Conflict-related health research in Syria, 2011–2019: a scoping review for The Lancet - AUB Commission on Syria

Abstract Background The volume of health-related publications on Syria has increased considerably over the course of the conflict compared with the pre-war period. This increase is largely attributed to commentaries, news reports and editorials rather than research publications. This paper seeks to characterise the conflict-related population and humanitarian health and health systems research focused inside Syria and published over the course of the Syrian conflict. Methods As part of a broader scoping review covering English, Arabic and French literature on health and Syria published from 01 January 2011 to 31 December 2019 and indexed in seven citation databases (PubMed, Medline (OVID), CINAHL Complete, Global Health, EMBASE, Web of Science, Scopus), we analyzed conflict-related research papers focused on health issues inside Syria and on Syrians or residents of Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, research focus, funding statements and key limitations and challenges of conducting research as described by the study authors. To gain additional insights, we examined, separately, non-research publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. Results Of 2073 papers identified in the scoping review, 710 (34%) exclusively focus on health issues of Syrians or residents inside Syria, of which 350 (49%) are conflict-related, including 89 (25%) research papers. Annual volume of research increased over time, from one publication in 2013 to 26 publications in 2018 and 29 in 2019. Damascus was the most frequently studied governorate (n = 33), followed by Aleppo (n = 25). Papers used a wide range of research methodologies, predominantly quantitative (n = 68). The country of institutional affiliation(s) of first and last authors are predominantly Syria (n = 30, 21 respectively), the United States (n = 25, 19 respectively) or the United Kingdom (n = 12, 10 respectively). The majority of authors had academic institutional affiliations. The most frequently examined themes were health status, the health system and humanitarian assistance, response or needs (n = 38, 34, 26 respectively). Authors described a range of contextual, methodological and administrative challenges in conducting research on health inside Syria. Thirty-one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. Conclusions Despite a growing volume of research publications examining population and humanitarian health and health systems issues inside conflict-ravaged Syria, there are considerable geographic and thematic gaps, including limited research on several key pillars of the health system such as governance, financing and medical products; issues such as injury epidemiology and non-communicable disease burden; the situation in the north-east and south of Syria; and besieged areas and populations. Recognising the myriad of complexities of researching active conflict settings, it is essential that research in/on Syria continues, in order to build the evidence base, understand critical health issues, identify knowledge gaps and inform the research agenda to address the needs of the people of Syria following a decade of conflict.

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Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

10.21203/rs.3.rs-93301/v1 ◽

2020 ◽

Author(s):

Marian Abouzeid ◽

Manal Elzalabany ◽

Iman Nuwayhid ◽

Samer Jabbour

Keyword(s):

Scoping Review ◽

The United States ◽

Research Literature ◽

Humanitarian Assistance ◽

Syrian Refugees ◽

Limited Information ◽

Health Issues ◽

Research Papers ◽

Wide Range ◽

Operational Activities

Abstract Backgorund. While there has been a growth of research on health and the Syrian conflict, most such research covers Syrian refugees. There is limited information about the scope and focus of research on health and population inside Syria. While there are several systemtic and scoping literarure reviews of health of Syrian refugees, there has not been a sccoping review of research literature on health issues inside Syria. Methods. As part of a broader scoping review covering January 2011 to December 2019, we examined English-language conflict-related research papers that studied health issues inside Syria and focused on Syrians or those permanently resident in Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, funding statements and reported key limitations and challenges of conducting research. To gain additional insights or data, we examined separately publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. Results. Of 2,088 papers identified in the scoping review, 708 (34%) exclusively focus on health issues of Syrians inside Syria, of which 350 (49%) are conflict-related with. Of conflict-related publications, 89 (25%) are research papers. Annual volume of research increased over time, from one publication in 2013 to 27 publications in each of 2018 and 2019. Damascus is the most frequently studied governorate (n=33), followed by Aleppo (n=25). Papers used a wide range of research methodologies, primarily quantitative (n=68). The country of institutional affiliation(s) of first and last authors are Syria (n=30, 20 respectively), the United States (n=25, 19 respectively) or the United Kingdom (n=12, 10 respectively). Themes most covered were health status, health system and humanitarian assistance, response or needs (n=38, 32, 26 respectively). Thirty one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. Authors encountered contextual, methodological and administrative challenges in doing research on health inside Syria. Conclusions. Although it is commonly stated that Syria is among the most documented of recent wars, our analysis shows that a relatively limited number of research studies focused on health or populations inside Syria have been published over the nine years of the conflict. Beyond the need to increase the volume of research, it is important to address the knowledge gaps identified in this review.

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Learning health systems in primary care: a systematic scoping review

BMC Family Practice ◽

10.1186/s12875-021-01483-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Danielle M. Nash ◽

Zohra Bhimani ◽

Jennifer Rayner ◽

Merrick Zwarenstein

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Health Systems ◽

Scoping Review ◽

Early Stage ◽

Point Of Care ◽

The United States ◽

Stage Of Development ◽

Integrated Health ◽

Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

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Strategies for reducing out of pocket payments in the health system: a scoping review

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00301-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Faride Sadat Jalali ◽

Parisa Bikineh ◽

Sajad Delavari

Keyword(s):

Health System ◽

Health Systems ◽

Scoping Review ◽

Health Financing ◽

Developed Countries ◽

Vulnerable Groups ◽

System A ◽

Out Of Pocket Payments ◽

Review Study ◽

Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

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29.F. Workshop: The Health Systems and Policy Monitor network: reforms and health system changes in the spotlight

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1337 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Health Policy ◽

Knowledge Transfer ◽

Health System ◽

Health Systems ◽

Comparative Research ◽

World Health ◽

State Of Health ◽

Wide Range ◽

Cross Country ◽

The Eu

Abstract The European Observatory established the Health Systems and Policy Monitor (HSPM) network in 2008, bringing together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. An important step was taken in 2011, when the Bertelsmann Health Policy Monitor, a 20-country-project with already significant overlap with the current HSPM network, merged with the Observatory's network of national lead institutions. Today, the network includes 40 institutions from 31 countries, with members participating in a wide range of activities and collaborations, such as writing the Observatory's flagship health system reports (HiTs), keeping the health policy community up-to-date on health system developments via the HSPM web platform, and contributing their expertise to reports, studies and knowledge transfer exercises co-ordinated by the Observatory for a variety of audiences, including ministries of health and international organisations such as the World Health Organization and the European Commission. In addition, network members participate in an annual meeting, hosted in a different member country every year, coming together over two days to exchange knowledge and experiences about the various health system reforms happening in their countries. The aim of these meetings is to present, discuss and start comparative research collaborations of the members that can inform policymaking. As part of a collaboration with the journal Health Policy, researchers of the HSPM network have published more than 100 articles on cross-country comparisons of policies or on ongoing nation health reforms in a special section - the Health Reform Monitor - of the journal. This workshop aims to provide the audience with an overview of the network and its expanding range of activities. An introductory presentation will briefly introduce the origins of the network and discuss its current line of work. The second presentation will provide an overview of reform trends that are routinely collected during the annual meetings as part of the “reform roundup”. The third presentation will give an example of how the network has contributed to the European Commission's State of Health in the EU initiative, by performing a 'rapid response” that informed the companion report to the State of Health in the EU country health profiles 2019. The fourth presentation is a typical example of the kind of collaborative work that the network is undertaking, i.e. involving multiple countries on a topic of shared interest. The workshop will conclude with a debate with the audience about the conceptual and methodological challenges as well as opportunities and future directions of cross-country comparative research and the HSPM network in particular. Key messages The Health Systems and Policy Monitor Network provides detailed descriptions of health systems and provides up to date information on reforms and changes that are particularly policy relevant. The Health Systems and Policy Monitor Network increasingly engages in comparative health systems research and knowledge transfer activities.

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Valuing Diversity and Inclusion in Healthcare: Pathways to Equip Workforces in the Post-COVID-19 New Normal (Preprint)

10.2196/preprints.34808 ◽

2021 ◽

Author(s):

Jiban Khuntia ◽

Xue Ning ◽

Wayne Cascio ◽

Rulon Stacey

Keyword(s):

United States ◽

Health System ◽

Health Systems ◽

The United States ◽

Mediating Effect ◽

New Normal ◽

Diversity And Inclusion ◽

Healthcare Workforce ◽

The Us ◽

Service Oriented

BACKGROUND The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. The healthcare workforce remains relatively homogenous, even though they are caring for a highly diverse array of patients (6-12). It is a perennial problem in the US healthcare workforce that has only been accentuated during the COVID-19 pandemic. Medical workers should reflect the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies in a post-COVID-19 “new normal” that will help achieve greater workforce diversity remains a challenge for health system leaders. OBJECTIVE Our primary objectives are (1) to explore the characteristics and perceived benefits of US health systems that value D&I; (2) to examine the influence of a workforce strategy designed to balance talent and D&I; and (3) to explore three pathways to better equip workforces and their relative influences on business- and service-oriented benefits: (a) improving D&I among existing employees (IMPROVE), (b) using multiple channels to find and recruit a workforce (RECRUIT), and (c) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). METHODS During February–March 2021, we surveyed 625 health system chief executive officers, in the United States, 135 (22%) of whom responded. We assessed workforce talent and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality’s (AHRQ) Compendium of the US. Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in talent and diversity benefits across the health systems. Then, we examined the relationship between IMPROVE, RECRUIT, and COLLABORATE pathways to equip the workforce. RESULTS Health system characteristics, such as size, location, ownership, teaching, and revenue, have varying influences on D&I and business and service outcomes. RECRUIT has the most substantial mediating effect on diversity-enabled business- and service-oriented outcomes of the three pathways. This is also true of talent-based workforce acquisitions. CONCLUSIONS Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

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Interventions for Improving Health Care Workers’ Retention in Epidemics – a Scoping Review

10.21203/rs.3.rs-951428/v1 ◽

2021 ◽

Author(s):

Zahra Zarei Jelyani ◽

Sadra Valiee ◽

Mohammad Kia ◽

Ali jajarmizadeh ◽

Sajad Delavari

Keyword(s):

Health Care ◽

Human Resources ◽

Health System ◽

Human Health ◽

Scoping Review ◽

Health Care Workers ◽

Health Resources ◽

The United States ◽

Human Beings ◽

Care Workers

Abstract Introduction: Generally, in Epidemics, such as COVID-19, health care workers (HCWs) faces many problems which lead to a shortage and weakening of human resources in the health system. Therefore, using effective strategies to retain human resources is one of the most important issues during outbreaks. This study aims to collect and classify the proposed interventions to strengthen human health resources and their sustainability during epidemics through scoping review.Methods: In this scoping review study, 2300 studies were retrieved through searching international databases –PubMed, Embase, Scopus and Web of Science. The retrieved studies were screened, and finally, 50 studies were included for analysis. The strategies were classified using inductive qualitative content analysis.Results: Most of the studies were conducted in the United States and the United Kingdom. The target population in 39 studies was all health workers; five studies were on physicians, five studies on nurses, and only one study on dentists. The proposed interventions were classified into five categories: preparation, protection, support, treatment, and feedback. Discussion: Most studies focused on providing interventions in one or two dimensions of human resources, but these interventions were summarized and categorized in this review. Therefore, this study has a holistic view of various dimensions of strengthening and maintaining human health resources during epidemics by providing a thematic map. Considering that human beings are multidimensional, policymakers and managers of the health system should use a set of interventions that simultaneously cover different aspects of their needs to strengthen and maintain HCWs.

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What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

BMC Public Health ◽

10.1186/s12889-019-7707-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 14

Author(s):

Jennifer B. Nuzzo ◽

Diane Meyer ◽

Michael Snyder ◽

Sanjana J. Ravi ◽

Ana Lapascu ◽

...

Keyword(s):

Public Health ◽

Infectious Disease ◽

Health System ◽

Natural Hazards ◽

Health Systems ◽

Scoping Review ◽

Disease Outbreaks ◽

World Health ◽

Infectious Disease Outbreaks ◽

System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

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STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL

Innovation in Aging ◽

10.1093/geroni/igz038.3054 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S829-S829

Author(s):

Teri Kennedy

Keyword(s):

Older Adults ◽

Health System ◽

Baby Boomers ◽

Health Systems ◽

Adult Population ◽

The United States ◽

Essential Elements ◽

Conceptual Approach ◽

American Hospital ◽

American Hospital Association

Abstract This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.

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Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-019-1005-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Naomi Muinga ◽

Steve Magare ◽

Jonathan Monda ◽

Mike English ◽

Hamish Fraser ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

New Technologies ◽

Digital Health ◽

Structured Interview ◽

Public Hospitals ◽

Adoption Process ◽

Efficient System ◽

Wide Range ◽

The Government

Abstract Background As healthcare facilities in Low- and Middle-Income Countries adopt digital health systems to improve hospital administration and patient care, it is important to understand the adoption process and assess the systems’ capabilities. This survey aimed to provide decision-makers with information on the digital health systems landscape and to support the rapidly developing digital health community in Kenya and the region by sharing knowledge. Methods We conducted a survey of County Health Records Information Officers (CHRIOs) to determine the extent to which digital health systems in public hospitals that serve as internship training centres in Kenya are adopted. We conducted site visits and interviewed hospital administrators and end users who were at the facility on the day of the visit. We also interviewed digital health system vendors to understand the adoption process from their perspective. Semi-structured interview guides adapted from the literature were used. We identified emergent themes using a thematic analysis from the data. Results We obtained information from 39 CHRIOs, 58 hospital managers and system users, and 9 digital health system vendors through semi-structured interviews and completed questionnaires. From the survey, all facilities mentioned purchased a digital health system primarily for administrative purposes. Radiology and laboratory management systems were commonly standalone systems and there were varying levels of interoperability within facilities that had multiple systems. We only saw one in-patient clinical module in use. Users reported on issues such as system usability, inadequate training, infrastructure and system support. Vendors reported the availability of a wide range of modules, but implementation was constrained by funding, prioritisation of services, users’ lack of confidence in new technologies and lack of appropriate data sharing policies. Conclusion Public hospitals in Kenya are increasingly purchasing systems to support administrative functions and this study highlights challenges faced by hospital users and vendors. Significant work is required to ensure interoperability of systems within hospitals and with other government services. Additional studies on clinical usability and the workflow fit of digital health systems are required to ensure efficient system implementation. However, this requires support from key stakeholders including the government, international donors and regional health informatics organisations.

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The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Global Maternal and Child Health - Anthropologies of Global Maternal and Reproductive Health ◽

10.1007/978-3-030-84514-8_5 ◽

2022 ◽

pp. 73-91

Author(s):

Meredith G. Marten

Keyword(s):

Health System ◽

Health Systems ◽

Newborn Care ◽

Health System Strengthening ◽

Respectful Maternity Care ◽

Health Issues ◽

The Public ◽

Governmental Organizations ◽

Non Governmental Organizations ◽

Sustainable Health

AbstractStrengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

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