Setting Up Community Health Programmes in Low and Middle Income Countries, Fourth Edition, by Ted Lankester and Nathan Grills, Oxford University Press, May 2019

2020 ◽  
Vol 7 (2) ◽  
pp. 155-158
Author(s):  
Sundeep Manoth ◽  
Bethany Carr

Universal health coverage is still out of reach for many people in the world and not surprisingly, it is those in rural areas made up of largely poor communities who are the most deprived. Setting Up Community Health and Development Programmes in Low and Middle-Income Settings is a practical tool to guide the process of starting, developing and maintaining a healthcare programme in these areas. Its purpose is to help stakeholders to empower communities to identify and solve their own problems so as to decrease inequality and inequity which remain serious issues in global health. This book also aims to assist academics, policy makers and planners to understand the realities of field-based development and progress. The book has a wide range of contributors with expertise in different areas and they address two main audiences. The first is those working in the field: programme managers, and practitioners from government and civil society involved in setting up or developing community health and development programmes, rural and urban. This book is also written for global health and other health care students, academics, policy makers and planners who wish to anchor their work in field-based situations.

2020 ◽  
Author(s):  
Bronwyn Harris ◽  
Motunrayo Ajisola ◽  
Raisa Alam ◽  
Jocelyn Antsley Watkins ◽  
Theodoros N Arvanitis ◽  
...  

AbstractObjectiveRemote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).MethodsWe reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.ResultsWe reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engaged with 419 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. mConsulting services are operating through provider platforms (n=5-17) and, at community-level, some direct experience of mConsulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. mConsulting can reduce affordability barriers and facilitate care-seeking practices.ConclusionsThere are indications of readiness for mConsulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply-chains to fully realise the continuity of care and responsiveness that mConsulting services offer, particularly during/beyond COVID-19.


The central role of the community and its place in both healthcare planning and service delivery is increasingly seen as a vital foundation for global health. The fourth edition of Setting up Community Health Programmes in Low and Middle Income Settings provides a practical introductory guide to the initiation, management, and sustaining of health care programmes in developing countries. The book has been fully revised to take into account the Millennium Development Goals, Sustainable Development Goals, and Universal Health Coverage. Taking an evidence-based approach the book provides rationales and contextualized examples of health at the community level. Key topics include non-communicable diseases, disability, addiction, abuse and mental health. This book provides a practical guide for community health workers including field workers, programme managers, medical professionals involved in front line health care, administrators, health planners and postgraduate students


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23014-e23014
Author(s):  
Emma Foreman ◽  
Isla Leslie ◽  
Hannah Lyons ◽  
Katherine Piddock ◽  
Anguraj Sadanandam ◽  
...  

e23014 Background: The number of annual global cancer deaths is rising and the majority of this burden, for a multitude of reasons, falls in low- and middle- income countries (LMICs). With the United Nations’ 3rd and 17th Sustainable Development Goals in mind (which include by 2030 “reduce by one third premature mortality from non-communicable diseases” and “partnership for the goals”) a survey was undertaken at the UK’s two largest comprehensive cancer centres to scope individual and team endeavours to work with colleagues in less well-resourced countries. Methods: Employees at the Royal Marsden Foundation Trust (RM) and Institute of Cancer Research (ICR) in London and Surrey, UK and The Christie NHS Foundation Trust (Christie), Manchester were invited to complete a survey to capture collaborative clinical care, research, education and training. Results: Responses were received from 520 multidisciplinary individuals across the 2 centres to two similar questionnaires. A large number had experience of working in some capacity in, or in collaboration with an LMIC. At the RM 14.62% of respondees were currently working with colleagues in LMICs. At The Christie 13.22% of staff had experience of working in LMICs in a supportive capacity. Those currently collaborating with colleagues in LMICs were working in a wide range of countries across Asia, Africa and South America in a range of initiatives spanning clinical care, research, education and training. Of those who answered the survey 64% at The Christie said they’d like to hear more about opportunities to be involved in supporting global health care, and 89% at RM/ICR said they’d be interested in joining a collaborative group working on global oncology initiatives at the institutions. Conclusions: This survey highlights the body of willing, interested individuals keen to work with colleagues in LMICs to improve cancer outcomes. The launch of the UK Global Cancer Network in 2020 will build upon these two surveys with a planned national survey of global health and cancer work undertaken by individuals in 2021.


2018 ◽  
Vol 3 (3) ◽  
pp. e000797 ◽  
Author(s):  
Helen Schneider ◽  
Nelisiwe Maleka

IntroductionStudies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012–2016.MethodsA search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted.ResultsThe 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries—India, South Africa and Brazil, in particular—leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories.ConclusionThe findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message—that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs.


Author(s):  
Bernard Hope Taderera

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.


2018 ◽  
Vol 66 (10) ◽  
pp. 1487-1491 ◽  
Author(s):  
Jean B Nachega ◽  
Nadia A Sam-Agudu ◽  
Lynne M Mofenson ◽  
Mauro Schechter ◽  
John W Mellors

Abstract Although significant progress has been made, the latest data from low- and middle-income countries show substantial gaps in reaching the third “90%” (viral suppression) of the UNAIDS 90-90-90 goals, especially among vulnerable and key populations. This article discusses critical gaps and promising, evidence-based solutions. There is no simple and/or single approach to achieve the last 90%. This will require multifaceted, scalable strategies that engage people living with human immunodeficiency virus, motivate long-term treatment adherence, and are community-entrenched and ‑supported, cost-effective, and tailored to a wide range of global communities.


2021 ◽  
Author(s):  
Abimbola Olaniran ◽  
Jane Briggs ◽  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
...  

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.


2020 ◽  
Vol 12 (3) ◽  
pp. 231-233
Author(s):  
Melissa Adomako ◽  
Alaei Kamiar ◽  
Abdulla Alshaikh ◽  
Lyndsay S Baines ◽  
Desiree Benson ◽  
...  

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.


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