Bottlenecks in integrating TB and HIV services in the Philippines: a qualitative implementation research

Abstract Background The Philippines is subdivided into 17 regions, with a devolved health system. It has a high burden of tuberculosis (TB) (554 per 100,000 population), and more than 25% increase in human immunodeficiency virus (HIV) incidence. However, years after the World Health Organization’s (WHO) recommendations on TB/HIV collaborative activities, only 24% of Filipinos with TB know their HIV status. The present study aims to describe implementation bottlenecks that hamper integration of TB and HIV services in the Philippines. Methods Ten focus group discussions with program managers, non-government organizations (NGO), patient organizations, and primary healthcare centers from different levels of the Philippine health system were conducted. Thematic analysis was used to analyze qualitative data. Results Implementation bottlenecks can be categorized into four areas: policy, operational, human resources, and patient-related factors. Mechanisms to cascade TB/HIV knowledge and policies from the national to the municipality level have been identified as barriers to integrated TB/HIV services. Double stigmatization among TB patients was also linked to poor uptake of HIV testing. Conclusion National policies and health promotion efforts need to be revisited to operationalize how information about TB/HIV policies is cascaded to the grassroots. Interventions to address double stigmatization should also be explored.

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Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique

BMC Health Services Research ◽

10.1186/s12913-019-4820-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Neusa BAY ◽

Edna JUGA ◽

Carlos MACUACUA ◽

José JOÃO ◽

Maria COSTA ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Health System ◽

Health Facility ◽

Essential Medicines ◽

World Health ◽

Diagnostic Tools ◽

Clinical Protocols ◽

Double Burden ◽

Related Factors

Abstract Background Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

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Factors associated with medication adherence of hypertensive patients in the Philippines: a systematic review

Clinical Hypertension ◽

10.1186/s40885-021-00176-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Margarita M. Gutierrez ◽

Rungpetch Sakulbumrungsil

Keyword(s):

Medication Adherence ◽

Longitudinal Research ◽

Vascular System ◽

Illness Perception ◽

The Philippines ◽

Library Science ◽

World Health ◽

Related Factors ◽

Hypertensive Patients ◽

Targeted Interventions

Abstract Background Diseases of the heart and vascular system are the leading cause of mortality in the Philippines. Hypertension, the most important modifiable risk factor, has a prevalence rate of 28% and a control rate of 20%. Despite the proven efficacy of pharmacologic treatment, medication adherence is reported to be as low as 66%. While there are publications that reported factors that affect adherence in Filipinos, there are no existing research that evaluated them systematically. This review is conducted to present and synthesize findings of published literatures. Methods Databases—PubMed, Scopus, Wiley Online library, Science Direct, JSTOR, Web of Science, SAGE journals, and Cochrane—were used to search for articles published from 2000 to 2020 that studied medication adherence in adult Filipino hypertensive population. Out of the initial 1514 articles, 15 articles met the criteria and were included in the analysis. The evidence from the included studies was summarized and discussed in a narrative review using the World Health Organization framework for adherence to long-term therapies as the framework. Result The factors that were positively associated with adherence were health care system-related factors: good patient-health provider relationship, accessibility of health services, use of specialty clinics and programs for hypertension, and health insurance. The factors found to be negatively associated with adherence are (1) social economic factors: younger age, single civil status, low educational attainment, and unemployment; (2) patient-related factors: low in health literacy and awareness, knowledge on hypertension, attitude towards hypertension, self-efficacy, and social support; (3) therapy-related factors: inconsistent drug regimen schedule, use of Thiazide and complementary and alternative medicines; (4) condition-related factors: low illness perception, and absence of comorbidities. Conclusions Findings should be interpreted with caution because of methodological limitations. Despite this, given that health systems related factors are modifiable, they can be the focus of interventions and future researches to increase medication adherence. Clinicians may also want to screen their Filipino hypertensive patients for factors that are associated to low adherence in order to provide a tailored advice. Longitudinal research studies with heterogeneous samples of hypertensive Filipinos are imperative so that targeted interventions can be developed for the population.

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Assessment of Care Provision for Hypertension at Emergency Department of an Urban Hospital in Mozambique

10.21203/rs.2.15910/v1 ◽

2019 ◽

Author(s):

Neusa Vanessa Amad Bay ◽

Edna JUGA ◽

Carlos MACUACUA ◽

Jose JOAO ◽

Maria ANIBAL ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Health System ◽

Health Facility ◽

Essential Medicines ◽

World Health ◽

Diagnostic Tools ◽

Clinical Protocols ◽

Double Burden ◽

Related Factors

Abstract Background: Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods: During a pragmatic and prospective 30-day snapshot study (with 24 hour surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral De Mavalane, Maputo, we assessed patient’s flow, infrastructure and resources through direct observation, and reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results: Hypertensive patients had several stops during their journey inside the health facility, and followed a non-standardized flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions: Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

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Obstacles to Claiming Permanence and Injury-Relatedness for “Posttraumatic” Headache

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.mayjun02 ◽

2009 ◽

Vol 14 (3) ◽

pp. 3-6

Author(s):

Robert J. Barth

Keyword(s):

Complete Recovery ◽

World Health ◽

Related Factors ◽

Posttraumatic Headache ◽

Sixth Edition ◽

Causative Relationship ◽

Short Period ◽

The One ◽

Health Organization ◽

Subjective Reports

Abstract “Posttraumatic” headaches claims are controversial because they are subjective reports often provided in the complex of litigation, and the underlying pathogenesis is not defined. This article reviews principles and scientific considerations in the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides) that should be noted by evaluators who examine such cases. Some examples in the AMA Guides, Sixth Edition, may seem to imply that mild head trauma can cause permanent impairment due to headache. The author examines scientific findings that present obstacles to claiming that concussion or mild traumatic brain injury is a cause of permanent headache. The World Health Organization, for example, found a favorable prognosis for posttraumatic headache, and complete recovery over a short period of time was the norm. Other studies have highlighted the lack of a dose-response correlation between trauma and prolonged headache complaints, both in terms of the frequency and the severity of trauma. On the one hand, scientific studies have failed to support the hypothesis of a causative relationship between trauma and permanent or prolonged headaches; on the other hand, non–trauma-related factors are strongly associated with complaints of prolonged headache.

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Exploring patient-provider factors for risk of developing Multi-drug Resistance Tuberculosis in Southern Ethiopia: Qualitative Operation Research (Preprint)

10.2196/preprints.13366 ◽

2019 ◽

Author(s):

Yitagesu Habtu ◽

Tesema Bereku ◽

Girma Alemu ◽

Ermias Abera

Keyword(s):

Phenomenological Study ◽

Treatment Success ◽

World Health ◽

Multi Drug Resistance ◽

Southern Ethiopia ◽

Drug Resistant ◽

Related Factors ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis

BACKGROUND Ethiopia is one of among thirty high burden countries of multi-drug resistant tuberculosis (MDR-TB) in the regions of world health organization. Contextual evidence on the emergence of the disease is limited at a program level. OBJECTIVE The aim of the study is to explore patient-provider factors that may facilitate the emergence of multi-drug resistant tuberculosis. METHODS We used a phenomenological study design of qualitative approach from June to July, 2015. We conducted ten in-depth interviews and 4 focus group discussions with purposely selected patients and providers. We designed and used an interview guide to collect data. Verbatim transcribes were exported to open code 3.4 for emerging thematic analysis. Domain summaries were used to support core interpretation. RESULTS The study explored patient-provider factors facilitating the emergence of multi-drug resistant tuberculosis. These factors as underlying, health system and patient-related factors. Especially, the a shows conflicting finding between having a history of discontinuing drug-susceptible tuberculosis and emergence of multi-drug resistant tuberculosis. CONCLUSIONS The patient-provider factors may result in poor early case identification, adherence to and treatment success in drug sensitive or multi-drug resistant tuberculosis. Our study implies the need for awareness creation about multi-drug resistant tuberculosis for patients and further familiarization for providers. This study also shows that patients developed multi-drug resistant tuberculosis though they had never discontinued their drug-susceptible tuberculosis treatment. Therefore, further studies may require for this discording finding.

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Health system responsiveness: a systematic evidence mapping review of the global literature

International Journal for Equity in Health ◽

10.1186/s12939-021-01447-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Gadija Khan ◽

Nancy Kagwanja ◽

Eleanor Whyle ◽

Lucy Gilson ◽

Sassy Molyneux ◽

...

Keyword(s):

Health System ◽

Grey Literature ◽

Feedback Loops ◽

Theoretical Development ◽

World Health ◽

Evidence Map ◽

Evidence Mapping ◽

Mapping Review ◽

System Responsiveness ◽

Health System Responsiveness

Abstract Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

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Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia

Globalization and Health ◽

10.1186/s12992-021-00702-7 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Amare Worku Tadesse ◽

Kassu Ketema Gurmu ◽

Selamawit Tesfaye Kebede ◽

Mahlet Kifle Habtemariam

Keyword(s):

Health Promotion ◽

Global Health ◽

Health System ◽

Universal Health Coverage ◽

World Health ◽

Health Coverage ◽

Health Security ◽

Universal Health ◽

Health Agenda

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

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The Potential Contribution of the Health System to Reducing Stunting in SUN Countries

Food and Nutrition Bulletin ◽

10.1177/0379572121998127 ◽

2021 ◽

pp. 037957212199812

Author(s):

Talata Sawadogo-Lewis ◽

Shannon E. King ◽

Tricia Aung ◽

Timothy Roberton

Keyword(s):

Health System ◽

Universal Coverage ◽

Reproductive Age ◽

World Health ◽

Potential Contribution ◽

Nutrition Interventions ◽

Lives Saved Tool ◽

Potential Impact ◽

Nutrition Sensitive ◽

Global Nutrition

Background: The global nutrition community has called for a multisectoral approach to improve nutritional outcomes. While most essential nutrition interventions are delivered through the health system, nutrition-sensitive interventions from other sectors are critical. Objective: We modeled the potential impact that Scaling Up Nutrition (SUN) interventions delivered by the health system would have on reaching World Health Assembly (WHA) stunting targets. We also included results for targets 2, 3, and 5. Methods: Using all available countries enrolled in the SUN movement, we identified nutrition interventions that are delivered by the health system available in the Lives Saved Tool. We then scaled these interventions linearly from 2012 up to nearly universal coverage (90%) in 2025 and estimated the potential impact that this increase would have with regard to the WHA targets. Results: Our results show that only 16 countries out of 56 would reach the 40% reduction in the number of stunted children by 2025, with a combined total reduction of 32% across all countries. Similarly, only 2 countries would achieve the 50% reduction in anemia for women of reproductive age, 41 countries would reach at least 50% exclusive breastfeeding in children under 6 months of age, and 0 countries would reach the 30% reduction in low birth weight. Conclusions: While the health system has an important role to play in the delivery of health interventions, focusing investments and efforts on the health system alone will not allow countries to reach the WHA targets by 2025. Concerted efforts across multiple sectors are necessary.

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Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

Globalization and Health ◽

10.1186/s12992-021-00676-6 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Antonio Bernabé-Ortiz ◽

Jessica H. Zafra-Tanaka ◽

Miguel Moscoso-Porras ◽

Rangarajan Sampath ◽

Beatrice Vetter ◽

...

Keyword(s):

Health System ◽

New Technologies ◽

Action Plan ◽

Building Blocks ◽

Communicable Diseases ◽

Noncommunicable Disease ◽

World Health ◽

Noncommunicable Diseases ◽

Diagnostic Tools ◽

Monitoring Tools

AbstractA key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

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Health system gaps in cardiovascular disease prevention and management in Nepal

BMC Health Services Research ◽

10.1186/s12913-021-06681-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Archana Shrestha ◽

Rashmi Maharjan ◽

Biraj Man Karmacharya ◽

Swornim Bajracharya ◽

Niharika Jha ◽

...

Keyword(s):

Human Resources ◽

Health System ◽

Health Systems ◽

National Health ◽

Task Force ◽

Health Spending ◽

Building Blocks ◽

Critical System ◽

Government Organizations ◽

The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

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