RESUMO
BACKGROUND: In 2014, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) introduced a new funding model. Following notice of their 2014-2016 allocation, Morocco took the bold decision to reallocate its entire allocated investment (US$ 8 029 632) for health systems strengthening (HSS) and submitted a comprehensive request for funding solely for interventions to strengthen the health system. AIMS: To explore the specific barriers and facilitators to Morocco's novel development and submission of a cross-cutting HSS funding request to the Global Fund and to document lessons learned and recommendations for policy and programme leaders interested in leveraging Global Fund investments for health systems. METHODS: A thorough desk review of key documents and 15 in-depth qualitative interviews were conducted with key stakeholders in Morocco in 2017. RESULTS: In preparation for the funding request, Morocco carried out a comprehensive assessment of the health system, which included extensive dialogue with stakeholders and partners. This action was critical to developing a shared understanding and support for adopting a cross-cutting HSS approach. Despite concerns about potential negative effects of diverting funding from disease-specific programmes, visionary leadership advocated effectively for investing in HSS, and this paved the way for the development of a clear Concept Note requesting Global Fund financial support for the health system more broadly. CONCLUSION: Morocco was the first country in the Global Fund's Middle/East North Africa region to invest its entire Global Fund allocation in strengthening the health system. Many important lessons have been learned from this novel experience and these are presented for shared learning. This opportunity for learning is timely as countries begin preparations for the upcoming funding cycle.
Assuntos
Síndrome da Imunodeficiência Adquirida , Administração Financeira , África do Norte , Organização do Financiamento , Saúde Global , Humanos , Cooperação Internacional , Oriente Médio , MarrocosAssuntos
Infecções por HIV/epidemiologia , Política de Saúde , Malária Falciparum/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , África Subsaariana/epidemiologia , Antimaláricos/administração & dosagem , Antimaláricos/efeitos adversos , Antimaláricos/provisão & distribuição , Quimioprevenção/economia , Quimioprevenção/métodos , Quimioprevenção/normas , Comorbidade , Combinação de Medicamentos , Diagnóstico Precoce , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Recém-Nascido , Mosquiteiros Tratados com Inseticida/provisão & distribuição , Malária Falciparum/diagnóstico , Malária Falciparum/economia , Malária Falciparum/epidemiologia , Controle de Mosquitos/economia , Controle de Mosquitos/métodos , Controle de Mosquitos/normas , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/economia , Complicações Parasitárias na Gravidez/epidemiologia , Pirimetamina/efeitos adversos , Pirimetamina/provisão & distribuição , Sulfadoxina/efeitos adversos , Sulfadoxina/provisão & distribuição , Organização Mundial da SaúdeRESUMO
OBJECTIVES: Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. METHODS: A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. FINDINGS: Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. CONCLUSION: There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.
Assuntos
Anticoncepção Pós-Coito , Países em Desenvolvimento/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Renda , HumanosAssuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Causas de Morte , Países em Desenvolvimento , Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/mortalidade , Mortalidade Materna , Complicações Infecciosas na Gravidez/mortalidade , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Estudos Transversais , Surtos de Doenças/prevenção & controle , Feminino , Previsões , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Cooperação Internacional , Serviços de Saúde Materna/provisão & distribuição , Serviços de Saúde Materna/tendências , Gravidez , Adulto JovemRESUMO
OBJECTIVES: Research on child labor and its effect on health has been limited. We sought to determine the impact of child labor on children's health by correlating existing health indicators with the prevalence of child labor in selected developing countries. METHODS: We analyzed the relationship between child labor (defined as the percentage of children aged 10 to 14 years who were workers) and selected health indicators in 83 countries using multiple regression to determine the nature and strength of the relation. The regression included control variables such as the percentage of the population below the poverty line and the adult mortality rate. RESULTS: Child labor was significantly and positively related to adolescent mortality, to a population's nutrition level, and to the presence of infectious disease. CONCLUSIONS: Longitudinal studies are required to understand the short- and long-term health effects of child labor on the individual child.
Assuntos
Mortalidade da Criança , Proteção da Criança/estatística & dados numéricos , Países em Desenvolvimento , Emprego/estatística & dados numéricos , Indicadores Básicos de Saúde , Adolescente , Criança , Comparação Transcultural , Ecologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Desnutrição/epidemiologia , Pobreza/estatística & dados numéricos , Política Pública , Análise de Regressão , Saneamento , Nações UnidasRESUMO
The proportion of neonatal deaths in children has significantly increased, comprising at present almost 40% of all the nearly 11 million deaths of children under the age of five. In order to further reduce child mortality, substantial prompt attention to and reductions in neonatal mortality and morbidity are necessary. The reasons for insufficient investment in neonatal care are mostly based on incorrect assumptions about the importance, cost, and difficulty of tackling the issue. Further research is needed on the cost-effectiveness of neonatal interventions, but there is sufficient knowledge and evidence on the range, effect and cost-effectiveness of interventions to support significant increase in investments and broader programmatic implementation of available approaches. The continuum of care that follows the life-cycle is part of a high impact program delivery, supported by enabling environment, encompassing strong political commitment and strengthened comprehensive health system, from community level to clinical services. The international community needs to increase its funding and extend programs in close coordination with national health programs that are translated into partnerships at national and international level.