Global Health Policy Research Articles

Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis.

Zero-dose children, or children who have not received any routine vaccination, are a priority population for global health policy makers as these children are at high risk of mortality from vaccine-preventable illnesses. We conducted a narrative review to identify potential interventions, both within and outside of the health sector, to reach zero-dose children. We reviewed the peer-reviewed and grey literature and identified 27 relevant resources. Additionally, we interviewed six key informants to enhance the synthesis of our findings. Data were organized into three priority settings: (1) urban slums, (2) remote or rural communities, and (3) conflict settings. We found that zero-dose children in the three priority settings face differing barriers to vaccination and, therefore, require context-specific interventions, such as leveraging slum health committees for urban slums or integrating with existing humanitarian response services for conflict settings. Three predominant themes emerged for grouping the various interventions: (1) community engagement, (2) health systems' strengthening and integration, and (3) technological innovations. The barriers to reaching zero-dose children are multifaceted and nuanced to each setting, therefore, no one intervention is enough. Technological interventions especially must be coupled with community engagement and health systems' strengthening efforts. Evaluations of the suggested interventions are needed to guide scale-up, as the evidence base around these interventions is relatively small.

The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study.

India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms. We seek to understand the views of a diverse group of policy actors in India to address the following research questions: what are the (i) conceptualizations of UHC, (ii) main barriers to realizing UHC, and (iii) policy strategies to address these barriers. We collected data through in-depth interviews with 38 policy actors from diverse backgrounds and analyzed using the Framework Method to develop themes both inductively and deductively using the Control Knob Framework of health systems. There was congruence in the conceptualization of UHC by policy actors. Quality of care, equity, financial risk protection, and a comprehensive set of services were the most commonly cited features. The lack of a comprehensive systems approach to health policies, inadequate and inefficient health financing mechanisms, and fragmentation between public and private sectors were identified as the main barriers to UHC. Contrasting views about specific strategies, health financing, provider payments, organization of the delivery system, and regulation emerged as the key policy interventions to address these barriers. This is the first systematic examination of a diverse set of policy actors' problem analyses and suggestions to advance UHC goals in India. The study underscores the need to recognize the complex and interlinked nature of health system reforms and initiate a departure from path-dependent vertical interventions to bring about transformative change.

A critical analysis of COVAX alliance and corresponding global health governance and policy issues: a scoping review

IntroductionThe COVAX alliance is a novel approach to international partnership in global health intended to achieve the worthy goal of ‘COVID-19 vaccine equity’. This study aimed to identify the implementation...

Mapping loneliness through social intelligence analysis: a step towards creating global loneliness map

ObjectivesLoneliness is a prevalent global public health concern with complex dynamics requiring further exploration. This study aims to enhance understanding of loneliness dynamics through building towards a global loneliness map...

Aligning global health policy and research with sustainable development: A strategic market approach

AbstractAttaining Sustainable Development Goal 3 (SDG 3: Health and Well‐Being) faces a dual challenge of diminishing returns of established intervention designs, and a threat to future gains from complex inter‐connected global health challenges like antimicrobial resistance and global biodiversity loss. The growing movement of context‐sensitive approaches could help realise yet untapped potential for intervention designs, but contemporary global health policy and research still remain dominated by a model of individual market style choices. This paper therefore aims to support the development of global health planning processes that are more grounded and integrative across the SDGs. Reiterating calls for disruptive policy change is unlikely to impact the modus operandi of global health policy and research. This paper therefore builds on a logic that already finds widespread and intuitive application in their underlying planning processes: ‘the market’. However, it challenges the dominant supply‐and‐demand approach to healthcare markets and redefines them from a strategic marketing perspective. Translated to the interface of populations and health systems, the strategic market is a site for solving problems that are defined by people with multidimensional health needs. This framework offers four guiding questions to define the strategic market and six premises as a simple intellectual starting point and checklist for more grounded and inter‐sectorial action across the SDGs. The analysis of data from one of the largest behavioural survey data sets, covering 6683 villagers across China, India, Lao PDR and Thailand, demonstrates the relevance of the premises empirically.

Biden Hears a WHO

The World Health Organization (WHO), the body charged with implementing global pandemic response, figured heavily in the Republican and Democratic campaigns of the 2020 US presidential election. The contrast was stark: Donald Trump drew on and ramped up dissatisfaction with the United Nations system in general and the WHO in particular, culminating in his decision to pull the US out of the WHO in the middle of the pandemic, while Joe Biden rescinded the decision to leave the WHO the day after assuming the presidency. Despite this difference, neither party heeded renewed calls during COVID to put health justice and primary healthcare at the heart of global health policy. Both parties continued to prefer private philanthropic sources of funding for global vaccine initiatives, and both sought economic returns on vaccine development, potentially missing a rare opportunity to incorporate global health justice into US global health diplomacy.

Unethical Issues in Twenty-First Century International Development and Global Health Policy

Abstract Billions in development aid is provided annually by international donors in the Majority World, much of which funds health equity. Yet, common neocolonial practices persist in development that compromise what is done in the name of well-intentioned policymaking and programming. Based on a qualitative analysis of fifteen case studies presented at a 2022 conference, this research examines trends involving unethical partnerships, policies, and practices in contemporary global health. The analysis identifies major modern-day issues of harmful policy and programming in international aid. Core issues include inequitable partnerships between and representation of international stakeholders and national actors, abuse of staff and unequal treatment, and new forms of microaggressive practices by Minority World entities on low-/middle-income nations (LMICs), made vulnerable by severe poverty and instability. When present, these issues often exacerbate institutionalized discrimination, hostile work environments, ethnocentrism, and poor sustainability in development. These unbalanced systems perpetuate a negative development culture and can place those willing to speak out at risk. At a time when the world faces increased threats including global warming and new health crises, development and global health policy and practice must evolve through inclusive dialogue and collaborative effort.

Impact of preventive chemotherapy on Strongyloides stercoralis: A systematic review and meta-analysis.

Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14-0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26-0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas.

Reinscribing global hierarchies: COVID–19, racial capitalism and the liberal international order

Abstract The COVID–19 pandemic led to debates within International Relations (IR) as to the extent to which it would cause a rupture in the so-called liberal international order (LIO). This article is concerned with why such a rupture did not occur and draws on theories of racial capitalism to answer this question. It explores the political economy of three dynamics of the global response to the pandemic—lockdowns, border controls and vaccine distribution—and argues that rather than causing a rupture, COVID–19 has reinscribed various domestic and global racial hierarchies. The global divisions of labour and hierarchies of expendability that manifested in the unequal burdens of COVID–19; the border policies that both included and excluded based on racialized notions of who carries disease and the necessity of keeping capital in circulation; and the intellectual property regime and profit motives of pharmaceutical companies that led to inequitable vaccine distribution, are all intimately linked with key ideational and material institutions of the LIO. By drawing theories of racial capitalism into the IR literature on global health, the article points to the need for domestic and global health policy to address the deep-rooted racial inequities that characterized the COVID–19 pandemic ahead of future disease outbreaks.

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation.

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era.

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action.

A Social, Not a Natural Science: Engaging With Broader Fields in Health Policy Analysis Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?"

Powell and Mannion's recent editorial discusses how different 'models' of the policy process have been applied within the health policy field. They present two ways forward for scholarship: more 'home grown' development of health-specific models, or deeper engagement with broader public policy scholarship. In this paper I argue for the latter approach for several reasons. First, health policy analysis is a social, not a natural science - and as such is not exceptional to other forms of policy scholarship. Second, many 'health policy models' are often grounded in conceptual work from elsewhere (or may not be health specific). Finally, there has been significant work to develop more nuanced understandings of theories, models, and frameworks available to particular analytical tasks and questions. As such, the growing body of global health policy scholarship may find it can benefit more from deeper engagement with existing conceptual work than constructing its own new models in most cases.

IMPROVING NOCOMIT-J PROGRAM AS A RESPONSE OF WOMEN’S AND YOUTH’S SUICIDE CASES SURGE DURING COVID-19

Suicide has been a long-time national problem for Japan as they hold the record for country with highest suicide rate according to WHO and the problem continues as of current. COVID - 19 which impacted most nation throughout the world including Japan, has a hand in influencing the increase of suicide rate in Japan. This increase is particularly evident in groups of youth and women who are among the most vulnerable groups in Japan, thus calls for more comprehensive sets of policy for suicide prevention. Currently there are prevention policies existing curRently. Among them there is a policy called NOCOMIT-J that will be the focus of this article. However, the rapid increase of suicide in pandemic time proves that there is an urgent need to improve the policy to suits the complexity of the situation. This paper aims to assess the variables behind the increase of suicide rates in Japan particularly for youth and women in order to use it as a basis calculation to improve the existing suicide prevention policy to focus on the group-specific problems. This paper will use qualitative method of descriptive case studies to analyze the unique factor contributing to women and youth suicide cases in pandemic time and use the result to suggest improvements for NOCOMIT-J policy by analyzing it in the established framework of holistic global mental health policy.

P13 Cost effectiveness of point of care diagnostics for AMR: a systematic review

Abstract Objectives Antimicrobial resistance (AMR) is a major threat to global health and is driven partly by overprescription of antibiotics. Point-of-care tests (POCTs) can reduce antibiotic prescribing by distinguishing different types of infections and the sensitivities of pathogens to antimicrobials. Although evidence for their clinical efficacy is mixed, they may be highly cost-effective interventions when their benefits in reducing the burden of AMR are considered. We aimed to systematically evaluate the cost effectiveness of different POCTs in reducing AMR for the first time to inform national and global health policies. Methods A systematic review was conducted in line with the PRISMA framework, and the protocol was registered on PROSPERO. MEDLINE, PubMed, EMBASE, Cochrane Library and Google Scholar were searched from January 2000 to November 2022 for studies that (i) were trial- or model-based economic evaluations, (ii) focused on POCTs aimed at reducing AMR or inappropriate antimicrobial prescription, (iii) included a cost-benefit metric and (iv) were original research written in English with full text available. Methodological quality was assessed using the Consensus of Health Economic Criteria. Results 157 studies were retrieved of which 20 were included after screening. These included both trial (n = 9) and modelling-based (n = 11) evaluations. Most focused on POCTs for respiratory infections (n = 9) with sexually transmitted infections and febrile illness other common conditions evaluated. A majority of studies utilized C-reactive protein POCTs (n = 11) with others utilizing pathogen-specific PCR tests or procalcitonin. Most evaluated the cost effectiveness of POCTs at reducing antimicrobial prescribing, with only 3 studies considering the societal cost of AMR. Most studies found that POCTs reduced antibiotic use, but with varying cost effectiveness: 16 studies showed cost efficacy by the threshold or other standards stipulated by the study, with POCTs for group B streptococcus and urinary tract infections notably not found to be cost effective. The reporting and methodological quality of the included studies was mixed: good (4), moderate (13) and low (3). Conclusions There is limited research on the cost effectiveness of POCTs in reducing AMR, and most studies do not account for the wider societal costs of AMR. Current forecasts estimate that AMR will cause 10 million deaths and cost the world 100 trillion USD per year in 2050: consequently, it is vital that evaluations of POCTs include the significant benefits from reducing AMR additional to the short-term benefits of avoided antibiotic prescriptions. Given the rising burden of AMR, such interventions merit further evaluation and integration into healthcare policy.

Mapping and Unpacking Global Governance Bodies: A Cross Sectional and Cross Organizational Analysis

Abstract Several recent studies have pointed to the increasing relevance of relatively informal, non-treaty-based global governance bodies (GGBs). Yet, a systematic fine-grained assessment of these bodies and their implications for global governance are still pending. To what extent, do non-treaty-based GGBs constitute a truly novel type of governance body, distinct from traditional treaty-based international organizations (IOs)? How do the distinctive features of GGBs affect their role in global governance? To what extent are GGB’s patterns of emergence and development specific to policy sectors? This article tackles these questions, drawing on an original dataset on GGBs in five distinct policy areas (banking and finance, energy, global health, Internet, and migration policy). We combine a micro-organizational perspective with a meso-level network approach to unpack the main features of non-treaty-based GGBs vis-à-vis, traditional IOs. Our results provide support to the general expectation that non-treaty-based GGBs offer distinctive opportunities for global governance with respect to traditional IOs. However, importantly, this relationship is not dichotomous. We find that GGBs exist on a continuum of fit-to-purpose designs ranging from hard, formal, and intergovernmental models to a soft, informal, and multistakeholder-based form of governance. Lastly, we also find notable variations across policy areas, where global health stands out given its decentralized network structure.

One Health Approach to Arbovirus Control in Africa: Interests, Challenges, and Difficulties.

The "One Health" concept considers that human and animal health, and ecosystems are closely related and aims to make a link between ecology and human and veterinary medicine. Due to the explosion in population growth along with the geographic and climatic conditions (equatorial and/or tropical climate), Africa is becoming a major hotspot for various socio-health issues associated with infectious diseases, including arboviruses. The incontestable advantages of a One Health approach in Africa lie in the fight against pathogens, such as arboviruses, and in the preservation of environmental, animal, and human health to ensure that the increasing high needs of this population are met as well as their protection against potential epidemics. The One Health strategy gives us a glimpse of the difficulties and challenges that the African continent faces. The importance of this approach in Africa is to establish guidelines and strategies for effective solutions and changes in behavior and harmful activities. Overall, the establishment of high-quality global health policies in the framework of the global health standards program would provide healthy and sustainable human-animal-environmental interactions for the welfare of all.

SAT-129 - Sub-optimal global public health policies and strategies to combat hepatocellular carcinoma

SAT-129 - Sub-optimal global public health policies and strategies to combat hepatocellular carcinoma

Evolution of the major alcohol companies key global policy vehicle through the prism of tax records 2011–19

BackgroundImportant insights have been generated into the nature of the activities of the International Center for Alcohol Policies (ICAP). Its successor, the International Alliance for Responsible Drinking (IARD) is less well understood. This study aims to rectify evidence limitations on the political activities of the alcohol industry at the global level.MethodsInternal Revenue Service filings were examined for ICAP and IARD each year between 2011 and 2019. Data were triangulated with other sources to establish what could be gleaned on the internal workings of these organisations.ResultsThe stated purposes of ICAP and IARD are near identical. The main declared activities were similar for both organisations and comprised public affairs/policy, corporate social responsibility, science/research and communications. Both organisations work extensively with external actors and it has become possible more recently to identify the main contractors supplying services to IARD.DiscussionThis study sheds light on the political activities of the alcohol industry at the global level. It suggests that the evolution of ICAP into IARD has not been accompanied by shifts in the organisation and activities of the collaborative efforts of the major alcohol companies.ConclusionAlcohol and global health research and policy agendas should give careful attention to the sophisticated nature of industry political activities.

Health services for catastrophic patients through the national health insurance program: literature review

Introduction. Achieving universal health coverage, also known as UHC, has emerged as an essential global health policy, especially in addressing the burden of spending on major (catastrophic) diseases. However, catastrophic health expenditures are not always synonymous with high healthcare costs. However, a major disaster for low-income households is financing that is not entirely covered by insurance. Objective. This study aims to provide data on the effects of national health insurance on disaster victims in various nations. Materials and Methods. this research is a literature study; electronic searches were carried out in five databases, Pro-quest, Google Scholar, JACC, Science Direct, and Pubmed, for relevant research published between 1986 and 2022. Only 102 articles were relevant. After screening by reading abstracts and viewing all articles, concerning the impact of catastrophic disease health insurance, only 12 articles were declared eligible from 2017 to 22. Results. The review results show that most health insurance positively affects disasters, as seen from the decrease in the incidence of CHE and the risk of OOP spending in a country. Income is a CHE factor in LMICs notwithstanding unfortunate preventive ways of behaving. Conclusion. This study concludes that health insurance impacts those who need treatment, especially those who suffer from costly diseases or catastrophic diseases. Even though insurance is a poverty alleviation factor, without a good economic status, health services will still be an obstacle for a person to access health services. Furthermore, factors other than insurance cause poverty, namely small expenses such as accommodation and transportation that are not covered.

Questioning global health in the times of COVID-19: Re-imagining primary health care through the lens of politics of knowledge

The advent of the COVID-19 pandemic and the inequitable response to it has created a space for rethinking the knowledge translation that informs current health policy formulation and planning. Wide recognition of the failure of global health governance and national health systems has led to calls for reviving the Primary Health Care (PHC) agenda for post-COVID health systems development. Despite the joint international declaration on PHC made four decades ago, it has had limited application. This paper argues that the recent attempts to rethink PHC will prove inadequate without analysing and learning from the politics of knowledge (PoK) underlying global health policy and planning. Even with the growing relevance of the spirit of the Alma-Ata Declaration (1978) and its operationalisation as detailed in the report of conference proceedings, reassessment of reasons for its limited implementation continues to be located largely in the political economy of the medical establishment, the international economic order or in national governance flaws. Failure to address the dominant knowledge paradigm in the Alma Ata articulation of PHC has contributed to its limited application. This calls for expansion in the analysis from knowledge translation to generation and hierarchisation of knowledge. The paper discusses how the application of PoK as an analytical lens helps understand the power equations underlying the process of knowledge generation and its translation into policy and practice. Beneath the techno-centric and commodified health system is the dominant ‘knowledge’ system whose foundations and assumptions ought to be interrogated. By following a PoK approach, a reorientation of thinking about the relationship between various forms of knowledge and knowledge holders is anticipated. A new health service system design is outlined—translating the spirit of PHC of 1978 into a ‘PHC Version 2.0’—that addresses the PoK gap in operational terms, with an approach to guide all levels of healthcare. It suggests how the world can be empowered to respond better by engaging with diverse ontologies and epistemologies to conceptualise knowledge and frame policies. Further, in the contexts of Asia, Africa and Latin America, it can contribute to the development of self-reliance to democratise general health policy and planning in the post-pandemic period.