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1.
J Glob Health ; 11: 05004, 2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33643637

RESUMO

Background: The focus of the study is to assess the advantages and shortcomings of China's public health system in the process of the COVID-19 prevention and to discuss the future reform of China's public health system. Methods: By searching literature and reports related to the COVID-19 prevention of China, we compared the prevention effectiveness with the prevention policies in the process of the COVID-19 prevention. Results: China's public health system can effectively combine national power to maximize the effectiveness of pandemic prevention. It improved the pandemic prevention ability of communities continuously and promoted the fairness of prevention. Traditional Chinese Medicine has also been used in pandemic prevention, which reduces the drug resistance of the virus. At the same time, the combination of the disease diagnosis and the Internet has reduced the spread speed of the pandemic. China's public health system also has some problems in response to the COVID-19, such as the shortage of medical resources, insufficient alerts, the low efficiency of reporting to superior government and the shortage of reward and punishment system for pandemic prevention. Conclusions: China's practice and efforts of the COVID-19 prevention can provide experience for other countries to improve their public health systems and accelerate the end of the COVID-19 pandemic.


Assuntos
/prevenção & controle , Saúde Pública , /epidemiologia , China/epidemiologia , Programas Governamentais , Humanos , Avaliação de Programas e Projetos de Saúde
2.
Sci Adv ; 7(6)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33547077

RESUMO

Despite numerous journalistic accounts, systematic quantitative evidence on economic conditions during the ongoing COVID-19 pandemic remains scarce for most low- and middle-income countries, partly due to limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. We assemble evidence from over 30,000 respondents in 16 original household surveys from nine countries in Africa (Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone), Asia (Bangladesh, Nepal, Philippines), and Latin America (Colombia). We document declines in employment and income in all settings beginning March 2020. The share of households experiencing an income drop ranges from 8 to 87% (median, 68%). Household coping strategies and government assistance were insufficient to sustain precrisis living standards, resulting in widespread food insecurity and dire economic conditions even 3 months into the crisis. We discuss promising policy responses and speculate about the risk of persistent adverse effects, especially among children and other vulnerable groups.


Assuntos
/economia , Países em Desenvolvimento/economia , Emprego/tendências , Renda/tendências , Pandemias/economia , Adulto , África/epidemiologia , Agricultura/economia , Ásia/epidemiologia , Criança , Colômbia/epidemiologia , Violência Doméstica , Recessão Econômica , Características da Família , Feminino , Programas Governamentais/economia , Humanos , Masculino , Estações do Ano , Inquéritos e Questionários
3.
Health Res Policy Syst ; 19(1): 4, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435989

RESUMO

INTRODUCTION: Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. METHODS: An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals. DISCUSSION: This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.


Assuntos
Financiamento da Assistência à Saúde , Projetos de Pesquisa , Cobertura Universal do Seguro de Saúde/economia , Programas Governamentais , Humanos , Irã (Geográfico)
4.
Lancet Glob Health ; 9(2): e181-e188, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33482139

RESUMO

BACKGROUND: The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. METHODS: We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect. FINDINGS: The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support. INTERPRETATION: Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening. FUNDING: Resolve to Save Lives: An Initiative of Vital Strategies.


Assuntos
Organização do Financiamento/economia , Saúde Global/economia , Cooperação Internacional , Orçamentos , /prevenção & controle , Países em Desenvolvimento , Programas Governamentais/economia , Humanos , Pandemias/prevenção & controle , Estados Unidos
9.
Health Res Policy Syst ; 18(1): 136, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33339524

RESUMO

Producing evidence in epidemics is crucial to control the current epidemic and prevent its recurrence in the future. Data must be collected and analyzed rapidly to recognize the most efficient and feasible methods with proper timelines. However, there are many challenges a research system may encounter during a crisis. This article has presented lessons learned from the COVID-19 pandemic for health research system (HRS) to deal with current and future crises. Therefore, a HRS needs to produce and use evidence in such a situation. The components Knowledge Translation Self-Assessment Tool for Research Institutes (SATORI) framework was used to review the actions required and respond to the COVID-19 pandemic in a national HRS. This framework consists of four categories of defining the research question, conducting research, translating the research results, and promoting the use of evidence. The work is proposed actions in response to the COVID-19 crisis and improving a HRS's resilience. While COVID-19 has serious harm to the health and broader socio-economic consequences, this threat should be accounted for as an opportunity to make research systems more accountable and responsible in the timely production and utilization of knowledge. It is time to seriously think about how HRS can build a better back to be resilient to potential shock and prepare for unforeseen emerging conditions.


Assuntos
Medicina Baseada em Evidências , Política de Saúde , Pandemias , Pesquisa Médica Translacional , /prevenção & controle , Programas Governamentais , Humanos , Conhecimento , Projetos de Pesquisa
10.
Healthc Pap ; 19(3): 47-52, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337303

RESUMO

Miller and Xie (2020) raise a call to action on creating a sustainable Canadian healthcare system as part of a more just and sustainable economic model. This commentary explores the economic dimensions of this call to action. It provides a brief overview of relevant concepts and insights from emerging schools of economic thinking, and contemplates challenges and opportunities for health system sustainability as the economic consequences of COVID-19 play out in coming years.


Assuntos
Canadá , Programas Governamentais , Humanos
11.
PLoS One ; 15(12): e0243724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351810

RESUMO

BACKGROUND: Government of India and the World Health Organization have guidelines for outpatient management of young infants 0-59 days with signs of Possible Serious Bacterial Infection (PSBI), when referral is not feasible. Implementation research was conducted to identify facilitators and barriers to operationalizing these guidelines. METHODS: Himachal Pradesh government implemented the guidelines in program settings supported by Centre for Health Research and Development, Society for Applied Studies. The strategy included community sensitization, skill enhancement of Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs) and Medical Officers (MOs) to identify PSBI and treat when referral was not feasible. The research team collected information on facilitators and barriers. A technical support unit provided training and oversight. FINDINGS: Among 1997 live births from June 2017 to January 2019, we identified 160 cases of PSBI in young infants resulting in a coverage of 80%, assuming an incidence of 10%. Of these,29(18.1%) had signs of critical illness (CI), 92 (57.5%) had clinical severe infection (CSI), 5 (3.1%)had severe pneumonia (only fast breathing in young infants 0-6 days), while 34 (21%) had pneumonia (only fast breathing in young infants 7-59 days). Hospital referral was accepted by 48/160 (30%), whereas 112/160 (70%) were treated with the simplified treatment regimens at primary level facilities. Of the 29 infants with CI, 18 (62%) accepted referral; 26 (90%) recovered while 3 (10%) who had accepted referral, died. Of the 92 infants who had CSI, 86 (93%) recovered, 65 (71%) received simplified treatment and one infant who had accepted referral, died. All the five infants who had severe pneumonia, recovered; 3 (60%) had received simplified treatment. Of the 34 pneumonia cases, 33 received simplified treatment of which 5 (15%) failed treatment; two out of these 5 died. Overall, 6/160 infants died (case-fatality-rate 3.4%); 2 in the simplified treatment (case-fatality-rate 1.8%) and 4 in the hospital group (case-fatality-rate 8.3%). Delayed identification and care-seeking by families and health system weaknesses like manpower gaps and interrupted supplies were challenges in implementation. CONCLUSIONS: Implementation of the guidelines in program settings is possible and acceptable. Scaling up would require creating community awareness, early identification and appropriate care-seeking, strengthening ASHA home-visitation program, building skills and confidence of MOs and ANMs, uninterrupted supplies and a dependable referral system.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções Bacterianas/terapia , Programas Governamentais/organização & administração , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/organização & administração , Assistência Ambulatorial/normas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Feminino , Programas Governamentais/normas , Visita Domiciliar/estatística & dados numéricos , Humanos , Ciência da Implementação , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença
12.
PLoS Negl Trop Dis ; 14(12): e0008973, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33382692

RESUMO

BACKGROUND: The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. METHODS AND FINDINGS: A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient's houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. CONCLUSIONS: Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory.


Assuntos
Educação em Saúde , Acesso aos Serviços de Saúde , Hanseníase/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Programas Governamentais , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Sri Lanka , Adulto Jovem
13.
Healthc Pap ; 19(3): 27-34, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337300

RESUMO

The National Health Service (NHS) in the UK is regarded by many as the world leader in sustainability. In this article, I present six main reasons for this. The first three reasons are that the UK passed appropriate legislation; a long-term strategy was developed; and a sustainability direction and delivery framework emerged for not only the NHS and the social system but also for its partner organizations in education. The UK has also committed resources, has a system of governance and accountability and continually reviews its current systems in a constant need for regeneration.


Assuntos
Assistência à Saúde , Medicina Estatal , Canadá , Programas Governamentais , Humanos , Reino Unido
14.
Healthc Pap ; 19(3): 41-46, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337302

RESUMO

Climate change concerns have gained traction with many Canadians and impacted their individual choices. However, as a country, we have repeatedly failed to meet international emission-reduction targets. Setting an ambitious goal of net zero in healthcare may continue the discouraging pattern of missing the mark. This commentary proposes a new approach - identifying practical solutions and measuring their beneficial impact for both health and the environment. A few options are suggested, some likely to benefit from near-term government investments. Making tangible progress where opportunities present themselves will create positive health and environmental benefits and a solid foundation for future achievements.


Assuntos
Mudança Climática , Assistência à Saúde , Canadá , Governo , Programas Governamentais , Humanos
15.
Healthc Pap ; 19(3): 53-56, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337304

RESUMO

The current pandemic is a stark reminder that crises bring to light society's vulnerabilities. In the lead paper of this issue of Healthcare Papers, Miller and Xie (2020) argue that the same is - and will be - true for climate change. They make a compelling and urgent case for its importance to health and healthcare in Canada and around the world. Opportunities to advance the multiple interrelated dimensions of sustainability in the health sector include understanding and mitigating the health implications of climate change; preparing the health sector for climate change; and accelerating the health sector's contribution to society-wide net-zero targets. High-performing, resilient health systems with their capacity to deeply engage with communities, and to respond dynamically to changing circumstances, will be key to proactively addressing climate change, just as they are proving to be in pandemic preparedness and response.


Assuntos
Mudança Climática , Programas Governamentais , Canadá , Humanos
16.
Healthc Pap ; 19(3): 57-60, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337305

RESUMO

Building on the article by Miller and Xie (2020) that raises a call to action for environmentally sustainable healthcare in Canada, this commentary posits that there is a responsibility to place that action in light of health equity. It also identifies an opportunity to build on an existing approach to health system improvement, that is spreading across Canada, by adding an additional aim around environmental sustainability and placing the outcomes for health systems firmly in health equity. By doing this in a clear, anti-racist and anti-colonial setting, sustainability can build on Canada's Indigenous knowledge and principles of sustainability to align health system sustainability with reconciliation and equity.


Assuntos
Programas Governamentais , Equidade em Saúde , Canadá , Assistência à Saúde , Humanos
17.
Healthc Pap ; 19(3): 61-66, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337306

RESUMO

The impacts of climate change can already be seen among many of the patients in our clinics and emergency rooms, and as with all disasters, the most impoverished and marginalized members of society are the hardest hit. The health system has a social accountability role to anticipate and respond to the evolving health needs of our society. We are the stewards of this planet, steering the course through current and future challenges. What we do now will determine what the world will be like for our children and grandchildren. At times like this, more than ever before, health workers around the world must unite and engage in contributing to shaping future policy directions and monitoring progress to create a post-COVID world where social accountability and sustainable development go hand in hand.


Assuntos
Criança , Família , Programas Governamentais , Humanos , Responsabilidade Social
18.
Healthc Pap ; 19(3): 67-73, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33337307

RESUMO

The health system is a major contributor to Canada's greenhouse gas emissions, largely arising from the ways that care is organized and delivered. Nurses, representing the largest group of regulated healthcare professionals, are experts in the organization and delivery of care, and are uniquely and critically positioned to witness and address the harmful effects of climate crisis. Thus, sustainable health systems cannot be achieved without nurses. Yet, nurses' capacity to lead on issues of climate crisis and sustainability remains underdeveloped. We argue that the nursing profession needs to widely embrace climate crisis as a priority nursing problem and to take visible leadership on this issue. To enable the transformation of the health system toward sustainable and equitable delivery of care, health systems should incorporate a sustainability lens into strategic decision making, and implement and scale up nurse-led models of care. It is time to move beyond "engaging" or even "empowering" nurses to participate in sustainability initiatives. It is time for nurses to lead.


Assuntos
Enfermeiras e Enfermeiros , Programas Governamentais , Humanos , Liderança
19.
Biomedica ; 40(Supl. 2): 77-79, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152191

RESUMO

The COVID-19 pandemic has generated a revolution of such magnitude that no aspect of human life will be the same from now on. The provision of health services and health education are not unrelated to this new normality imposed by the disease, and its consequences have been reflected in the need to use protocols and resources based on virtuality that most of us had not valued in their real dimension. Telehealth and telemedicine will be basic tools for professionals and teachers and it is our obligation to know them, apply them, and innovate to adapt to this reality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Colômbia/epidemiologia , Confidencialidade , Infecções por Coronavirus/prevenção & controle , Educação a Distância , Programas Governamentais , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Disseminação de Informação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Utilização de Procedimentos e Técnicas , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Universidades , Recursos Humanos
20.
BMC Health Serv Res ; 20(1): 996, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129317

RESUMO

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization. METHODS: Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description. RESULTS: Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology. CONCLUSIONS: The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.


Assuntos
Assistência Médica , Avaliação de Processos em Cuidados de Saúde , Instituições de Assistência Ambulatorial , Feminino , Programas Governamentais , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Masculino , Programas de Rastreamento/métodos , Encaminhamento e Consulta , Parceiros Sexuais , Sobreviventes , Estados Unidos
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