Strengthening the evidence-policy interface for patient safety: enhancing global health through hospital partnerships.

Strengthening the evidence-policy interface is a well-recognized health system challenge in both the developed and developing world. Brokerage inherent in hospital-to-hospital partnerships can boost relationships between "evidence" and "policy" communities and move developing countries towards evidence based patient safety policy. In particular, we use the experience of a global hospital partnership programme focused on patient safety in the African Region to explore how hospital partnerships can be instrumental in advancing responsive decision-making, and the translation of patient safety evidence into health policy and planning. A co-developed approach to evidence-policy strengthening with seven components is described, with reflections from early implementation. This rapidly expanding field of enquiry is ripe for shared learning across continents, in keeping with the principles and spirit of health systems development in a globalized world.

Developed-developing country partnerships: benefits to developed countries?

Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed--this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.

Development of an evaluation framework for African-European hospital patient safety partnerships.

BACKGROUND: Patient safety is recognised as a significant healthcare problem worldwide, and healthcare-associated infections are an important aspect. African Partnerships for Patient Safety is a WHO programme that pairs hospitals in Africa with hospitals in Europe with the objective to work together to improve patient safety. OBJECTIVE: To describe the development of an evaluation framework for hospital-to-hospital partnerships participating in the programme. METHODS: The framework was structured around the programme's three core objectives: facilitate strong interhospital partnerships, improve in-hospital patient safety and spread best practices nationally. Africa-based clinicians, their European partners and experts in patient safety were closely involved in developing the evaluation framework in an iterative process. RESULTS: The process defined six domains of partnership strength, each with measurable subdomains. We developed a questionnaire to measure these subdomains. Participants selected six indicators of hospital patient safety improvement from a short-list of 22 based on their relevance, sensitivity to intervention and measurement feasibility. Participants proposed 20 measures of spread, which were refined into a two-part conceptual framework, and a data capture tool created. CONCLUSION: Taking a highly participatory approach that closely involved its end users, we developed an evaluation framework and tools to measure partnership strength, patient safety improvements and the spread of best practice.

Incident prediabetes/diabetes and blood pressure in urban and rural communities in the Democratic Republic of Congo.

BACKGROUND: The Democratic Republic of Congo (DRC) faces increased morbidity and mortality due to treatable and preventable noncommunicable diseases. However, it continues to struggle with political and economic instability, which impedes much needed health infrastructure improvements. The present study was designed as a low-cost determination of the prevalence of incident prediabetes/diabetes in the DRC. METHOD: Fasting blood glucose, body mass index, blood pressure, and age were assessed in adult participants in health screenings conducted throughout urban and rural DRC. Communities were divided into three categories, based on physical activity (means of transport) and diet, ie, traditional (nonmotorized transport and vegetable/starch-based diets); transitional (incorporating traditional practices with motorized transport) and modern (motorized transport and protein/ processed foods). Fasting blood glucose and blood pressure were established using finger prick blood samples and monitors approved by the US Food and Drug Administration. RESULTS: The prevalence of incident prediabetes/diabetes was over 47% for the traditional population, 88.6% for the transitional population, and 91.4% for the modern communities. Fasting blood glucose levels analyzed through an analysis of covariance, with age and body mass index as covariates, demonstrated that fasting blood glucose levels of male and female subgroups in the traditional community (101.8 ± 29.3 mg/dL and 95.4 ± 27.8 mg/dL, respectively), were significantly reduced compared with the transitional (122.1 ± 19.4 mg/dL and 122.8 ± 23.9 mg/dL), and modern (118.8 ± 15.9 mg/dL and 114.1 ± 17.1 mg/dL) populations. Additionally, for the male and female subgroups, logistic regression analysis confirmed a significant association between incident prediabetes/diabetes, fasting blood glucose, diet, and level of physical activity. CONCLUSION: There is a higher than expected prevalence of incident prediabetes/diabetes in the DRC adult population, without a clear association with risk factors pertaining to diet, level of physical activity, body mass index, and blood pressure. The substantial morbidity and mortality associated with diabetes highlights the critical need for further and more precise diabetic diagnostic testing throughout the DRC.

Seasonal hematocrit variation and health risks in the adult population of Kinshasa, Democratic Republic of Congo.

Hematocrit (Hct) as an indicator of blood viscosity and mean arterial blood pressure (MAP) were assessed according to the season in adult participants of health screenings conducted throughout Kinshasa, Democratic Republic of Congo. Data was collected at the end of summer (April) and the end of winter (August) and identified by gender. Male Hcts in August were significantly higher (P < 0.0001) than in April (48.3% +/- 4.2% and 45.7% +/- 2.3%, respectively) while male MAP (85.0 +/- 8.4 mm Hg) was identical to that recorded in April (85.4 +/- 7.7 mm Hg). August female Hcts (41.4% +/- 3.1%) were statistically higher than those recorded in April (39.6% +/- 1.9%, P = 0.001), MAP being 82.3 +/- 7.3 vs 87.9 +/- 6.6 mm Hg, respectively (P = 0.0001). Systolic and diastolic blood pressures, heart rate, body mass indices, ages, and personal and familial medical histories of the August and April groups were not significantly different. This study offers further support for the assertion that the relationship between blood viscosity and pressure of a healthy population shows that increased Hct, and therefore increased blood viscosity is associated with lowered MAP, and presumably peripheral vascular resistance.