. Anticipated impediments to estimating heterogeneity for each parameter are discouraging despite considerable technical progress in recent years. Here we identify acquisition of infection as the single process where heterogeneity most fundamentally impacts model outputs, due to cohort selection imposed by dynamic forces of infection. Individuals with higher risk of acquiring infection are predominantly affected by the pathogen, leaving the unaffected pool with those whose intrinsic risk is lower. This causes susceptibility pools to attain average risks which are lower under higher forces of infection. Interventions that modify the force of infection change the strength of selection, and therefore alter average risks in the pools which feed further incidence. Inability to account for these dynamics is what makes homogenous models unsuitable. We introduce concrete metrics to approximate risk inequality in tuberculosis, demonstrate their utility in mathematical models, and pack the information into a risk inequality coefficient which can be calculated and reported by national tuberculosis programs for use in policy development and modeling.

scholarly journals The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Osman Abdullahi ◽  
Ngari Moses ◽  
Deche Sanga ◽  
Willetts Annie
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Clinical Signs ◽  
World Health ◽  
Routine Practice ◽  
Public And Private ◽  
Systematic Screening ◽  
Tb Treatment ◽  
Resource Limited ◽  
Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

scholarly journals The role of active case finding in reducing patient incurred catastrophic costs for tuberculosis in Nepal

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Suman Chandra Gurung ◽  
Kritika Dixit ◽  
Bhola Rai ◽  
Maxine Caws ◽  
Puskar Raj Paudel ◽  
...  
Keyword(s):  
Social Protection ◽  
Case Finding ◽  
World Health ◽  
Active Case Finding ◽  
Annual Household Income ◽  
Chi Square ◽  
Active Case ◽  
Pre Treatment ◽  
Health Organization

Abstract Background The World Health Organization (WHO) End TB Strategy has established a milestone to reduce the number of tuberculosis (TB)- affected households facing catastrophic costs to zero by 2020. The role of active case finding (ACF) in reducing patient costs has not been determined globally. This study therefore aimed to compare costs incurred by TB patients diagnosed through ACF and passive case finding (PCF), and to determine the prevalence and intensity of patient-incurred catastrophic costs in Nepal. Methods The study was conducted in two districts of Nepal: Bardiya and Pyuthan (Province No. 5) between June and August 2018. One hundred patients were included in this study in a 1:1 ratio (PCF: ACF, 25 consecutive ACF and 25 consecutive PCF patients in each district). The WHO TB patient costing tool was applied to collect information from patients or a member of their family regarding indirect and direct medical and non-medical costs. Catastrophic costs were calculated based on the proportion of patients with total costs exceeding 20% of their annual household income. The intensity of catastrophic costs was calculated using the positive overshoot method. The chi-square and Wilcoxon-Mann-Whitney tests were used to compare proportions and costs. Meanwhile, the Mantel Haenszel test was performed to assess the association between catastrophic costs and type of diagnosis. Results Ninety-nine patients were interviewed (50 ACF and 49 PCF). Patients diagnosed through ACF incurred lower costs during the pre-treatment period (direct medical: USD 14 vs USD 32, P = 0.001; direct non-medical: USD 3 vs USD 10, P = 0.004; indirect, time loss: USD 4 vs USD 13, P <  0.001). The cost of the pre-treatment and intensive phases combined was also lower for direct medical (USD 15 vs USD 34, P = 0.002) and non-medical (USD 30 vs USD 54, P = 0.022) costs among ACF patients. The prevalence of catastrophic direct costs was lower for ACF patients for all thresholds. A lower intensity of catastrophic costs was also documented for ACF patients, although the difference was not statistically significant. Conclusions ACF can reduce patient-incurred costs substantially, contributing to the End TB Strategy target. Other synergistic policies, such as social protection, will also need to be implemented to reduce catastrophic costs to zero among TB-affected households.

Purveyors of the Commercial Determinants of Health Have No Place at Any Policy Table Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool"

2020 ◽  
Author(s):  
Ronald Labonté
Keyword(s):  
Public Health ◽  
Global Governance ◽  
Policy Development ◽  
Conflicts Of Interest ◽  
Nutrition Policy ◽  
Determinants Of Health ◽  
World Health ◽  
Governmental Organization ◽  
Good Citizen ◽  
Health Organization

With public health attention on the commercial determinants of health showing little sign of abatement, how to manage conflicts of interest (COI) in regulatory policy discussions with corporate actors responsible for these determinants is gaining critical traction. The contribution by Ralston et al explores how COI management has itself become a terrain of contestation in their analysis of submissions on a draft World Health Organization (WHO) tool to manage COI conflicts in development of nutrition policy. The authors identify two camps in conflict with one another: a corporate side emphasizing their individual good intents and contributions, and an non-governmental organization (NGO) side maintaining inherent structural conflicts that require careful proscribing. The study concludes that the draft tool does a reasonable job in ensuring COI are avoided and policy development sheltered from corporate self-interests, introducing novel improvements in global governance for health. At the same time, the tool appears to adhere to a belief that private economic (corporate) and public good (citizen) conflicts can indeed be managed. I question this assumption and posit that public health needs to be much bolder in its critique of the nature of power, influence, and self-interests that pervade and risk dominating our stakeholder models of global governance.

RISING DOMESTIC VIOLENCE DURING EMERGENCIES AND THE COVID-19 PANDEMIC

2021 ◽  
pp. 111-123
Author(s):  
Tamara K. Rostovskaya ◽  
◽  
Natal’ya A. Bezverbnaya ◽  
Keyword(s):  
Domestic Violence ◽  
World Health ◽  
Main Body ◽  
Scientific Publications ◽  
Non Profit ◽  
Emergency Situations ◽  
Quantitative And Qualitative Research ◽  
The Usa ◽  
Health Organization ◽  
Restrictive Measures

The issue of the situation of women facing domestic violence in emergency situations, including the environmental and man-made disasters, pandemics, in general, remains poorly understood. The main body of scientific publications on the topic is represented by quantitative and qualitative research conducted in Australia, Canada, New Zealand, and the USA. Several important events have taken place in the Russian Federation over the past few years, which, in our opinion, have aggravated the issue of domestic violence: firstly, cessation of the statistical recording of offenses related to beating the family members and other close persons, therefore, the main data were obtained by the authors from non-profit organizations that provide assistance to victims of domestic violence. The second event that affected every country and territory is the COVID-19 pandemic: the first and second waves of the pandemic entailed restrictive measures, which provoked socio-economic tensions in isolation. The COVID-19 pandemic is classified as a public health emergency of international concern by the World Health Organization Declaration. In that context, the issue of the risks of domestic violence is of particular relevance

Sign in / Sign up

Export Citation Format

Share Document