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Background: During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). Methods: We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. Results: After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients' time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Conclusions: Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.
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COVID-19 , Atención a la Salud , Países en Desarrollo , Enfermedades no Transmisibles , Humanos , COVID-19/epidemiología , Programas de Gobierno/organización & administración , Programas de Gobierno/normas , Hipertensión/epidemiología , Hipertensión/terapia , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Pandemias , Atención a la Salud/organización & administración , Atención a la Salud/normas , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , InternacionalidadRESUMEN
INTRODUCTION: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. METHODS: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. EXPECTED OUTCOMES: Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518).
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Actitud del Personal de Salud , Servicios de Salud Materna , Calidad de la Atención de Salud , Respeto , Inclusión Social , Parto Obstétrico/psicología , Parto Obstétrico/normas , Estudios de Factibilidad , Femenino , Programas de Gobierno/organización & administración , Programas de Gobierno/normas , Humanos , Ciencia de la Implementación , Recién Nacido , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Mortalidad Materna , Obstetricia/métodos , Obstetricia/organización & administración , Obstetricia/normas , Pakistán/epidemiología , Parto/psicología , Mortalidad Perinatal , Embarazo , Atención Prenatal/organización & administración , Atención Prenatal/psicología , Atención Prenatal/normas , Sistemas de Apoyo Psicosocial , Salud Pública/métodos , Salud Pública/normasRESUMEN
Since their introduction two decades ago, Community Wildfire Protection Plans (CWPPs) have become a common planning tool for improving community preparedness and risk mitigation in fire-prone regions, and for strengthening coordination among federal and state land management agencies, local government, and residents. While CWPPs have been the focus of case studies, there are limited large-scale studies to understand the extent of, and factors responsible for, variation in stakeholder participation-a core element of the CWPP model. This article describes the scale and scope of participation in CWPPs across the western United States. We provide a detailed account of participants in over 1,000 CWPPs in 11 states and examine how levels of participation and stakeholder diversity vary as a function of factors related to planning process, planning context, and the broader geographic context in which plans were developed. We find that CWPPs vary substantially both by count and diversity of participants and that the former varies as a function of the geographic scale of the plan, while the latter varies largely as a function of the diversity of landowners within the jurisdiction. More than half of participants represented local interests, indicating a high degree of local engagement in hazard mitigation. Surprisingly, plan participation and diversity were unrelated to wildfire hazard. These findings suggest that CWPPs have been largely successful in their intent to engage diverse stakeholders in preparing for and mitigating wildfire risk, but that important challenges remain. We discuss the implications of this work and examine how the planning process and context for CWPPs may be changing.
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Participación de la Comunidad/métodos , Conservación de los Recursos Naturales/métodos , Gestión de Riesgos/organización & administración , Incendios Forestales/prevención & control , Conducta Cooperativa , Diversidad Cultural , Incendios/prevención & control , Geografía , Programas de Gobierno/métodos , Programas de Gobierno/organización & administración , Historia del Siglo XXI , Humanos , Gestión de Riesgos/métodos , Estados UnidosAsunto(s)
COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Programas de Gobierno/organización & administración , Máscaras/provisión & distribución , Juego de Reactivos para Diagnóstico/provisión & distribución , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/virología , Prueba de COVID-19/instrumentación , Control de Enfermedades Transmisibles/economía , Programas de Gobierno/economía , Humanos , Máscaras/economía , Juego de Reactivos para Diagnóstico/economía , SARS-CoV-2/patogenicidad , Estados Unidos/epidemiologíaAsunto(s)
Investigación Biomédica/organización & administración , Agencias Gubernamentales , Programas de Gobierno/organización & administración , Neoplasias/terapia , Política , Investigación Biomédica/legislación & jurisprudencia , Programas de Gobierno/legislación & jurisprudencia , Humanos , Estados UnidosAsunto(s)
Programas de Gobierno , Pandemias/prevención & control , Administración en Salud Pública , Desarrollo de Vacunas , Vacunas Virales , Animales , Brotes de Enfermedades , Programas de Gobierno/economía , Programas de Gobierno/legislación & jurisprudencia , Programas de Gobierno/organización & administración , Humanos , Pandemias/economía , Salud Pública , Estados Unidos , Zoonosis/epidemiologíaRESUMEN
Since its early spread in early 2020, the disease caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coronavirus Disease 2019 (COVID-19) has caused mass disruptions to health services. These have included interruptions to programs that aimed to prevent, control, and eliminate neglected tropical diseases (NTDs). In March 2020, the World Health Organization (WHO) released interim guidelines recommending the temporary cessation of mass drug administration (MDA), community-based surveys, and case detection, while encouraging continuation of morbidity management and vector control where possible. Over the course of the following months, national programs and implementing partners contributed to COVID-19 response efforts, while also beginning to plan for resumption of NTD control activities. To understand the challenges, opportunities, and recommendations for maximizing continuity of disease control during public health emergencies, we sought perspectives from Nigeria and Guinea on the process of restarting NTD control efforts during the COVID-19 pandemic. Through semistructured interviews with individuals involved with NTD control at the local and national levels, we identified key themes and common perspectives between the 2 countries, as well as observations that were specific to each. Overall, interviewees stressed the challenges posed by COVID-19 interruptions, particularly with respect to delays to activities and related knock-on impacts, such as drug expiry and prolonged elimination timelines, as well as concerns related to funding. However, respondents in both countries also highlighted the benefits of a formal risk assessment approach, particularly in terms of encouraging information sharing and increasing coordination and advocacy. Recommendations included ensuring greater availability of historical data to allow better monitoring of how future emergencies affect NTD control progress; continuing to use risk assessment approaches in the future; and identifying mechanisms for sharing lessons learned and innovations between countries as a means of advancing postpandemic health systems and disease control capacity strengthening.
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COVID-19 , Control de Enfermedades Transmisibles/organización & administración , Enfermedades Desatendidas/prevención & control , Control de Enfermedades Transmisibles/economía , Programas de Gobierno/economía , Programas de Gobierno/organización & administración , Guinea , Humanos , Administración Masiva de Medicamentos , Nigeria , SARS-CoV-2 , Medicina Tropical/métodosRESUMEN
BACKGROUND: Gauteng province, with 26.3% of South Africa's population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa's reported COVID-19 cases. AIM: The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. MATERIAL AND METHODS: Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. RESULTS: Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. CONCLUSION: Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.
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COVID-19/epidemiología , Pandemias , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Femenino , Programas de Gobierno/organización & administración , Humanos , Masculino , Investigación Cualitativa , Sudáfrica/epidemiología , Encuestas y CuestionariosRESUMEN
Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.
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Centros Médicos Académicos/organización & administración , COVID-19/etnología , Desastres/prevención & control , Equidad en Salud/normas , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/virología , Defensa Civil/organización & administración , Consenso , Diversidad Cultural , Etnicidad/estadística & datos numéricos , Programas de Gobierno/organización & administración , Programas de Gobierno/normas , Disparidades en Atención de Salud/etnología , Humanos , Grupos Minoritarios/estadística & datos numéricos , Formulación de Políticas , Salud Pública/normas , SARS-CoV-2/genética , Participación Social , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS: In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING: Bill & Melinda Gates Foundation.
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COVID-19/prevención & control , Países en Desarrollo/economía , Desarrollo Económico , Financiación de la Atención de la Salud , Agencias Internacionales/economía , COVID-19/economía , COVID-19/epidemiología , Financiación Gubernamental/economía , Financiación Gubernamental/organización & administración , Salud Global/economía , Programas de Gobierno/economía , Programas de Gobierno/organización & administración , Programas de Gobierno/estadística & datos numéricos , Programas de Gobierno/tendencias , Producto Interno Bruto , Gastos en Salud/estadística & datos numéricos , Gastos en Salud/tendencias , Humanos , Agencias Internacionales/organización & administración , Cooperación InternacionalAsunto(s)
COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Programas de Gobierno/organización & administración , Pandemias/prevención & control , COVID-19/epidemiología , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Programas de Gobierno/legislación & jurisprudencia , Humanos , Liderazgo , Pandemias/estadística & datos numéricos , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study was to assess the extent to which public support for outbreak containment policies varies with respect to the severity of an infectious disease outbreak. METHODS: A web-enabled survey was administered to 1017 residents of Singapore during the coronavirus disease 2019 (COVID-19) pandemic, and was quota-sampled based on age, sex, and ethnicity. A fractional-factorial design was used to create hypothetical outbreak vignettes characterised by morbidity and fatality rates, and local and global spread of an infectious disease. Each respondent was asked to indicate which response policies (among five policies restricting local movement and four border control policies) they would support in five randomly assigned vignettes. Binomial logistic regressions were used to predict the probabilities of support as a function of outbreak attributes, personal characteristics, and perceived policy effectiveness. RESULTS: Likelihood of support varied across government response policies but was generally higher for border control policies compared with internal policies. The fatality rate was the most important factor for internal policies, while the degree of global spread was the most important for border control policies. In general, individuals who were less healthy, had higher-income, and were older were more likely to support these policies. Perceived effectiveness of a policy was a consistent and positive predictor of public support. CONCLUSIONS: Our findings suggest that campaigns to promote public support should be designed specifically to each policy and tailored to different segments of the population. They should also be adapted based on the evolving conditions of the outbreak in order to receive continued public support.
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COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/organización & administración , Programas de Gobierno/organización & administración , Opinión Pública , Adulto , Factores de Edad , COVID-19/mortalidad , Emigración e Inmigración/legislación & jurisprudencia , Etnicidad , Femenino , Estado de Salud , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Factores Sexuales , Singapur/epidemiología , Factores SocioeconómicosAsunto(s)
COVID-19/diagnóstico , Pruebas Dirigidas al Consumidor/economía , Desarrollo de Medicamentos/economía , Sistemas de Atención de Punto/economía , Diagnóstico Precoz , Programas de Gobierno/economía , Programas de Gobierno/organización & administración , Humanos , National Institutes of Health (U.S.) , Estados UnidosAsunto(s)
Prestación Integrada de Atención de Salud/economía , Programas de Gobierno/organización & administración , United States Department of Veterans Affairs/organización & administración , Veteranos/estadística & datos numéricos , Centers for Medicare and Medicaid Services, U.S. , Humanos , Estados UnidosRESUMEN
As vice president, Joe Biden was the cancer advocate-in-chief. As president, he has a different public health crisis to deal with-COVID-19-but given Biden's passion for cancer research, many expect he will build on the previous Moonshot initiative with another push to accelerate the pace of progress in cancer control.
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Investigación Biomédica/economía , Investigación Biomédica/legislación & jurisprudencia , Política de Salud , Neoplasias/epidemiología , Neoplasias/terapia , Política , COVID-19/economía , Financiación Gubernamental , Programas de Gobierno/organización & administración , Humanos , Objetivos Organizacionales , Pandemias , Apoyo a la Investigación como Asunto , Estados UnidosRESUMEN
COVID 19 pandemic has posed challenges for public mental healthcare delivery, particularly in LAMI countries such as India. However, this unique situation has also brought in opportunities to revisit the health system and optimally utilize the available resources. In this brief report, we report one such new initiative in which existing community health workers (CHWs), known as ASHAs (Accredited Social Health Activist) acted as a bridge between patients with mental illness and the District Mental Health Program (DMHP) of Ramanagara district of Karnataka State, India. They maintained continuity of care of 76 patients by delivering mental healthcare services to the patients' doorstep. This has paved the way to rethink and revisit their role in public mental healthcare delivery not only during COVID 19 times, but also beyond.