scholarly journals Giants On Clay Feet – COVID-19, infection control, and public health laboratory networks in England, the US, and (West-)Germany (1945-2020)

2020 ◽  
Author(s):  
Claas Kirchhelle
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Local Level ◽  
West Germany ◽  
Robert Koch Institute ◽  
Political Autonomy ◽  
Public Health Systems ◽  
The Us ◽  
Control And Prevention ◽  
Anglo American

COVID-19 has exposed significant differences in public health systems’ ability to mount effective test and trace responses. This article analyses the historical and structural reasons behind the relative success of Germany and the problems experienced in Britain and the US during the first wave of the pandemic. It also asks why recent international surveys overestimated Anglo-American preparedness. The article argues that the answer lies in the different evolution of public health systems as well as varying public health capacities at the local level. In Germany, post-1994 reforms of the decentralised public health system managed to overcome decades of political neglect and underinvestment and strengthen federal integration without compromising public health capacity at the state and communal level. This joint strengthening of the centre and hinterland allowed the Robert Koch Institute to function as an effective coordinating hub for locally tailored COVID-19 responses. By contrast, the decades after 1970 saw world-renowned Anglo-American public health systems face increasing challenges posed by funding cuts, privatisation, overambitious reforms, and increasing loss of political autonomy. Both the US Centers for Disease Control and Prevention and Public Health England retained significant prestige, which resulted in an overestimation of capacity by international reviews. However, once centres in Atlanta and Colindale had been overwhelmed, there was little local and state public health capacity to fall back on.

IANPHI and National Public Health Institutes

Public Health ◽  
2020 ◽  
Author(s):  
Ellen Whitney ◽  
Katherine Seib ◽  
Jessica Blackburn ◽  
Jacob Clemente ◽  
Courtenay M. Dusenbury ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Health Systems ◽  
Health Programs ◽  
Public Health Programs ◽  
Public Health Systems ◽  
The World ◽  
National Public Health ◽  
Control And Prevention ◽  
National Public Health Institutes

More than one hundred countries around the world have established national public health institutes (NPHIs) to coordinate and lead their public health systems. Some NPHIs, such as the US Centers for Disease Control and Prevention (CDC), South African National Institute for Communicable Diseases (NICD), Brazilian Oswaldo Cruz Foundation (FIOCRUZ), and Chinese Center for Disease Control and Prevention, have developed over time. Others, such as the Public Health Agency of Canada (PHAC), emanated in response to more recent global public health threats like severe acute respiratory syndrome (SARS). NPHI functionalities range from combatting primarily infectious diseases to comprehensive mandates to lead national efforts for prevention and control of both infectious and noncommunicable disease threats. The International Association of National Public Health Institutes (IANPHI), envisioned in 2001 and chartered in 2006, serves to link and catalyze the capacity of NPHIs around the world through a robust international professional and scientific network. IANPHI works closely with the World Health Organization (WHO) through a formal partnership agreement. The Bill & Melinda Gates Foundation, the Rockefeller Foundation, member dues and peer assistance, bilateral cooperative agreements, and private-sector partnerships support its activities. IANPHI’s members encompass more than five billion people across six continents. IANPHI is the only organization whose mission is to strengthen national public health institutes. To do this, IANPHI’s work focuses on (a) supporting a robust scientific community of NPHI directors through an annual meeting, a listserv, and collaborative activities; (b) developing and distributing guidelines and tools that strengthen NPHIs’ abilities to conduct and evaluate public health programs and efforts, including the IANPHI NPHI development framework, the Staged Development Tool, NPHI-to-NPHI evaluation guidance, and a best practices series; and (c) investing in projects designed to create NPHIs and strengthen public health systems in low-resource countries. IANPHI helps NPHIs by advocating for strong and well-supported NPHIs and providing timely information and insights for public health programs and actions.

scholarly journals Qualitative Assessment of Factors Influencing Implementation Effectiveness and Sustainability of Strategies for Increasing Tobacco Use Treatment in Vietnam Health Centers

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
Health Centers ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Implementation Effectiveness ◽  
Public Health Systems

PURPOSE Effective strategies are needed to increase the implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries. Our cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in community health centers (CHCs) in Vietnam. In this paper, we present findings from a postimplementation qualitative assessment of factors that influence implementation effectiveness and program sustainability. METHODS We conducted semistructured qualitative interviews (N = 52) with 13 CHC medical directors (ie, physicians), 25 CHC health care providers, and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. RESULTS Facilitators of implementation effectiveness included training that increased confidence and skill, satisfaction with point-of-service tools, increasing patient demand for TDT, and, for the intervention arm, the value of a VHW referral system that reduced provider burden. The primary challenge to sustainability is the competing priorities driven by the Vietnam Ministry of Health, which may result in fewer resources for TDT compared with other health programs. However, providers and VHWs described several options for adapting the implementation strategies to address challenges and increase the engagement of local government committees and other sectors to sustain gains. CONCLUSION Our findings offer insight into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, these results illustrate the dynamic interplay between barriers to and facilitators of sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems, like that of Vietnam. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, as well as planning for adaptations and subsequent resource allocations, to meet Article 14 goals.

scholarly journals A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Nancy VanDevanter ◽  
Milkie Vu ◽  
Ann Nguyen ◽  
Trang Nguyen ◽  
Hoang Van Minh ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Local Level ◽  
World Health ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Care Providers ◽  
Public Health Systems ◽  
Factors Influencing

Abstract Background Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. Methods We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. Results Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. Conclusion Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users. Trial registration NCT02564653, registered September 2015

scholarly journals COVID-19 response by the Hopi Tribe: impact of systems improvement during the first wave on the second wave of the pandemic

2021 ◽  
Vol 6 (5) ◽  
pp. e005150
Author(s):  
Duane Humeyestewa ◽  
Rachel M. Burke ◽  
Harpriya Kaur ◽  
Darren Vicenti ◽  
Royce Jenkins ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Care Center ◽  
Scale Up ◽  
Mitigation Measures ◽  
Incident Management ◽  
Surveillance Programme ◽  
Health Care Center ◽  
Public Health Systems ◽  
Control And Prevention

The Hopi Tribe is a sovereign nation home to ~7500 Hopi persons living primarily in 12 remote villages. The Hopi Tribe, like many other American Indian nations, has been disproportionately affected by COVID-19. On 18 May 2020, a team from the US Centers for Disease Control and Prevention (CDC) was deployed on the request of the tribe in response to increases in COVID-19 cases. Collaborating with Hopi Health Care Center (the reservation’s federally run Indian Health Service health facility) and CDC, the Hopi strengthened public health systems and response capacity from May to August including: (1) implementing routine COVID-19 surveillance reporting; (2) establishing the Hopi Incident Management Authority for rapid coordination and implementation of response activities across partners; (3) implementing a community surveillance programme to facilitate early case detection and educate communities on COVID-19 prevention; and (4) applying innovative communication strategies to encourage mask wearing, hand hygiene and physical distancing. These efforts, as well as community adherence to mitigation measures, helped to drive down cases in August. As cases increased in September–November, the improved capacity gained during the first wave of the pandemic enabled the Hopi leadership to have real-time awareness of the changing epidemiological landscape. This prompted rapid response coordination, swift scale up of health communications and redeployment of the community surveillance programme. The Hopi experience in strengthening their public health systems to better confront COVID-19 may be informative to other indigenous peoples as they also respond to COVID-19 within the context of disproportionate burden.

scholarly journals Effects of transition on HIV and non-HIV services and health systems in Kenya: a mixed methods evaluation of donor transition

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniela C. Rodríguez ◽  
Diwakar Mohan ◽  
Caroline Mackenzie ◽  
Jess Wilhelm ◽  
Ezinne Eze-Ajoku ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Service Delivery ◽  
Health Systems ◽  
Local Level ◽  
Health Facilities ◽  
Government Support ◽  
Hiv Care ◽  
Local Context ◽  
Mixed Methods Evaluation ◽  
The Us

Abstract Background In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). Methods We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities. Quantitative data from a facility survey and health service delivery data were gathered and combined with data from two rounds of interviews and focus group discussions (FGDs) conducted at national and sub-national level to document the design and implementation of GP. The survey included 230 health facilities across 10 counties, and 59 interviews and 22 FGDs were conducted with government officials, health facility providers, patients, and civil society. Results We found that PEPFAR moved quickly from announcing the GP to implementation. Despite extensive conversations between the US government and the Government of Kenya, there was little consultation with sub-national actors even though the country had recently undergone a major devolution process. Survey and qualitative data identified a number of effects from GP, including discontinuation of certain services, declines in quality and access to HIV care, loss of training and financial incentives for health workers, and disruption of laboratory testing. Despite these reports, service coverage had not been greatly affected; however, clinician strikes in the post-transition period were potential confounders. Conclusions This study found similar effects to earlier research on transition and provides additional insights about internal country transitions, particularly in decentralized contexts. Aside from a need for longer planning periods and better communication and coordination, we raise concerns about transitions driven by epidemiological criteria without adaptation to the local context and their implication for priority-setting and HIV investments at the local level.

Maternal health services in China’s western rural areas: uptake and correlates

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Chengfang Liu ◽  
Linxiu Zhang ◽  
Yaojiang Shi ◽  
Huan ZHOU ◽  
Alexis Medina ◽  
...  
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Services ◽  
Health Systems ◽  
Uptake Rate ◽  
Rural Areas ◽  
Design Methodology ◽  
Maternal Health Services ◽  
Western China ◽  
Public Health Systems

Purpose Many public health systems have struggled with the dual questions of (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it. The objective of this study is to assess the uptake rate of a new set of maternal health services in poor rural areas of China. Design/methodology/approach The analysis is based on the survey responses of women’s representatives and village cadres from almost 1000 villages in June 2012 as part of a wide-scale public health survey in Sichuan, Gansu and Yunnan provinces in the western part of China. Findings We find that the uptake rate of maternal health services (including in-hospital delivery, antenatal care visits and post-partum care visits) in poor rural areas of western China are far below average in China, and that the rates vary across provinces and ethnic groups. Our analyses demonstrate that distance, income, ethnicity and availability appear to be systematically correlated with low uptake rates of all maternal health services. Demand-side factors seem to be by far the most important sources of the differences between subpopulations. We also find that there is potential for creating a Conditional Cash Transfer program to improve the usage of maternal health services. Originality/value We believe that our results will contribute positively to the exploration of answers to the dual questions that many public health systems have struggled with (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it.

scholarly journals Integrating oral health with public health systems under the framework of the Global Charter for the Public's Health

2018 ◽  
Vol 69 (3) ◽  
pp. 167-170
Author(s):  
Aimee Lee ◽  
Marta Lomazzi ◽  
Hyewon Lee ◽  
Raman Bedi
Keyword(s):  
Public Health ◽  
Oral Health ◽  
Health Systems ◽  
Public Health Systems
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