scholarly journals Health System Strategies and Adolescent Sexual Health: A Systematic Review of the Literature using Rodgers Concept Analysis Framework

2021 ◽  
Vol 14 (1) ◽  
pp. 526-536
Author(s):  
Wilfred Njabulo Nunu ◽  
Lufuno Makhado ◽  
Jabu Tsakani Mabunda ◽  
Rachel Tsakani Lebese
Keyword(s):  
Sexual Health ◽  
Health Outcomes ◽  
Health System ◽  
Conceptual Framework ◽  
Health Systems ◽  
Concept Analysis ◽  
Sexual Practices ◽  
Analysis Framework ◽  
Adolescent Sexual Health ◽  
Antecedents And Consequences

Background: Health Systems Strategies play a key role in determining Adolescent Sexual Health outcomes. This study aims to review the literature on the relationship between Health Systems Strategies and Adolescent Sexual Health issues guided by Rodger's evolutionary concept analysis framework. The study further develops a Conceptual Framework that would guide a study that seeks to “Develop strategies to facilitate safe sexual practices in adolescents through Integrated Health Systems in selected Districts in Zimbabwe.” Methods: Adolescents, Health Systems, Sexual Health, and Strategies were used to search for published literature (in English) on Google Scholar, PUBMED, EBSCO, Cochran Library, and Science Direct. A total of 142 Articles and 11 reports were obtained, and the content was screened for relevance. This led to 42 articles and 03 reports being found suitable and relevant, and thus, the content was reviewed. Thematic analysis was done to identify attributes, antecedents, and consequences of Health Systems Strategies on Adolescent Sexual Health. These findings were then used to inform the development of the Conceptual Framework. Results: Key attributes, antecedents and consequences of Health System Strategies on Adolescent Sexual Health were identified. Strategies to Improve Adolescent Sexual Health outcomes were also identified. Conclusions: Different contextual factors influence policy changes and the consequences are mixed, with both positive and negative outcomes.

scholarly journals Health System Strategies and Adolescent Sexual Health: Systematic review using Rodgers Concept Analysis Framework

2020 ◽  
Author(s):  
Wilfred Njabulo Nunu ◽  
Lufuno Makhado ◽  
Jabu Tsakani Mabunda ◽  
Rachel Tsakani Lebese
Keyword(s):  
Sexual Health ◽  
Health Outcomes ◽  
Health System ◽  
Conceptual Framework ◽  
Health Systems ◽  
Concept Analysis ◽  
Review Literature ◽  
Sexual Practices ◽  
Analysis Framework ◽  
Adolescent Sexual Health

Abstract Background: Health Systems Strategies have been key in determining Adolescent Sexual Health outcomes. This study therefore aims to review literature on relationship between Health Systems Strategies and Adolescent Sexual Health issues guided by Rodgers evolutionary concept analysis framework. The study further develops a Conceptual Framework that would guide a study that seeks to “develop strategies to facilitate safe sexual practices in adolescents through Integrated Health Systems in selected Districts in Zimbabwe”.Methods: The words Adolescents, Health Systems, Sexual Health and Strategies were used to search for published literature (in English) on Google Scholar, PUBMED, EBSCO and Science Direct. 111 Articles and 04 reports were obtained and their content screened for relevance and 32 articles 01 report were found suitable and relevant and thus were reviewed. Thematic analysis to identify attributes, antecedents and consequences of Health Systems Strategies on Adolescent Sexual Health was done. These findings were then used to inform the development of the Conceptual Framework.Results: Identified attributes were: contextual, dynamic, engaging and advocating, and inefficient Health Systems in addressing Adolescent Sexual Health. Identified antecedents of these Health System Strategies on Adolescent Sexual Health included; adolescent sexual rights, lack of understanding of what sexual health is, need for integrated Adolescent Sexual Health systems, available resources and type of society. Consequences of these Health Systems Strategies on Adolescent Sexual Health were identified to be; weak Adolescent Sexual Health programs, parallel and fragmented Health Systems, vulnerability and heightened risks for poor health outcomes and challenges in interacting with different ethnic groups and gender.Conclusions: Adolescents are very vulnerable and need to be protected at all costs. There is need to have comprehensive Health Systems Strategies that would positively influence Adolescent Sexual Health.

scholarly journals Developing Strategies for Integrating Indigenous Health and Modern Health Systems for Improved Adolescent Sexual Health Outcomes in Umguza and Mberengwa Districts in Zimbabwe

2021 ◽  
Vol 14 ◽  
pp. 117863292110360
Author(s):  
Wilfred Njabulo Nunu ◽  
Lufuno Makhado ◽  
Jabu Tsakani Mabunda ◽  
Rachel Tsakani Lebese
Keyword(s):  
Sexual Health ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Low Income ◽  
Information Dissemination ◽  
Indigenous Health ◽  
Second Phase ◽  
Health Issues ◽  
Adolescent Sexual Health

Background: Strategies to improve sexual health outcomes have evolved over the years due to technology’s evolution to ensure that they are relevant. Challenges have been noticed in different systems that run parallel, particularly in Low-Income Countries where the majority utilise Indigenous Health Systems. Optimisation of resources and minimisation of conflicts could be realised through integrated health systems in the management of adolescents’ sexual health issues. This study sought to develop strategies to facilitate Indigenous Health System and Modern Health System integration to improve the management of Adolescent Sexual Health issues, leveraging results from 3 papers. Methods: A multi-stage approach was utilised, with Phase 1 focussing on a preliminary assessment through merging findings from the 4 papers. The Strengths, Weaknesses, Opportunities, and Threats analyses were then used, followed by the Basic Logic Model to identify critical aspects that needed to be considered in building the strategies. The second phase used the Build, Overcome, Eliminate and Minimise framework to build the strategies. Results: A total of 5 strategies were proposed to facilitate this integration, and these included revival of committees that were inclusive of all stakeholders; allocating Indigenous Health System space in clinics to work in; establishing adolescent-friendly clinics; intensifying information dissemination on sexual health-related issues, and developing clear Terms of Reference and procedures to govern this integration and ensure it is a success. Conclusions: Implementing these strategies could facilitate this integration and ensure that programs are planned and implemented in a complementary manner, thereby reducing conflicts between the 2 systems and ensuring collaborative efforts towards shared goals that would transform to better Sexual Health Outcomes for adolescents.

scholarly journals Indigenous Health Systems and Adolescent Sexual Health in Umguza and Mberengwa Districts of Zimbabwe: Community Key Stakeholders’ Perspectives

2021 ◽  
Vol 14 ◽  
pp. 117863292110135
Author(s):  
Wilfred Njabulo Nunu ◽  
Lufuno Makhado ◽  
Jabu Tsakani Mabunda ◽  
Rachel Tsakani Lebese
Keyword(s):  
Sexual Health ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Indigenous Health ◽  
Belief Systems ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Adolescent Sexual Health ◽  
Community Stakeholders

Different stakeholders play varying roles in shaping up adolescent sexual behaviours that, in turn, influence their sexual experiences. In Zimbabwe, it has been reported that adolescents from cultural districts exhibit poor sexual health outcomes as compared to other districts. Therefore, this study sought to explore the role of different key community stakeholders in the indigenous health system and how it impacts on adolescent sexual health issues. The study further explored how the indigenous health system could be integrated into the modern health system. A qualitative cross-sectional survey was conducted on purposively and snowballed respondents in Umguza and Mberengwa districts. Interviews and focus group discussions were used to gather and record data from participants. The recorded data were transcribed verbatim, translated to English, coded and thematically analysed on MAXQDA Analytics Pro 2020. Four superordinate and 12 subordinate themes emerged from the data during analysis. Stakeholders play varied roles in adolescents’ upbringing and support though there are contradicting teachings from the indigenous health system and modern health system. It is possible to integrate these two systems though there were foreseen logistical challenges and clashes in the values and belief systems. Participants made suggestions on how these challenges could be overcome. There is a window of opportunity to pursue the suggested ways of integrating indigenous health systems and modern health systems for improved adolescent sexual health outcomes.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals Cognitive testing of a survey instrument to assess sexual practices, behaviours, and health outcomes: a multi-country study protocol

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lianne Gonsalves ◽  
Erin C. Hunter ◽  
Vanessa Brizuela ◽  
Joseph D. Tucker ◽  
Megan L. Srinivas ◽  
...  
Keyword(s):  
Data Collection ◽  
Sexual Health ◽  
Health Outcomes ◽  
Study Protocol ◽  
Survey Instrument ◽  
Sexual Practices ◽  
World Health ◽  
Cognitive Interviews ◽  
Country Study ◽  
Health Related

Abstract Background Population level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a ‘global’ standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the interpretability and comparability of the survey instrument in a number of diverse countries. Methods This study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: (1) localizing the instrument using forward and back-translation; (2) using a series of cognitive interviews to understand how participants engage with each survey question; (3) revising the core instrument based on interview findings; and (4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a ‘wave’ of data collection) will be completed simultaneously by 5+ countries, with a total of three waves. This stepwise approach facilitates iterative improvements and sharing across countries. Discussion An important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.

scholarly journals Cognitive Testing of a Survey Instrument to Assess Sexual Practices, Behaviours, and Health Outcomes: a Multi-country Study Protocol

2021 ◽  
Author(s):  
Lianne Gonsalves ◽  
Erin C Hunter ◽  
Joseph D Tucker ◽  
Megan L Srini ◽  
Evelyn Gitau ◽  
...  
Keyword(s):  
Data Collection ◽  
Sexual Health ◽  
Health Outcomes ◽  
Study Protocol ◽  
Survey Instrument ◽  
Sexual Practices ◽  
World Health ◽  
Cognitive Interviews ◽  
Country Study ◽  
Health Related

Abstract Background: Population level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a ‘global’ standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the validity and comparability of the survey instrument in a number of diverse countries.Methods:This study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: 1) localizing the instrument using forward and back-translation; 2) using a series of cognitive interviews to understand how participants engage with each survey question; 3) revising the core instrument based on interview findings; and 4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a ‘wave’ of data collection) will be completed simultaneously by 6-7 countries. This stepwise approach facilitates iterative improvements and sharing across countries. Discussion:An important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.

scholarly journals Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-Income Countries: A Qualitative Evidence Synthesis

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Sandy Oliver ◽  
Sonja Merten ◽  
Wai Wai Han ◽  
Kaspar Wyss
Keyword(s):  
Health System ◽  
Conceptual Framework ◽  
Health Systems ◽  
Evidence Synthesis ◽  
A Priori ◽  
Qualitative Evidence Synthesis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Dynamic Attributes ◽  
Low And Middle Income

Background: A country’s health system faces pressure when hit by an unexpected shock, such as what we observe in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The concept of resilience is highly relevant in this context and is a prerequisite for a health system capable of withstanding future shocks. By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications. Methods: The review uses the best-fit framework synthesis approach. An a priori conceptual framework was selected and a coding framework created. A systematic search identified 4284 unique citations from electronic databases and reports by non-governmental organisations, 12 of which met the inclusion criteria. Data were extracted and coded against the pre-existing themes. Themes outside of the a priori framework were collated to form a refined list of themes. Then, all twelve studies were revisited using the new list of themes in the context of each study. Results: Ten themes were generated from the analysis. Five confirmed the a priori conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms. Conclusion: The refined conceptual model shows how the themes inter-connect. The foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience. This review prompts countries to consider building the foundations of resilience described here as a priority to better prepare for future shocks.

System change in the spirit of reconciliation in action: The All Nations Health Partnership

2019 ◽  
Vol 33 (2) ◽  
pp. 61-64
Author(s):  
Ray J. Racette
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
System Change ◽  
Health District ◽  
System Reform ◽  
Health Partnership ◽  
Working Together ◽  
Improve Health

The urgency for reforming our health systems to improve health outcomes and service pathways is pressing and must be championed by leaders. Coalitions of the willing must be created to lead this movement. The All Nations Health Partners in Kenora, Ontario, have formed to lead health system reform in the Kenora Health District and are doing so in the spirit of Reconciliation in Action. All nations and organizations working together to reduce health disparities and improve health outcomes for all people.

scholarly journals Analysing the performance of health systems in Asian countries: What Myanmar can learn from Bangladesh and Vietnam

2020 ◽  
Author(s):  
Curt Löfgren ◽  
Zin Mar Win
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Health System ◽  
Technical Efficiency ◽  
Health Systems ◽  
English Language ◽  
Returns To Scale ◽  
Infant Mortality Rate ◽  
Asian Countries

Abstract Background Advancements in medicine leads, among other things, to increasing life expectancy. However, at the same time, health care costs are increasing, and this may not be sustainable in the future. Governments and health care organizations need to implement efficiency measures in order to maximize health outcomes within available resources. This study aims to compare the technical efficiency of health systems in Asian countries, and to identify “efficient peers” for each “inefficient country”: in particular, for Myanmar. Methods A DEA variable returns to scale output-oriented model was used to evaluate technical efficiency in thirteen Asian countries. The input variables were current health expenditure per capita, the density of doctors, and the density of nurses and midwifery personnel. Two output variables, health adjusted life expectancy (HALE) and the infant mortality rate were (IMR) analysed separately. Myanmar may learn how to improve efficiency of its health care system through studying its efficient peers from DEA results. A review of relevant English language literature was used as a basis for informing a comparative analysis of the health systems of Myanmar and its efficient peers, Bangladesh and Vietnam. Results Among the thirteen Asian countries studied, 38.5% and 53.8% of countries were technically efficient when HALE and IMR were used as the measured output respectively. More countries were efficient at reducing IMR than increasing HALE. Myanmar is one of the most inefficient countries, and it should look at the health systems of its efficient peers, Bangladesh and Vietnam, to make its health system technically more efficient. Conclusions The results of this study suggested that countries with inefficient health systems can improve their health outcomes without increasing their health care resources. As DEA measures efficiency only, future studies should take into account equity to assess comprehensive health system performance.

scholarly journals Building a Culture of Health

2017 ◽  
Vol 12 (1) ◽  
pp. 6-8
Author(s):  
David Briggs
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Delivery Systems ◽  
Health Priorities ◽  
Health Delivery ◽  
Work Health ◽  
Published Research ◽  
Health Delivery Systems

Commentary and published research on the value of healthcare has become more evident in recent times. There has been a noticeable shift from the focus on efficiency of health systems and practice to a greater focus on what effectively works, or more so, what doesn’t work. Health delivery systems struggle with increased demand on existing services and other health priorities remain underserviced. What do we need to do to better examine and understand what delivers value to people, communities, the health system and at the same time improves health outcomes? ........

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