scholarly journals Status of Palliative Oncology Care for Children and Young People in Sub-Saharan Africa: A Perspective Paper on Priorities for New Frontiers

2021 ◽  
pp. 1395-1405
Author(s):  
Eve Namisango ◽  
Nickhill Bhakta ◽  
Joanne Wolfe ◽  
Michael J. McNeil ◽  
Richard A. Powell ◽  
...  
Keyword(s):  
Health Systems ◽  
Building Blocks ◽  
Late Presentation ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Children With Cancer ◽  
Cancer Symptoms ◽  
Palliative Oncology ◽  
Oncology Care ◽  
Sub Saharan

PURPOSE The burden of cancer disproportionately affects low- and middle-income countries. Low 5-year survival figures for children with cancer in low-income countries are due to late presentation at diagnosis, treatment abandonment, absence of sophisticated multidisciplinary care, and lack of adequate resources. The reasons for late presentation are partly due to limited awareness of cancer symptoms, high treatment costs, and facility-level barriers to timely access to treatment. Given the systemic challenges, the regional need for palliative oncology care for children care is high. Despite the enormity of the need for palliative oncology for children with cancer in Africa, its level of development remains poor. This paper presents the evidence on the status of palliative oncology care for children in sub-Saharan Africa. METHODS This review provides an overview of the current status of palliative oncology care for children in sub-Saharan Africa, using the WHO building blocks for health systems strengthening as reference points, before proposing a forward-looking prioritized agenda for its development. RESULTS We noted that survival rates for children with cancer remain much poorer in Africa compared with developed countries and palliative oncology care resources are scant. Our results also show low coverage for palliative oncology care services for children, lack of a critical mass of health workers with the skills to deliver the care, a lack of robust documentation of the burden of cancer, widespread lack of access to essential controlled medicines, limited funding from government and limited coverage for palliative oncology care in most cancer control plans. CONCLUSION This review highlights priority areas for action that align to the WHO health system building blocks for strengthening health systems.

scholarly journals Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii9-ii21
Author(s):  
Fatuma Manzi ◽  
Tanya Marchant ◽  
Claudia Hanson ◽  
Joanna Schellenberg ◽  
Elibariki Mkumbo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Systems ◽  
Building Blocks ◽  
Realist Evaluation ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Empowerment Theory ◽  
Multiple Sources ◽  
Programme Theory

Abstract Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.

scholarly journals Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review

2020 ◽  
Vol 35 (6) ◽  
pp. 701-717 ◽  
Author(s):  
Edina Amponsah-Dacosta ◽  
Benjamin M Kagina ◽  
Jill Olivier
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Human Papillomavirus ◽  
Health Systems ◽  
Data Extraction ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Significant Health ◽  
Immunization Programmes

Abstract Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.

scholarly journals Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Bernardo Nuche-Berenguer ◽  
Linda E. Kupfer
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Diabetes Care ◽  
Healthcare Workers ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Diagnostic Tools ◽  
Inclusion Criteria ◽  
Care Health ◽  
Sub Saharan

Background. Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective. We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology. We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results. Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion. Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

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