Strategies to strengthen a climate-resilient health system: a scoping review.

BACKGROUND: Climate change is a major global threat to human health and puts tremendous pressure on health systems. Therefore, a resilient health system is crucial to enhance, maintain, and restore the population's health. This study aimed to identify interventions and actions to strengthen a climate-resilient health system to deal with the adverse health effects of climate change. METHOD: This study was a scoping review. Five databases and Google Scholar search engine were searched using relevant keywords. Initially, 4945 documents were identified, and 105 were included in the review. Content thematic analysis method was applied using MAXQDA 10 software. RESULTS: Overall, 87 actions were identified for building a climate-resilient health system and were classified into six themes (i.e., governance and leadership; financing; health workforce; essential medical products and technologies; health information systems; and service delivery). The most commonly reported actions were formulating a national health and climate change adaptation plan, developing plans for essential services (electricity, heating, cooling, ventilation, and water supply), assessing the vulnerabilities and capacities of the health system, and enhancing surveillance systems targeting climate-sensitive diseases and their risk sources. CONCLUSIONS: A holistic and systemic approach is needed to build a climate-resilient health system owing to its complex adaptive nature. Strong governance and leadership, raising public awareness, strategic resource allocation, climate change mitigation, emergency preparedness, robust health services delivery, and supporting research, are essential to building a climate-resilient health system.

Challenges and opportunities for Iranian global health diplomacy: lessons learned from action for prevention and control of noncommunicable diseases.

BACKGROUND: The steady rise in noncommunicable diseases (NCDs) worldwide has been a key global health challenge. Governments have the primary responsibility for taking action to prevent and control NCDs. Given the growing importance of globalization of healthcare as well as the increasing use of soft power, governments need to identify challenges and opportunities to enhance global health diplomacy (GHD) for NCD prevention and control. The purpose of this qualitative research was to explain the challenges and opportunities of GHD for NCDs in Iran. METHODS: This study was conducted in 2020 using a qualitative approach and through in-depth, semi-structured interviews with 21 experts and specialists in related fields such as health policy, healthcare management, epidemiology and other related specialties. The participants were selected from all levels of diplomacy, including global, regional and national levels, with at least 3 years of experience in managerial, executive and scientific activities. Data analysis was performed by content analysis with an inductive approach. Data were analysed using inductive content analysis. RESULTS: The identified challenges were categorized into five main themes, including content challenges, structural challenges, process challenges, governance challenges and cultural challenges. Opportunities extracted from the interviews were also categorized into four main themes, including strong political will, utilizing the capacity of nongovernmental organizations (NGOs), multisectoral collaborations and a well-developed health system. CONCLUSIONS: NCD prevention and control requires a multilateral collaboration-based solution. Recognition of the challenges and opportunities in GHD can help draw significant lessons for building the necessary capacities and implementing more effective policies to prevent and control NCDs.

Taxonomy of effective strategies to reduce unnecessary caesareans: a systematic review.

BACKGROUND: The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable. AIMS: This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections. METHODS: We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions. RESULTS: Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections. CONCLUSIONS: A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.