scholarly journals Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261524
Author(s):  
Anup Bastola ◽  
Rolina Dhital ◽  
Richa Shah ◽  
Madhusudan Subedi ◽  
Pawan Kumar Hamal ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Qualitative Study ◽  
Service Delivery ◽  
Health System ◽  
Health Workforce ◽  
Building Blocks ◽  
Access To Medicines ◽  
Health System Strengthening ◽  
Positive Experiences ◽  
Disease Hospital

Introduction The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient’s experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening’s implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. Methods In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization’s six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. Results Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients’ thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. Conclusion This study approached a unique way to strengthen the health system by exploring patients’ feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government’s role to continue its efforts to strengthen the health system.

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

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.  

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

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.

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

2019 ◽  
Vol 18 ◽  
pp. 232595821882328 ◽  
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.

scholarly journals Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Zarni Htun ◽  
Yingxi Zhao ◽  
Hannah Gilbert ◽  
Chunling Lu
Keyword(s):  
Civil Society ◽  
Qualitative Study ◽  
Health System ◽  
Global Fund ◽  
Scale Up ◽  
Building Blocks ◽  
Key Informants ◽  
The Impact ◽  
Hiv Aids

Abstract Background The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). Methods We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. Results We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. Conclusion There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

scholarly journals Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar

2017 ◽  
Author(s):  
Matthew H. Bonds ◽  
Andres Garchitorena ◽  
Laura Cordier ◽  
Ann C. Miller ◽  
Margaret McCarty ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Low Income ◽  
Building Blocks ◽  
International Standards ◽  
Health District ◽  
Health System Strengthening ◽  
Systems Research ◽  
Data Platform ◽  
Government District

AbstractObjectiveWe demonstrate a replicable model health district for Madagascar. The governments of many low-income countries have adopted health policies that follow international standards, and yet there are four hundred million people without basic access to primary care. Closing this global health delivery gap is typically framed as an issue of scale-up, accomplished primarily through integrating international donor funds with broad-based health system strengthening (HSS) efforts. However, there is no established process by which healthcare systems measure improvements at the point of service and how those, in turn, impact population health. There is no gold standard, equivalent to randomized trials of individual-level interventions, for health systems research. Here, we present a framework for a model district in Madagascar where national policies are implemented along with additional health system interventions to allow for bottom-up adaptation.SettingThe intervention takes place in a government district in Madagascar, which includes 1 district hospital, 20 primary care health centers, and a network of community health workers.InterventionThe program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district and pioneers a data platform that includes 1) strengthening the district’s health management information systems; 2) monitoring and evaluation dashboards; and 3) a longitudinal cohort demographic and health study of over 1,500 households, with a true baseline in intervention and comparison groups.ConclusionThe integrated intervention and data platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates. It thus supports field-based implementation and policy research to fill the know-do gap, while providing the foundation for a new science of sustaining health.Data Sharing StatementData can be made available upon request by [email protected].

scholarly journals Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Maya Semrau ◽  
Atalay Alem ◽  
Jose L. Ayuso-Mateos ◽  
Dan Chisholm ◽  
Oye Gureje ◽  
...  
Keyword(s):  
Mental Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Building Blocks ◽  
Health System Strengthening ◽  
Mental Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundThere is a large treatment gap for mental, neurological or substance use (MNS) disorders. The ‘Emerging mental health systems in low- and middle-income countries (LMICs)’ (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.AimsTo provide a set of proposed recommendations for mental health system strengthening in LMICs.MethodThe Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012–2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.ResultsThe proposed recommendations align closely with the World Health Organization's key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.ConclusionsThese recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.Declaration of interestNone.

scholarly journals Safety of health workers: a key priority in COVID-19 pandemic

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Bhakta Bahadur K.C.
Keyword(s):  
Health System ◽  
Capacity Building ◽  
Health Workforce ◽  
Health Workers ◽  
Building Blocks ◽  
Political Commitment ◽  
Safety Equipment ◽  
High Exposure ◽  
The World ◽  
High Level

Although, the health workforce is one of the most significant building blocks of the health system, the preparation to ensure safety from COVID-19 remains inadequate across the world. Therefore, there is an increasingly growing number of health workers being infected from COVID-19 globally, making health workers the most vulnerable population to the pandemic. Most of the countries lack the safety equipment in place resulting in high exposure of health workers to this fatal SARS-COV2. Besides these, health workers' behaviour is also contributing infection to themselves. A high-level political commitment together with the investment in the health sectors to increase the supply of protective gears and capacity building of health workers is key to save and protect them from COVID-19 pandemic.

scholarly journals Barriers to increase surgical productivity in Sierra Leone: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056784
Author(s):  
Juul Bakker ◽  
A J van Duinen ◽  
Wouter W E Nolet ◽  
Peter Mboma ◽  
Tamba Sam ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Sierra Leone ◽  
Health Workers ◽  
Health System Strengthening ◽  
Financial Barriers ◽  
Public And Private ◽  
Factors Influencing ◽  
Surgical Workforce ◽  
Training Opportunities

ObjectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.Design and methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.Participants and setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.ResultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.DiscussionBroader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.

scholarly journals The relevance of educational attainments of parents of medical students for health workforce planning: data from Guiné-Bissau

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Paulo Ferrinho ◽  
Inês Fronteira ◽  
Tiago Correia ◽  
Clotilde Neves
Keyword(s):  
Medical Students ◽  
Health System ◽  
Health Workforce ◽  
Parental Influence ◽  
Health Sector ◽  
Workforce Planning ◽  
Health System Strengthening ◽  
Fragile States ◽  
Cross Sectional ◽  
Health Workforce Planning

Abstract Background In this article, we analyze data collected in the context of health workforce planning (HWFP) for Guiné-Bissau as part of the development of the third National Health Strategy, to study the relationship between educational achievement of parents and medical student characteristics and professional expectations. Methods Cross-sectional analytical study of all first-year medical students in Guiné-Bissau during December 2016. Results Our results confirm that the isolated effect of each parent is different as it is the combined education of both parents. Parental influence also seems to vary according to the sex of the offspring. The higher the education of the father, the stronger the urban background of the offspring. Level of education of parents is also important in relation to the decision to study medicine and the age of starting those studies. It is also an important influence as to expectation regarding place of future practice: the highest the educational level, particularly of the father, the highest the expectation for a future urban practice. Conclusions Our main interest in medical education is to study it as a health system intervention in order to contribute to health system’s strengthening in fragile states. This is discussed in the context of two frameworks: the labor market framework and WHO’s health system strengthening framework. Our data and that of others, recognize that household characteristics are important regarding future training and a future career in the health sector. This recognition should be integrated into HWFP frameworks.

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