NGOs and government partnership for health systems strengthening: A qualitative study presenting viewpoints of government, NGOs and donors in Pakistan

Abstract Background Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. Methods An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model. Results Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. Conclusion KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

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Addressing Gaps for Health Systems Strengthening: A Public Perspective on Health Systems’ Response towards COVID-19

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179047 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9047

Author(s):

Nur Zahirah Balqis-Ali ◽

Weng Hong Fun ◽

Munirah Ismail ◽

Rui Jie Ng ◽

Faeiz Syezri Adzmin Jaaffar ◽

...

Keyword(s):

Content Analysis ◽

Qualitative Study ◽

Health Systems ◽

Building Block ◽

Building Blocks ◽

Health Systems Strengthening ◽

Complex Interactions ◽

Public Perspective ◽

Whole Systems ◽

Depth Interviews

Strengthening the health systems through gaps identification is necessary to ensure sustainable improvements especially in facing a debilitating outbreak such as COVID-19. This study aims to explore public perspective on health systems’ response towards COVID-19, and to identify gaps for health systems strengthening by leveraging on WHO health systems’ building blocks. A qualitative study was conducted using open-ended questions survey among public followed by in-depth interviews with key informants. Opinions on Malaysia’s health systems response towards COVID-19 were gathered. Data were exported to NVIVO version 12 and analysed using content analysis approach. The study identified various issues on health systems’ response towards COVID-19, which were then mapped into health systems’ building blocks. The study showed the gaps were embedded among complex interactions between the health systems building blocks. The leadership and governance building block had cross-cutting effects, and all building blocks influenced service deliveries. Understanding the complexities in fostering whole-systems strengthening through a holistic measure in facing an outbreak was paramount. Applying systems thinking in addressing gaps could help addressing the complexity at a macro level, including consideration of how an action implicates other building blocks and approaching the governance effort in a more adaptive manner to develop resilient systems.

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Feasibility of health systems strengthening in South Sudan: a qualitative study of international practitioner perspectives

BMJ Open ◽

10.1136/bmjopen-2015-009296 ◽

2015 ◽

Vol 5 (12) ◽

pp. e009296 ◽

Cited By ~ 10

Author(s):

Abigail Jones ◽

Natasha Howard ◽

Helena Legido-Quigley

Keyword(s):

Qualitative Study ◽

Health Systems ◽

South Sudan ◽

Health Systems Strengthening

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Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

Globalization and Health ◽

10.1186/s12992-021-00738-9 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Kristen Meagher ◽

Bothaina Attal ◽

Preeti Patel

Keyword(s):

Political Economy ◽

Health Systems ◽

Armed Conflict ◽

Narrative Review ◽

Health Systems Strengthening ◽

The Political ◽

Systems Research ◽

Political Economy Of Health ◽

And Gender

Abstract Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.

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Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-06376-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Embleton Lonnie ◽

Shah Pooja ◽

Gayapersad Allison ◽

Kiptui Reuben ◽

Ayuku David ◽

...

Keyword(s):

Qualitative Study ◽

Health System ◽

Health Systems ◽

Cultural Context ◽

Healthcare Providers ◽

Children And Youth ◽

Economic Factors ◽

Health Coverage ◽

Socially Constructed ◽

Prompt Attention

Abstract Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

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COVID‐19 calls for health systems strengthening in Africa: A case of Nigeria

The International Journal of Health Planning and Management ◽

10.1002/hpm.3296 ◽

2021 ◽

Author(s):

Emmanuel Ebuka Elebesunu ◽

Gabriel Ilerioluwa Oke ◽

Yusuff Adebayo Adebisi ◽

Ifeanyi McWilliams Nsofor

Keyword(s):

Health Systems ◽

Health Systems Strengthening

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The Role of International NGOs in Health Systems Strengthening: The Case of Timor-Leste

International Journal of Health Services ◽

10.2190/hs.44.2.i ◽

2014 ◽

Vol 44 (2) ◽

pp. 323-335 ◽

Cited By ~ 9

Author(s):

Mary Anne Mercer ◽

Susan M. Thompson ◽

Rui Maria de Araujo

Keyword(s):

Health Systems ◽

Health Systems Strengthening ◽

Timor Leste ◽

International Ngos

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677. Using a Multisectoral One Health Approach to Prioritize Zoonotic Diseases in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.683 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S244-S244

Author(s):

Vikram Krishnasamy ◽

Casey Barton Behravesh ◽

Kate Varela ◽

Grace Goryoka ◽

Nadia Oussayef ◽

...

Keyword(s):

United States ◽

Health Systems ◽

Disease Surveillance ◽

One Health ◽

The United States ◽

Zoonotic Disease ◽

Zoonotic Diseases ◽

Health Systems Strengthening ◽

Transmission Potential ◽

Us Government

Abstract Background Emerging and endemic zoonoses continue to have adverse global impacts. One Health approaches promoting multisectoral, transdisciplinary collaboration are important methods to address zoonoses threats through disease surveillance, prevention, control, and response. We conducted a One Health Zoonotic Disease Prioritization (OHZDP) workshop in the United States (US) to identify zoonotic diseases of greatest national concern that should be jointly addressed by the Centers for Disease Control (CDC), US Department of Agriculture (USDA), Department of the Interior, and partners. Methods We used CDC’s OHZDP tool to prioritize zoonoses. Workshop participants selected criteria for prioritization, and developed questions and weights for each criterion. Questions were answered using available literature and expert opinion with subsequent scoring resulting in a ranked zoonotic disease list. After agreeing on a final prioritized disease list, participants used components of the One Health Systems Mapping and Analysis Resource Toolkit, developed by USDA and University of Minnesota, to review multidisciplinary coordination processes for the prioritized zoonotic diseases. Results Participants selected epidemic or pandemic potential, disease severity, economic impact, introduction or increased transmission potential, and national security as criteria to prioritize 56 zoonoses. The eight prioritized zoonotic diseases for the US were zoonotic influenzas, salmonellosis, West Nile virus, plague, emerging coronaviruses (e.g., SARS, MERS), rabies, brucellosis, and Lyme disease. Agencies then discussed recommendations to enhance One Health approaches to surveillance, response, prevention, and control of the prioritized zoonoses. Key themes and next steps for further implementation of One Health approaches were identified. Conclusion This OHZDP workshop represents the first use of a One Health approach to zoonotic disease prioritization in the United States. It is a critical step forward in US government agency collaboration using One Health approaches. Further, the workshop created a foundation for future US government One Health systems strengthening for the prioritized zoonoses. Disclosures All authors: No reported disclosures.

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