scholarly journals Addressing Gaps for Health Systems Strengthening: A Public Perspective on Health Systems’ Response towards COVID-19

2021 ◽  
Vol 18 (17) ◽  
pp. 9047
Author(s):  
Nur Zahirah Balqis-Ali ◽  
Weng Hong Fun ◽  
Munirah Ismail ◽  
Rui Jie Ng ◽  
Faeiz Syezri Adzmin Jaaffar ◽  
...  
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Health Systems ◽  
Building Block ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Complex Interactions ◽  
Public Perspective ◽  
Whole Systems ◽  
Depth Interviews

Strengthening the health systems through gaps identification is necessary to ensure sustainable improvements especially in facing a debilitating outbreak such as COVID-19. This study aims to explore public perspective on health systems’ response towards COVID-19, and to identify gaps for health systems strengthening by leveraging on WHO health systems’ building blocks. A qualitative study was conducted using open-ended questions survey among public followed by in-depth interviews with key informants. Opinions on Malaysia’s health systems response towards COVID-19 were gathered. Data were exported to NVIVO version 12 and analysed using content analysis approach. The study identified various issues on health systems’ response towards COVID-19, which were then mapped into health systems’ building blocks. The study showed the gaps were embedded among complex interactions between the health systems building blocks. The leadership and governance building block had cross-cutting effects, and all building blocks influenced service deliveries. Understanding the complexities in fostering whole-systems strengthening through a holistic measure in facing an outbreak was paramount. Applying systems thinking in addressing gaps could help addressing the complexity at a macro level, including consideration of how an action implicates other building blocks and approaching the governance effort in a more adaptive manner to develop resilient systems.

scholarly journals Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001384 ◽  
Author(s):  
Emma Sacks ◽  
Melanie Morrow ◽  
William T Story ◽  
Katharine D Shelley ◽  
D Shanklin ◽  
...  
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Health Sector ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Health It ◽  
The Sustainable Development ◽  
Health Goals ◽  
Effective Community ◽  
Community Roles

Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.

scholarly journals Status of Palliative Oncology Care for Children and Young People in Sub-Saharan Africa: A Perspective Paper on Priorities for New Frontiers

2021 ◽  
pp. 1395-1405
Author(s):  
Eve Namisango ◽  
Nickhill Bhakta ◽  
Joanne Wolfe ◽  
Michael J. McNeil ◽  
Richard A. Powell ◽  
...  
Keyword(s):  
Health Systems ◽  
Building Blocks ◽  
Late Presentation ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Children With Cancer ◽  
Cancer Symptoms ◽  
Palliative Oncology ◽  
Oncology Care ◽  
Sub Saharan

PURPOSE The burden of cancer disproportionately affects low- and middle-income countries. Low 5-year survival figures for children with cancer in low-income countries are due to late presentation at diagnosis, treatment abandonment, absence of sophisticated multidisciplinary care, and lack of adequate resources. The reasons for late presentation are partly due to limited awareness of cancer symptoms, high treatment costs, and facility-level barriers to timely access to treatment. Given the systemic challenges, the regional need for palliative oncology care for children care is high. Despite the enormity of the need for palliative oncology for children with cancer in Africa, its level of development remains poor. This paper presents the evidence on the status of palliative oncology care for children in sub-Saharan Africa. METHODS This review provides an overview of the current status of palliative oncology care for children in sub-Saharan Africa, using the WHO building blocks for health systems strengthening as reference points, before proposing a forward-looking prioritized agenda for its development. RESULTS We noted that survival rates for children with cancer remain much poorer in Africa compared with developed countries and palliative oncology care resources are scant. Our results also show low coverage for palliative oncology care services for children, lack of a critical mass of health workers with the skills to deliver the care, a lack of robust documentation of the burden of cancer, widespread lack of access to essential controlled medicines, limited funding from government and limited coverage for palliative oncology care in most cancer control plans. CONCLUSION This review highlights priority areas for action that align to the WHO health system building blocks for strengthening health systems.

scholarly journals Measuring development assistance for health systems strengthening and health security: an analysis using the Creditor Reporting System database

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 584
Author(s):  
Jessica Kraus ◽  
Gavin Yamey ◽  
Marco Schäferhoff ◽  
Hugo Petitjean ◽  
Jessica Hale ◽  
...  
Keyword(s):  
Health Systems ◽  
Emergency Preparedness ◽  
Keyword Search ◽  
Reporting System ◽  
Development Assistance ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Health Coverage ◽  
Health Security ◽  
Development Assistance For Health

Background: Health systems strengthening (HSS) and health security are two pillars of universal health coverage (UHC). Investments in these areas are essential for meeting the Sustainable Development Goals and are of heightened relevance given the emergence of the 2019 novel coronavirus disease (COVID-19). This study aims to generate information on development assistance for health (DAH) for these areas, including how to track it and how funding levels align with country needs. Methods: We developed a framework to analyze the amount of DAH disbursed in 2015 for the six building blocks of the health system (‘system-wide HSS’) plus health security (emergency preparedness, risk management, and response) at both the global (transnational) and country level. We reviewed 2,427 of 32,801 DAH activities in the Creditor Reporting System (CRS) database (80% of the total value of disbursements in 2015) and additional public information sources. Additional aid activities were identified through a keyword search. Results: In 2015, we estimated that US$3.1 billion (13.4%) of the US$22.9 billion of DAH captured in the CRS database was for system-wide HSS and health security: US$2.5 billion (10.9%) for system-wide HSS, mostly for infrastructure, and US$0.6 billion (2.5%) for system-wide health security. US$567.1 million (2.4%) was invested in supporting these activities at the global level. If responses to individual health emergencies are included, 7.5% of total DAH (US$1.7B) was for health security. We found a correlation between DAH for HSS and maternal mortality rates, and we interpret this as evidence that HSS aid generally flowed to countries with greater need. Conclusions: Achieving UHC by 2030 will require greater investments in system-wide HSS and proactive health emergency preparedness. It may be appropriate for donors to more prominently consider country needs and global functions when investing in health security and HSS.

scholarly journals VISION 2035 PUBLIC HEALTH SURVEILLANCE IN INDIA

2021 ◽  
Author(s):  
James Blanchard ◽  
Reynold Washington ◽  
Marissa Becker ◽  
N Vasanthakumar ◽  
K Madan Gopal ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Systems ◽  
Prevention And Control ◽  
Public Health Surveillance ◽  
Building Blocks ◽  
Health Surveillance ◽  
Health Care Facilities ◽  
Health Systems Strengthening ◽  
And Control

NITI Aayog’s mandate is to provide strategic directions to the various sectors of the Indian economy. In line with this mandate, the Health Vertical released a set of four working papers compiled in a volume entitled ‘Health Systems for New India: Building Blocks – Potential Pathways to Reform’ during November 2019. “India’s Public Health Surveillance by 2035” is a continuation of the work on Health Systems Strengthening. It contributes by suggesting mainstreaming of surveillance by making individual electronic health records the basis for surveillance.Public Health Surveillance (PHS) cuts across primary, secondary, and tertiary levels of care. Surveillance is an important Public Health function. It is an essential action for disease detection, prevention, and control. Surveillance is ‘Information for Action’. This paper is a joint effort of the Health vertical, NITI Aayog, and the Institute for Global Public Health, University of Manitoba, Canada, with contributions from technical experts from the Government of India, States, and International agencies. In 2035, • India’s Public Health Surveillance will be a predictive, responsive, integrated, and tiered system of disease and health surveillance that is inclusive of Prioritised, emerging, and re-emerging communicable and non-communicable diseases and conditions. • Surveillance will be primarily based on de-identified (anonymised) individual-level patient information that emanates from health care facilities, laboratories, and other sources. • Public Health Surveillance will be governed by an adequately resourced effective administrative and technical structure and will ensure that it serves the public good. • India will provide regional and global leadership in managing events that constitute a Public Health Emergency of International Concern. Multiple disease outbreaks have prompted India to proactively respond with prevention and control measures. These actions are based on information from public health surveillance. India was able to achieve many successes in the past. Smallpox was eradicated and polio was eliminated. India has been able to reduce HIV incidence and deaths and advance and accelerate TB elimination efforts. Many outbreaks of vector-borne diseases, acute encephalitis syndromes, acute febrile illnesses, diarrhoeal and respiratory diseases have been promptly detected, identified and managed. These successes are a result of effective community-based, facility-based, and health system-based surveillance. The program response involved multiple sectors, including public and private health care systems and civil society.

scholarly journals Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study

2019 ◽  
Vol 112 (5) ◽  
pp. 192-199 ◽  
Author(s):  
Chantelle Rizan ◽  
Julia Montgomery ◽  
Charlotte Ramage ◽  
Jan Welch ◽  
Graeme Dewhurst
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Unmet Needs ◽  
Junior Doctors ◽  
Loss Of Control ◽  
Data Set ◽  
Time Out ◽  
The Uk ◽  
The Impact ◽  
Depth Interviews

Objectives The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an ‘F3’ year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. Design This is an exploratory qualitative study, using in-depth interviews and content analysis. Setting UK. Participants Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. Main outcome measures Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. Results There were four predominant themes arising within the data set which can be framed as ‘unmet needs’ arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a ‘break’. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. Conclusions This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce.

scholarly journals The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Andrew M. Briggs ◽  
Joanne E. Jordan ◽  
Deborah Kopansky-Giles ◽  
Saurab Sharma ◽  
Lyn March ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Systems ◽  
Logic Model ◽  
Health Systems Strengthening ◽  
Data Driven ◽  
Key Informants ◽  
Country Level ◽  
Global Guidance ◽  
Guiding Principles ◽  
Contemporary Context

Abstract Background Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. Methods An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model. Results Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. Conclusion KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

scholarly journals Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii9-ii21
Author(s):  
Fatuma Manzi ◽  
Tanya Marchant ◽  
Claudia Hanson ◽  
Joanna Schellenberg ◽  
Elibariki Mkumbo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Systems ◽  
Building Blocks ◽  
Realist Evaluation ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Empowerment Theory ◽  
Multiple Sources ◽  
Programme Theory

Abstract Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.

scholarly journals Challenges of Transcultural Caring Among Health Workers in Mashhad-Iran: A Qualitative Study

2015 ◽  
Vol 8 (7) ◽  
pp. 203 ◽  
Author(s):  
Rana Amiri ◽  
Abbas Heidari ◽  
Nahid Dehghan-Nayeri ◽  
Abou Ali Vedadhir ◽  
Hosein Kareshki
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Cultural Difference ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Cultural Issues ◽  
Transcultural Care ◽  
Communication Barrier ◽  
Depth Interviews

<p><strong>BACKGROUND: </strong>One of the consequences of migration is cultural diversity in various communities. This has created challenges for healthcare systems.</p><p><strong>OBJECTIVES: </strong>The aim of this study is to explore the health care staffs’ experience of caring for Immigrants in Mashhad- Iran.</p><p><strong>SETTING:</strong> This study is done in Tollab area (wherein most immigrants live) of Mashhad. Clinics and hospitals that immigrants had more referral were selected.</p><p><strong>PARTICIPANTS:</strong> Data were collected through in-depth interviews with medical and nursing staffs. 15 participants (7 Doctors and 8 Nurses) who worked in the more referred immigrants’ clinics and hospitals were entered to the study.<strong> </strong></p><p><strong>DESIGN: </strong>This is a qualitative study with content analysis approach. Sampling method was purposive. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed by using latent qualitative content analysis.</p><p><strong>RESULTS:</strong> The data analysis consisted of four main categories; (1) communication barrier, (2) irregular follow- up, (3) lack of trust, (4) cultural- personal trait.</p><p><strong>CONCLUSION:</strong> Result revealed that health workers are confronting with some trans- cultural issues in caring of immigrants. Some of these issues are related to immigration status and some related to cultural difference between health workers and immigrants. These issues indicate that there is transcultural care challenges in care of immigrants among health workers. Due to the fact that Iran is the context of various cultures, it is necessary to consider the transcultural care in medical staffs. The study indicates that training and development in the area of cultural competence is necessary.</p>

scholarly journals Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Vaitiare Mulderij-Jansen ◽  
Izzy Gerstenbluth ◽  
Ashley Duits ◽  
Adriana Tami ◽  
Ajay Bailey
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
Entomological Surveillance ◽  
Vector Borne Diseases ◽  
System Building ◽  
Vector Borne ◽  
Dutch Caribbean ◽  
Health System Building Blocks

Abstract Background Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks. Methods From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data. Results This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance). Conclusions This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases. Graphical abstract

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