Did the first Global Fund grant (2003–2006) contribute to malaria control and health system strengthening in Timor-Leste?

Abstract People-centred mental healthcare is an influential concept for health system strengthening and sustainable development that has been developed and promoted primarily in Western contexts. It characterizes service users, families and communities as active participants in health system development. However, we have limited understanding of how well people-centred mental healthcare aligns with the multiplicity of peoples, cultures, languages and contexts in low- and middle-income countries (LMICs). Timor-Leste, a lower-middle income country in South-East Asia, is in the process of strengthening its National Mental Health Strategy 2018–22 to align with people-centred mental healthcare. To support the implementation of this Strategy, this study investigated the acceptability and feasibility of people-centred mental health services in Timor-Leste. In-depth semi-structured individual (n = 57) and group interviews (n = 15 groups) were conducted with 85 adults (≥18 years). Participants were service users, families, decision-makers, service providers and members of civil society and multilateral organizations across national and sub-national sites. Government and non-government mental health and social care was also observed. Framework analysis was used to analyse interview transcripts and observation notes. The study found that the ecology of mental healthcare in Timor-Leste is family-centred and that government mental health services are largely biomedically oriented. It identified the following major challenges for people-centred mental health services in Timor-Leste: different sociocultural perceptions of (in)dividual personhood, including a diminished status of people with mental illness; challenges in negotiating individual and family needs; a reliance on and demand for biomedical interventions; and barriers to health service access and availability. Opportunities for people-centred mental healthcare are better available within the social and disability sectors, which focus on social inclusion, human rights and peer support. Accounting for local cultural knowledge and understandings will strengthen design and implementation of people-centred mental healthcare in LMIC settings.

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22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1092 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Health System ◽

Health Systems ◽

Building Blocks ◽

The State ◽

Lessons Learned ◽

Three Dimensions ◽

Health System Strengthening ◽

New Work ◽

State Of Health ◽

The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

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Global need: including rehabilitation in health system strengthening

The Lancet ◽

10.1016/s0140-6736(21)00207-5 ◽

2021 ◽

Vol 397 (10275) ◽

pp. 665-666

Author(s):

Tiago S Jesus ◽

Michel D Landry

Keyword(s):

Health System ◽

Health System Strengthening

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Health System Factors Constrain HIV Care Providers in Delivering High-Quality Care: Perceptions from a Qualitative Study of Providers in Western Kenya

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958218823285 ◽

2019 ◽

Vol 18 ◽

pp. 232595821882328 ◽

Cited By ~ 4

Author(s):

Becky Genberg ◽

Juddy Wachira ◽

Catherine Kafu ◽

Ira Wilson ◽

Beatrice Koech ◽

...

Keyword(s):

Qualitative Study ◽

Health System ◽

Working Environment ◽

Health System Strengthening ◽

Eastern Africa ◽

Hiv Care ◽

Care Providers ◽

High Quality ◽

Western Kenya ◽

System Factors

The burden on health systems due to increased volume of patients with HIV continues to rapidly increase. The goal of this study was to examine the experiences of HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. Sixty care providers within the Academic Model Providing Access to Healthcare program in western Kenya were recruited into this qualitative study. We conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. Health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.

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Regulatory standards and processes for over-the-counter availability of hormonal contraception and drugs for medical abortion in five countries in the Eastern Mediterranean Region

Health Research Policy and Systems ◽

10.1186/s12961-020-00661-2 ◽

2021 ◽

Vol 19 (S1) ◽

Author(s):

Anne Ammerdorffer ◽

Mark Laws ◽

Arinze Awiligwe ◽

Florence Erb ◽

Wallada Im-Amornphong ◽

...

Keyword(s):

Reproductive Health ◽

Health System ◽

Emergency Contraception ◽

Sexual And Reproductive Health ◽

Self Care ◽

Medical Abortion ◽

Health System Strengthening ◽

World Health ◽

Over The Counter ◽

Regulatory Status

AbstractThe World Health Organization 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights includes recommendations on self-administration of injectable contraception, over-the-counter (OTC) oral contraception and self-management of medical abortion. A review of the regulatory status of these two self-care interventions can highlight processes required to ensure that the quality of the medicines and safety of individuals are safeguarded in the introduction and scale-up in countries. This review outlines the legal regulatory status of prescription-only medicine (POM) and OTC contraceptives, including emergency contraception, and drugs for medical abortion in Egypt, Jordan, Lebanon, Morocco and Tunisia using information obtained from internet searches, regulatory information databases and personal contacts. In addition, the review examines whether the national medicines regulatory authorities have documented procedures available to allow for a change in status from a POM to OTC to allow for increased accessibility, availability and uptake of self-care interventions recommended by WHO. Egypt, Jordan and Lebanon have a documented national OTC list available. The only contraceptive product mentioned in the OTC lists across all five countries is ellaOne (ulipristal acetate for emergency contraception), which is publicly registered in Lebanon. None of the five countries has an official documented procedure to apply for the change of POM to OTC. Informal procedures exist, such as the ability to apply to the national medicines regulatory authority for OTC status if the product has OTC status in the original country of manufacture. However, many of these procedures are not officially documented, highlighting the need for establishing sound, affordable and effective regulation of medical products as an important part of health system strengthening. From a public health perspective, it would be advantageous for licensed products to be available OTC. This is particularly the case for settings where the health system is under-resourced or over-stretched due to health emergencies. Readiness of national regulatory guidelines and OTC procedures could lead to increased access, availability and usage of essential self-care interventions for sexual and reproductive health and rights.

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Resilience Testing of Health Systems: How Can It Be Done?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094742 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4742

Author(s):

Heather L. Rogers ◽

Pedro Pita Barros ◽

Jan De Maeseneer ◽

Lasse Lehtonen ◽

Christos Lionis ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

Phase 1 ◽

Action Planning ◽

Health System Strengthening ◽

System Transformation ◽

Traffic Light ◽

Phase 0 ◽

Five Phases ◽

Quantitative Indicators

The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation.

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Preparedness for Mitigating Noncommunicable Diseases in Gaindakot Municipality, Nepal: Perspectives of Key informants

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37567 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1320-1324

Author(s):

Narayan Sapkota ◽

Damaru Prasad Paneru

Keyword(s):

Health System ◽

Health Workforce ◽

Prevention And Control ◽

Local Level ◽

Building Blocks ◽

Health System Strengthening ◽

High Morbidity ◽

Major Public Health Problem ◽

Screening Services ◽

And Control

Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level. Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal. Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis. Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level. Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.

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