Dominican Republic: The response to the COVID-19 pandemic in 2020

2020 ◽  
Vol 128 (S2) ◽  
pp. S227-S235
Author(s):  
Magdalena Rathe
Keyword(s):  
Dominican Republic ◽  
Health System ◽  
International Standards ◽  
Caribbean Region ◽  
Level Of Care ◽  
Population Assignment ◽  
Risk Environment ◽  
Pandemic Preparedness ◽  
Environment And Health ◽  
Installed Capacity

The paper presents the situation in the Dominican Republic in terms of pandemic preparedness, the policies implemented to respond to it, the achievements made, and the challenges for the future. The COVID-19 pandemic found the Dominican Republic unprepared to deal with it, with significant deficiencies in the areas of prevention, early detection and notification, rapid response and mitigation, compliance with international standards, risk environment and health system strength. The country had the most infections in the entire Caribbean region and one of the most important in Latin America, however, the policies implemented were appropriate and the country faced lower rates of both serious illness and mortality, compared to the rest of the region. The health system, so far, has been able to respond, without exceeding the installed capacity in terms of beds and intensive care units. The worst part of the response preparedness is the weakness of the first level of care and its underfinancing, concluding on the necessity of investing adequately in strengthening the first level of care, implementing the population assignment using geographical criteria, developing payment for results mechanisms to increase quality and efficiency and putting in place the unified electronic medical record, in order to make it feasible to establish a prevention strategy.

2019 TOKYO DECLARATION

2021 ◽  
Vol 9 (4) ◽  
pp. 83-85
Author(s):  
James Appleyard
Keyword(s):  
Human Resources ◽  
Health System ◽  
Health Professionals ◽  
Ethical Framework ◽  
Life Balance ◽  
Individual Level ◽  
Service Environment ◽  
Environment And Health ◽  
Individual Physician ◽  
The Individual

As the Congress explored the nature of burnout among doctors and health professionals in differing settings and in different nations it is clear that burnout is a global phenomenon. An organizational paradigm changes to a person- and people-centered system that incorporates complexity, is adaptive and integrative is essential. Such a change will enable continuing medical education be effective and the current unaffordable and unnecessary waste of human resources that the Congress identified reduced. The Congress reviewed a range of features precipitating burnout including a dysfunctional work–life balance and a variety of relatively simple individually protective factors. It is because of this variety that person- and people-centered initiatives rather than narrowly based top-down management solutions will prove effective Individual-level actions can be taken to reduce stress and poor health symptoms through effective coping and promoting healthy behavior. But there needs to be a much better alignment between the health system and the individual physician so that there are shared professional values within a clear medical ethical framework [23] that encourages professional development and adaptation to the health service environment and health system.

Abstract P128: Impact of the COVID-19 Pandemic in Houston on Stroke Care in a Health System of 10 Stroke Centers

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sujan T Reddy ◽  
Tzu-ching Wu ◽  
Suja S Rajan ◽  
Amirali Tahanan ◽  
Mohammad H Rahbar ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Health System ◽  
Stroke Care ◽  
Pandemic Preparedness ◽  
Initial Drop ◽  
Mild Stroke ◽  
Transferred Patients ◽  
The Impact

Introduction: We assessed the impact of COVID-19 pandemic on stroke admissions and care metrics within a health system of 10 stroke centers, with 4 comprehensive stroke centers (CSC) in the greater Houston region. Methods: Between January-June 2019 and January-June 2020, we compared the proportion of ischemic strokes (total & direct CSC presentations) & intracerebral hemorrhage (ICH) relative to total admissions using logistic regression, and among the direct CSC presentations, we compared door to tPA and thrombectomy times using Wilcoxon Rank Sum. Results: A total of 4808 cases were assessed (Table 1). There was an initial drop of ~30% in cases at the pandemic onset (Fig.1). Numerically fewer patients in the 2020 period were seen at primary and CSCs (Table 1). Compared to 2019, there was a significant reduction in transferred patients [N(%), 829 (36) vs. 637 (34), p=0.02], in hospital strokes [N(%), 111 (5) vs. 69 (4), p=0.04], and mild strokes (NIHSS 1-5) [N (%), 891 (43) vs. 635 (40),p=0.02], and no significant differences in the proportions of total ischemic strokes [OR (95% CI)=0.92 (0.79, 1.06), p=0.23], direct CSC presentations [OR (95% CI) =0.96 (0.86, 1.08), p=0.48] and ICH [OR (95% CI) =1.14 (0.98, 1.33), p=0.08] in 2020 (Fig. 1). Among the direct ischemic strokes at CSCs, there were similar mean (SD) (mins) door to tPA [44 (17) vs. 42 (17), p=0.14] but significantly prolonged door to thrombectomy times [94 (15) vs. 85 (20), p=0.005] in 2020. Conclusion: COVID-19 pandemic led to reduced mild stroke admissions, transfers and in hospital stroke alerts, & prolonged door to thrombectomy times. Identifying reasons to mitigate this discrepancy is crucial for next pandemic preparedness.

scholarly journals Identifying Users’ Requirements for Emergency Mapping Team Operations in the Dominican Republic

2020 ◽  
Vol 9 (3) ◽  
pp. 165
Author(s):  
Gregorio Rosario Michel ◽  
Santiago Muñoz Tapia ◽  
Fernando Manzano Aybar ◽  
Vladimir Guzmán Javier ◽  
Joep Crompvoets
Keyword(s):  
Dominican Republic ◽  
Spatial Data ◽  
Online Survey ◽  
Caribbean Region ◽  
Geospatial Information ◽  
Data Infrastructure ◽  
Future Studies ◽  
Wide Range ◽  
The Caribbean ◽  
The Impact

In recent years, a growing number of stakeholders have been taking part in the generation and delivery of geospatial information and services to reduce the impact of severe natural disasters on the communities. This is mainly due to a huge demand for accurate, current and relevant knowledge about the impacted areas for a wide range of applications in risk-informed decision makings. The aim of this paper is to identify users’ requirements for emergency mapping team (EMT) operations in the Dominican Republic (DR). An online survey was applied to collect data from key users involved in the Inter-Institutional Geospatial Information Team in DR. Our findings suggest a set of users’ requirements for EMT operations: (1) standardization; (2) establishing and maintaining a spatial data infrastructure; (3) partnership; (4) effective communication among stakeholders; and (5) capacity building. A better understanding of the users’ requirements and the associated information workflows will lead to a superior level of readiness for EMT operations in DR. This knowledge will support future studies/practices at the local and national levels in the Caribbean region, which share similar challenges in terms of natural hazards and development issues.

Political gridlock will cripple Haiti's healthcare

2016 ◽  
Keyword(s):  
Dominican Republic ◽  
Health System ◽  
Healthcare System ◽  
Political Crisis ◽  
Content Type

Subject Challenges facing the healthcare system. Significance A doctors' strike in Haiti has highlighted the parlous state of the country's health system, which is struggling to cope with successive medical crises. The health system requires a large funding injection to restore and improve medical provisions to the population, but the current political crisis looks set to prevent the development of a long-term strategy. Impacts Deteriorating healthcare may lead to an increase in migration to the Dominican Republic. Washington's decision not to fund October's election raises the risk of further delays, distracting political focus from healthcare. Electoral problems may deter some aid agencies from increasing funding, undermining healthcare assistance.

Recent U.S. Economic Policies and the Central Caribbean Economies

1992 ◽  
Vol 20 (4) ◽  
pp. 55-71 ◽  
Author(s):  
Addington Coppin
Keyword(s):  
Dominican Republic ◽  
The United States ◽  
The Other ◽  
Caribbean Region ◽  
Economic Policies ◽  
Employment Opportunities ◽  
Caribbean Basin Initiative ◽  
The Caribbean ◽  
Per Capita ◽  
Trade And Investment

This study examines the trade and investment performances of three economies in the Central Caribbean region since the Caribbean Basin Initiative (CBI) and associated programs. We find that the rapid growth in nontraditional exports from these economies to the United States did not necessarily translate into net foreign exchange earnings. On a per capita basis, export-related investment in Haiti was much lower than in the other two economies — Jamaica and the Dominican Republic. As a percentage of the labor force, gross employment gains for Jamaica have been significantly larger than those in either the Dominican Republic or Haiti. It appears that the policies favoring expansion in the offshore sector may foster employment opportunities of females, especially where traditional sectors are in decline.

scholarly journals Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar

2017 ◽  
Author(s):  
Matthew H. Bonds ◽  
Andres Garchitorena ◽  
Laura Cordier ◽  
Ann C. Miller ◽  
Margaret McCarty ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Low Income ◽  
Building Blocks ◽  
International Standards ◽  
Health District ◽  
Health System Strengthening ◽  
Systems Research ◽  
Data Platform ◽  
Government District

AbstractObjectiveWe demonstrate a replicable model health district for Madagascar. The governments of many low-income countries have adopted health policies that follow international standards, and yet there are four hundred million people without basic access to primary care. Closing this global health delivery gap is typically framed as an issue of scale-up, accomplished primarily through integrating international donor funds with broad-based health system strengthening (HSS) efforts. However, there is no established process by which healthcare systems measure improvements at the point of service and how those, in turn, impact population health. There is no gold standard, equivalent to randomized trials of individual-level interventions, for health systems research. Here, we present a framework for a model district in Madagascar where national policies are implemented along with additional health system interventions to allow for bottom-up adaptation.SettingThe intervention takes place in a government district in Madagascar, which includes 1 district hospital, 20 primary care health centers, and a network of community health workers.InterventionThe program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district and pioneers a data platform that includes 1) strengthening the district’s health management information systems; 2) monitoring and evaluation dashboards; and 3) a longitudinal cohort demographic and health study of over 1,500 households, with a true baseline in intervention and comparison groups.ConclusionThe integrated intervention and data platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates. It thus supports field-based implementation and policy research to fill the know-do gap, while providing the foundation for a new science of sustaining health.Data Sharing StatementData can be made available upon request by [email protected].

scholarly journals Co-learning during the co-creation of a dengue early warning system for the health sector in Barbados

2022 ◽  
Vol 7 (1) ◽  
pp. e007842
Author(s):  
Anna M Stewart-Ibarra ◽  
Leslie Rollock ◽  
Sabu Best ◽  
Tia Brown ◽  
Avriel R Diaz ◽  
...  
Keyword(s):  
Health System ◽  
Early Warning ◽  
Health Sector ◽  
Disease Outbreaks ◽  
Warning System ◽  
Early Warning Systems ◽  
Adaptation Strategy ◽  
Caribbean Region ◽  
Climate Information ◽  
Climate And Health

Over the past decade, the Caribbean region has been challenged by compound climate and health hazards, including tropical storms, extreme heat and droughts and overlapping epidemics of mosquito-borne diseases, including dengue, chikungunya and Zika. Early warning systems (EWS) are a key climate change adaptation strategy for the health sector. An EWS can integrate climate information in forecasting models to predict the risk of disease outbreaks several weeks or months in advance. In this article, we share our experiences of co-learning during the process of co-creating a dengue EWS for the health sector in Barbados, and we discuss barriers to implementation as well as key opportunities. This process has involved bringing together health and climate practitioners with transdisciplinary researchers to jointly identify needs and priorities, assess available data, co-create an early warning tool, gather feedback via national and regional consultations and conduct trainings. Implementation is ongoing and our team continues to be committed to a long-term process of collaboration. Developing strong partnerships, particularly between the climate and health sectors in Barbados, has been a critical part of the research and development. In many countries, the national climate and health sectors have not worked together in a sustained or formal manner. This collaborative process has purposefully pushed us out of our comfort zone, challenging us to venture beyond our institutional and disciplinary silos. Through the co-creation of the EWS, we anticipate that the Barbados health system will be better able to mainstream climate information into decision-making processes using tailored tools, such as epidemic forecast reports, risk maps and climate-health bulletins, ultimately increasing the resilience of the health system.

scholarly journals Experience in implementing the International Standards for Assessing Newborn Growth INTERGROWTH-21st

2021 ◽  
Vol 66 (1) ◽  
pp. 117-124
Author(s):  
I. I. Ryumina ◽  
M. M. Markelova ◽  
M. V. Narogan ◽  
I. V. Orlovskaya ◽  
A. E. Perepelkina ◽  
...  
Keyword(s):  
Postnatal Growth ◽  
Physical Development ◽  
Premature Baby ◽  
International Standards ◽  
Pediatric Practice ◽  
Anthropometric Parameters ◽  
Intrauterine Growth ◽  
National Medical ◽  
Environment And Health ◽  
Premature Babies

The physical development of newborns and infants is the most important parameter in assessing their health. However, the standards of anthropometric parameters, and most importantly their growth in premature babies, especially those born with low and extremely low body weight, are still controversial.Objective: to apply the methodology for measuring and assessing the main anthropometric indicators of newborns using the international standards of postnatal growth of premature babies INTERGROWTH-21st to resolve the issue of the feasibility of its adaptation and widespread introduction into neonatological and pediatric practice in the Russian Federation. 4876 children were born at Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology (participant of the international project for the implementation of INTERGROWTH-21st standards in neonatological and pediatric practice) from 15.05.2018 to 26.11.2018. 439 (9%) of them were born premature, of which 376 children (89,3%) with gestational age confirmed by ultrasound were included in the study. There was a detailed file for each child to assess the environment and health of the mother, the course of pregnancy, childbirth, the state of health of the child from birth to discharge from the hospital. 2.1% of children classified by INTERGROWTH-21st as children with intrauterine growth retardation, according to Fenton charts, had normal intrauterine growth. When comparing the postnatal growth at discharge from hospital on the Fenton scale, more children were classified as children with impaired postnatal growth; the discrepancy between INTERGROWTH-21st and Fenton diagrams was 8%. At discharge, 52% of premature babies were exclusively breastfed, 28.8% of premature babies were at mixed feeding.Conclusion. On the one hand, the use of INTERGROWTH-21st scales helps to correct nutrition in case of delay in physical development, and, on the other hand, it reduces the risk of metabolic disorders associated with an aggressive desire to achieve rapid growth of a premature baby.

Electrokit: Power Utility Toolkit-The Overview: Best Practices in Electric Power Distribution Companies in the Latin America and Caribbean Region

2021 ◽  
Author(s):  
Augusto Bonzi Teixeira ◽  
Eric Fernando Boeck Daza ◽  
Michelle Carvalho Metanias Hallack ◽  
Virginia Snyder ◽  
Arturo Daniel Alarcon Rodriguez ◽  
...  
Keyword(s):  
Best Practices ◽  
Power Distribution ◽  
Action Plan ◽  
International Standards ◽  
Caribbean Region ◽  
Power Utility ◽  
Current Trends ◽  
Electric Power Distribution ◽  
Latin America And Caribbean ◽  
Power Utilities

The Electrokit is an initiative created by the IDB to strengthen transformation and continuous improvement of electric utilities in the LAC region. It follows international standards that characterize and evaluate utilities based on indicators and best practices. The Electrokit is organized in 16 activities that are common to most electricity utilities. The aim of the toolkit is to provide power utilities, policy and decision-makers access to best practices, current trends, and expertise to: (i) identify challenges, develop a strategy and action plan for addressing them; and (ii) support utilities to be more sustainable, efficient, improve customer experience and accelerate innovation to stay ahead of the rapidly sector transformation. The Overview presents the main objectives of the toolkit, the structure of its areas and activities, and a guide on how companies could design an action plan.

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