Health technology assessment and healthcare environmental sustainability: Prioritizing effort and maximizing impact.

The growing global focus on and sense of urgency toward improving healthcare environmental sustainability and moving to low-carbon and resilient healthcare systems is increasingly mirrored in discussions of the role of health technology assessment (HTA). This Perspective considers how HTA can most effectively contribute to these goals and where other policy tools may be more effective in driving sustainability, especially given the highly limited pool of resources available to conduct environmental assessments within HTA. It suggests that HTA might most productively focus on assessing those technologies that have intrinsic characteristics which may cause specific environmental harms or vulnerabilities, while the generic environmental impacts of most other products may be better addressed through other policy and regulatory mechanisms.

What Should Healthcare Systems Consider When Modernizing Call Centers? Early Considerations From the Veterans Health Administration.

GOAL: Growing numbers of hospitals and payers are using call centers to answer patients' clinical and administrative questions, schedule appointments, address billing issues, and offer supplementary care during public health emergencies and national disasters. In 2020, the Veterans Health Administration (VA) implemented VA Health Connect, an enterprise-wide initiative to modernize call centers. VA Health Connect is designed to improve the care experience with the convenience, flexibility, and simplicity of a single toll-free number connected to a range of 24/7 virtual services. The services are organized into four areas: administrative guidance for scheduling and general inquiries; pharmacy support for medication matters; clinical triage for evaluation of symptoms and recommended care; and virtual visits with providers for urgent and episodic care. Through a qualitative evaluation of VA Health Connect, we sought to identify the factors that affected the development of this program and to compile considerations to support the implementation of other enterprise-wide initiatives. METHODS: The evaluation team interviewed 29 clinical and administrative leads from across the VA. These leads were responsible for the modernization of their local service networks. PhD-level qualitative methodologists conducted the interviews, asking participants to reflect on barriers and facilitators to modernization and implementation. The team employed a rapid qualitative analytic approach commonly used in healthcare research to distill robust results. PRINCIPAL FINDINGS: A review of the early implementation of VA Health Connect found: (1) deadlines proved challenging but provided momentum for the initiative; (2) a balance between standardized processes and local adaptations facilitated implementation; (3) attention to staffing, hiring, and training of call center staff before implementation expedited workflows; (4) establishing national and local leadership commitment to the innovation from the onset increased team cohesion and efficacy; and (5) anticipating information technology infrastructure needs prevented delays to modernization and implementation. PRACTICAL APPLICATIONS: Our findings suggest that healthcare systems would benefit from anticipating likely obstacles (e.g., delays in software implementations and negotiations with unions), thus providing ample time to secure leadership buy-in and identify local champions, communicating early and often, and supporting flexible implementation to meet local needs. VA leadership can use this evaluation to refine implementation, and it could also have important implications for regulators, federal health exchanges, insurers, and other healthcare systems when determining resource levels for call centers.

Reducing time to differentiated service delivery for newly-diagnosed people living with HIV in Kigali, Rwanda: a pilot, unblinded, randomized controlled trial.

BACKGROUND: Differentiated service delivery (DSD) programs for people living with HIV (PWH) limit eligibility to patients established on antiretroviral therapy (ART), yet uncertainty exists regarding the duration on ART necessary for newly-diagnosed PWH to be considered established. We aimed to determine the feasibility, acceptability, and preliminary impact of entry into DSD at six months after ART initiation for newly-diagnosed PWH. METHODS: We conducted a pilot randomized controlled trial in three health facilities in Rwanda. Participants were randomized to: (1) entry into DSD at six months after ART initiation after one suppressed viral load (DSD-1VL); (2) entry into DSD at six months after ART initiation after two consecutive suppressed viral loads (DSD-2VL); (3) treatment as usual (TAU). We examined feasibility by examining the proportion of participants assigned to intervention arms who entered DSD, assessed acceptability through patient surveys and by examining instances when clinical staff overrode the study assignment, and evaluated preliminary effectiveness by comparing study arms with respect to 12-month viral suppression. RESULTS: Among 90 participants, 31 were randomized to DSD-1VL, 31 to DSD-2VL, and 28 to TAU. Among 62 participants randomized to DSD-1VL or DSD-2VL, 37 (60%) entered DSD at 6 months while 21 (34%) did not enter DSD because they were not virally suppressed. Patient-level acceptability was high for both clinical (mean score: 3.8 out of 5) and non-clinical (mean score: 4.1) elements of care and did not differ significantly across study arms. Viral suppression at 12 months was 81%, 81% and 68% in DSD-1VL, DSD-2VL, and TAU, respectively (p = 0.41). CONCLUSIONS: The majority of participants randomized to intervention arms entered DSD and had similar rates of viral suppression compared to TAU. Results suggest that early DSD at six months after ART initiation is feasible for newly-diagnosed PWH, and support current WHO guidelines on DSD. TRIAL REGISTRATION: Clinicaltrials.gov NCT04567693; first registered on September 28, 2020.

Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study.

BACKGROUND: The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system. METHODS: This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 - 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis. RESULTS: Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period. Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices. CONCLUSION: It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.

Implications of technological advancement of surgery in low and middle-income countries' a narrative review.

Countries that are striving to keep pace with emerging technologies in surgical practices and still not able to cope with exemplary international standards are in dire need of resources to build and strengthen their healthcare system. This review focusses on the impeding factors that hinder in adaptation of advanced technology and machinery in the health care industry. Considering the immense potential for current surgical technologies to transform the delivery of healthcare, their implementation in LMICs confronts considerable challenges due to lack of infrastructure, human capital and inadequate resources. To address these difficulties, various entities, including healthcare institutions, government and non-governmental organisations, and foreign partners, must work together. Building capacity through intended education and training initiatives, building infrastructure, and collaborative partnerships are critical for overcoming hurdles to effective deployment of surgical technology in low-income communities of the world.

Building disability-inclusive health systems.

Health systems often fail people with disabilities, which might contribute to their shorter life expectancy and poorer health outcomes than people without disabilities. This Review provides an overview of the existing evidence on health inequities faced by people with disabilities and describes existing approaches to making health systems disability inclusive. Our Review documents a broad range of health-care inequities for people with disabilities (eg, lower levels of cancer screening), which probably contribute towards health differentials. We identified 90 good practice examples that illustrate current strategies to reduce inequalities. Implementing such strategies could help to ensure that health systems can expect, accept, and connect people with disabilities worldwide, deliver on their right to health, and achieve health for all.

System-wide governance challenges of the Ebonyi State Malaria Elimination Programme and recommendations for malaria health system strengthening: a qualitative study among stakeholders in Ebonyi state, Nigeria.

OBJECTIVES: The burden of malaria has persistently been high in Ebonyi state and Nigeria despite long-standing collaborations with international partners with huge and increased amounts of financial investments. We explored the system-wide governance challenges of the Ebonyi State Malaria Elimination Programme (SMEP) and the factors responsible in order to make recommendations for malaria health system strengthening. DESIGN: We did a qualitative study informed by the health system governance framework by Mikkelsen-Lopez et al and Savedoff's concept of governance. SETTING AND PARTICIPANTS: Between 18 October 2022 and 8 November 2022, 25 semistructured face-to-face in-depth interviews were conducted in English with purposively selected key stakeholders in the Ebonyi SMEP aged 18 years or older with at least 2 years of involvement in the SMEP and who gave consent. ANALYSIS: Data were analysed deductively and the analytical strategy was informed by the framework method for the analysis of qualitative data by Gale et al. RESULTS: Many system-wide governance challenges of the SMEP were identified including the absence of state's strategic vision and plans for malaria elimination; very weak primary and secondary healthcare systems; inadequate financial allocation and untimely release of budgeted funds by the state government; lack of human resources for health and very poor mosquito net distribution system. Other challenges were inadequate stakeholders' participation; poor accountability culture; impaired transparency and corruption and impaired ability to address corruption. The fundamental responsible factors were the lack of state government's concern for people's welfare and lack of interest and commitment to the malaria elimination effort, chronic non-employment of staff and lack of human resources in the entire health sector including SMEP, and nepotism and godfatherism. CONCLUSIONS: The system-wide governance challenges and the responsible factors call for changing the 'business as usual' and refocusing on strengthening malaria health system governance in addressing the persisting malaria health problems in Ebonyi state (and Nigeria).

Transforming Kidney Health: The Role of Nursing Leadership in Value-Based Care.

This article examines the critical role of nursing leadership in the transition of nephrology care toward value-based models, highlighting how interdisciplinary care teams and population health management strategies are instrumental in improving patient outcomes and achieving health equity in kidney care. By reviewing both historical and present value-based care models in nephrology, this article showcases the evolution of care delivery and the strategic alignment of health care practices with value-based objectives. We introduce "HEALTH" as an innovative blueprint for nephrology nursing leadership, encapsulating key strategies to enhance kidney health care within the framework of value-based models. The acronym HEALTH stands for Holistic Care Integration, Equity and Tailored Care, Analytics and Machine Learning, Leverage Federal Programs, Training and Education, and Habit of Improvement, each representing a cornerstone in the strategic approach to advancing nephrology care. Through this lens, we discuss the impact of nursing leadership in fostering a culture of continuous improvement, leveraging technological advancements, and advocating for comprehensive and equitable patient care. This article aims to provide a roadmap for nursing leaders in nephrology to navigate the complexities of health care delivery, ensuring high-quality, cost-effective care that addresses the needs of a diverse patient population.

Commissioning and co-production in health and care services in the United Kingdom and Ireland: An exploratory literature review.

INTRODUCTION: This exploratory literature review seeks to examine the literature around commissioning processes in the co-production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co-production in service design and delivery? What are the contextual factors that influence these processes? METHOD: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008-2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty-seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. RESULTS: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co-production; navigating relationships and the collective voice. CONCLUSION: Commissioning processes were commonly a barrier to the co-production of health and care services. Though co-production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer-term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. PATIENT AND PUBLIC CONTRIBUTION: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement.

[Organization and practice in family medicine. What's new in the 2024 literature?] / Organisation des soins en médecine de famille. Quoi de neuf dans la littérature scientifique en 2024 ?

This is a selection of some important studies recently published and dealing with several key organization and functioning features of family medicine. This year, the articles focus on organizational responses to emergencies in family medicine. In this field, the use of primary care professionals other than physicians is an interesting solution. One article examines direct access to a physiotherapist, with very positive results, while a second explores the wide-ranging skills of advanced practice nurses in the emergency field. In some countries, such as Belgium, the use of teleconsultation in primary care is also being considered to avoid inappropriate use of hospital emergencies. Finally, more macroscopic organizational aspects of the healthcare system and the role of primary care in health emergencies will be considered in the last article.

Cet article présente une sélection d'études récemment publiées et explorant différents aspects du fonctionnement de la médecine de famille (MF). Elles sont centrées sur les réponses organisationnelles face à l'urgence en MF. Dans ce domaine, le recours à d'autres professionnels de soins primaires que les médecins est une approche intéressante. Ainsi un premier article porte sur l'accès direct au physiothérapeute et montre des résultats très positifs ; un second décrit les compétences des infirmières de pratique avancée mobilisables dans l'urgence. Le recours à la téléconsultation est aussi envisagé pour une utilisation plus appropriée des urgences hospitalières dans certains pays. Enfin, les aspects organisationnels plus macroscopiques sur la place des soins primaires dans l'urgence sanitaire sont réfléchis dans un dernier article.

Factors influencing the organisational homeostasis in healthcare organisations.

PURPOSE: The purpose of this study is to identify organisational homeostasis factors in the context of healthcare organisations and to develop a conceptual model for green transformation. DESIGN/METHODOLOGY/APPROACH: The organisational homeostasis factors were determined by review of literature study and the opinions of healthcare experts. Scheduled interviews and closed-ended questionnaires are employed to collect data for this research. This study employed "TISM methodology" and "MICMAC analysis" to better comprehend how the components interact with one another and prioritise them based on their driving and dependence power. FINDINGS: This study identified 10 factors of organisational homeostasis in healthcare organisation. Recognition of interdependence, hormesis, strategic coalignment, consciousness on dependence of healthcare resources and cybernetic principle of regulations are the driving or key factors of this study. RESEARCH LIMITATIONS/IMPLICATIONS: The study's primary focus was on the organisational homeostasis factors in healthcare organisations. The methodological approach and structural model are used in a healthcare organisation; in the future, these approaches can be applied to other industries as well. PRACTICAL IMPLICATIONS: The key drivers of organisational homeostasis and the identified factors will be better comprehended and understood by academic and important stakeholders in healthcare organisations. Prioritizing the factors helps the policymakers to comprehend the organisational homeostasis for green transformation in healthcare. ORIGINALITY/VALUE: In this study, the TISM and MICMAC analysis for healthcare is proposed as an innovative approach to address the organisational homeostasis concept in the context of green transformation in healthcare organisations.

Monitoring multistage healthcare processes using state space models and a machine learning based framework.

Monitoring healthcare processes, such as surgical outcomes, with a keen focus on detecting changes and unnatural conditions at an early stage is crucial for healthcare professionals and administrators. In line with this goal, control charts, which are the most popular tool in the field of Statistical Process Monitoring, are widely employed to monitor therapeutic processes. Healthcare processes are often characterized by a multistage structure in which several components, states or stages form the final products or outcomes. In such complex scenarios, Multistage Process Monitoring (MPM) techniques become invaluable for monitoring distinct states of the process over time. However, the healthcare sector has seen limited studies employing MPM. This study aims to fill this gap by developing an MPM control chart tailored for healthcare data to promote early detection, confirmation, and patient safety. As it is important to detect unnatural conditions in healthcare processes at an early stage, the statistical control charts are combined with machine learning techniques (i.e., we deal with Intelligent Control Charting, ICC) to enhance detection ability. Through Monte Carlo simulations, our method demonstrates better performance compared to its statistical counterparts. To underline the practical application of the proposed ICC framework, real data from a two-stage thyroid cancer surgery is utilized. This real-world case serves as a compelling illustration of the effectiveness of the developed MPM control chart in a healthcare setting.

Effect of integrated supportive supervision on availability of resources for health care service delivery and uptake of services in Ekiti State, Southwest Nigeria, evidence from the Saving One Million Lives program for result supported facilities.

Introduction: a world bank performance-based financing program. The Saving One Million Lives program for results supported integrated supportive supervision (ISS) in selected primary health facilities (PHF) in Ekiti State, Nigeria. The study assessed the impact of ISS on health service outputs and outcomes such as infrastructure, basic equipment, human resources for health (HRH), essential drugs, number of children receiving immunization, number of mothers who gave birth in the facility, number of new and continuing users of modern family planning and the number of pregnant women screened for HIV (human immunodeficiency virus). Methods: a cross-sectional survey of 70 SOME-supported facilities was used for the study. Parametric and non-parametric method of analysis was employed to compare the mean values of study indicators gathered over the 4 rounds of ISS visits from January 2018 to August 2020. Results: the study demonstrated that ISS approach has a positive effect on PHC service outputs and outcomes such as infrastructure, basic equipment, health human resources (HRH), essential drugs, contraceptives prevalence rate, skilled birth attendant as well as postnatal care. However, there was no significant impact on HIV screening for pregnant women. Conclusion: integrated supportive supervision approach has a positive effect on the quality of health care delivery in PHCs in Ekiti State, Nigeria. It is therefore recommended that periodic ISS visits should be routinely carried out in all PHCs across the State in the country and can be further extended to secondary and tertiary facilities.

The management of rare disease patients from a grassroot perspective: the role of patients' organizations in the global recognition of rare diseases in Cameroon.

Introduction: rare diseases (RD) are extremely complex health conditions. Persons affected by these conditions in Cameroon are often neglected in society and health systems through the inexistence of policies and programs. In Cameroon, there exists no program or policy conceived to address their needs in terms of access to quality health care, timely and reliable diagnosis, treatments, education, etc. The consequence is that persons living with a RD (PLWRD) and their families do not participate in social life. The unique fate of PLWRD reveals that the principle of social justice and equity is flawed in Cameroon. However, patients, in order to survive in society, rely on patients' organizations (PO) to improve their quality of life (QoL) and advocate for a better consideration in the society. The aim of this paper is to highlight how initiatives from a grassroot perspective like POs can inform decision-makers to address the needs of PLWRD and their families. Methods: the study associated a systematic literature review and semi-structured interviews with parents of children suffering from a RD and who are members of a PO. Through the systematic literature review we highlighted the impact POs have in the development of research on RDs, patient literacy, patient empowerment and advocacy while semi-structured interviews brought out the needs of patients and their families. Results: findings, on the one hand show that, in Cameroon PLWRD face a number of challenges like the incurability of their condition, catastrophic medical expenses, stigmatization and marginalization, etc. and though in POs their QoL still remains poor. On the other hand, where POs are empowered they are key actors in research on RDs and help decision-makers on having a better insight into the type of RD that exists across a geographical area, the sociodemographic profile of patients, etc. for a better management of PLWRD. Conclusion: the study suggests that the ministry of public health should create a network with existing RD POs to adequately meet the needs of PLWRD.

Lactation induction for transgender women and transfeminine people in health care: a scoping review.

There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

The impact of devolution on local health systems: Evidence from Greater Manchester, England.

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach. We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents. Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (-110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed. Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.

Climate finance opportunities for health and health systems.

Climate change poses significant risks to health and health systems, with the greatest impacts in low- and middle-income countries - which are least responsible for greenhouse gas emissions. The Conference of Parties 28 at the 2023 United Nations Climate Change Conference led to agreement on the need for holistic and equitable financing approaches to address the climate and health crisis. This paper provides an overview of existing climate finance mechanisms - that is, multilateral funds, voluntary market-based mechanisms, taxes, microlevies and adaptive social protection. We discuss these approaches' potential use to promote health, generate additional health sector resources and enhance health system sustainability and resilience, and also explore implementation challenges. We suggest that public health practitioners, policy-makers and researchers seize the opportunity to leverage climate funding for better health and sustainable, climate-resilient health systems. Emphasizing the wider benefits of investing in health for the economy can help prioritize health within climate finance initiatives. Meaningful progress will require the global community acknowledging the underlying political economy challenges that have so far limited the potential of climate finance to address health goals. To address these challenges, we need to restructure financing institutions to empower communities at the frontline of the climate and health crisis and ensure their needs are met. Efforts from global and national level stakeholders should focus on mobilizing a wide range of funding sources, prioritizing co-design and accessibility of financing arrangements. These stakeholders should also invest in rigorous monitoring and evaluation of initiatives to ensure relevant health and well-being outcomes are addressed.

Le changement climatique fait peser des risques considérables sur la santé et les systèmes de santé, affectant principalement les pays à revenu faible et intermédiaire ­ alors qu'ils contribuent le moins aux émissions de gaz à effet de serre. Lors de la Conférence des Nations Unies sur le changement climatique de 2023, la 28e Conférence des Parties a abouti à un accord sur la nécessité d'adopter des approches de financement équitables et holistiques pour résoudre la crise climatique et sanitaire. Le présent document offre un aperçu des dispositifs de financement climatique existants ­ à savoir des fonds multilatéraux, des mécanismes de marché volontaires, des micro-taxes et une protection sociale adaptative. Nous évoquons la possibilité de recourir à ces approches en vue de promouvoir la santé, de générer des ressources supplémentaires pour le secteur de la santé et de renforcer la viabilité et la résilience des systèmes de santé; nous nous intéressons également aux défis que représente leur mise en œuvre. Nous suggérons que les professionnels de la santé publique, les responsables politiques et les chercheurs profitent de cette occasion pour obtenir des fonds climatiques afin d'améliorer la santé et de développer des systèmes de santé durables et adaptés au changement climatique. Souligner tout l'intérêt, pour l'économie, d'investir dans la santé peut aider à inscrire la santé en priorité dans les initiatives de financement climatique. Réaliser des progrès significatifs implique que la communauté internationale prenne conscience des enjeux sous-jacents en matière d'économie politique, enjeux qui ont jusqu'à présent limité le potentiel du financement climatique dans l'atteinte des objectifs de santé. Pour y remédier, nous devons restructurer les institutions financières afin d'accroître l'autonomie des communautés en première ligne face à la crise climatique et sanitaire, et de faire en sorte que leurs besoins soient satisfaits. Les efforts des parties prenantes à l'échelle nationale et mondiale doivent porter sur la mobilisation d'un large éventail de sources de financement, en mettant l'accent sur la conception conjointe et l'accessibilité des modalités financières. Ces parties prenantes doivent en outre investir dans un suivi étroit et une évaluation rigoureuse des initiatives pour veiller à obtenir des résultats pertinents en termes de santé et de bien-être.

El cambio climático plantea riesgos importantes para la salud y los sistemas sanitarios, con mayores impactos en los países de ingresos bajos y medios, que son los menos responsables de las emisiones de gases de efecto invernadero. La 28.ª Conferencia de las Partes en la Conferencia de las Naciones Unidas sobre el Cambio Climático de 2023 condujo a un acuerdo sobre la necesidad de enfoques de financiación holísticos y equitativos para abordar la crisis climática y sanitaria. Este documento ofrece una visión general de los mecanismos de financiación climática existentes, es decir, los fondos multilaterales, los mecanismos voluntarios basados en el mercado, los impuestos, los microimpuestos y la protección social adaptable. Analizamos el uso potencial de estos enfoques para promover la salud, generar recursos adicionales para el sector sanitario y mejorar la sostenibilidad y la resiliencia de los sistemas sanitarios. Sugerimos que los profesionales de la salud pública, los responsables de formular las políticas y los investigadores aprovechen la oportunidad de utilizar la financiación climática para mejorar la salud y los sistemas sanitarios sostenibles y resilientes al cambio climático. Destacar los beneficios más amplios de invertir en salud para la economía puede ayudar a priorizar la salud dentro de las iniciativas de financiación climática. Para lograr avances significativos será necesario que la comunidad mundial reconozca los problemas de economía política subyacentes que hasta ahora han limitado el potencial de la financiación para abordar los objetivos de salud. Para superar estos desafíos, necesitamos reestructurar las instituciones financieras para empoderar a las comunidades que se encuentran en primera línea de la crisis climática y sanitaria y asegurar que se satisfacen sus necesidades. Los esfuerzos de las partes interesadas a nivel mundial y nacional deben centrarse en movilizar una gran variedad de fuentes de financiación y priorizar el diseño conjunto y la accesibilidad de los acuerdos de financiación. Estas partes interesadas también deben invertir en la supervisión y evaluación rigurosas de las iniciativas para garantizar que se abordan los resultados pertinentes en materia de salud y bienestar.