Capabilities Of Health System Research Articles

The Trends of Neonatal Mortality Rate Among South East Asia Countries from 2000-2017

Background: Neonatal MortalityRate (NMR) reflects the quality of health services provided by the government. It is very important to disclose the health system capability of each country in managing mother and child health programs because it is an essential health policy that should be prioritized. The health system capability of a country will determine the welfare and social guarantee because most of NMR causes are preventable. Several components such as maternal factors, neonatal and health services were determined as predictors of NMR. The objective of this study is to compare neonatal mortality trends among eight South East Asia Countries (SEAC) from 2000 to 2017. Method: A cross-sectional design was used to analyze the data regarding the causes of neonatal death between 2000 and 2017. Data were taken from World Health Organization Maternal Child Epidemiology Estimation (WHO MCEE) database.The collected data were live birth; neonatal mortality rate; and the big five of neonatal mortality etiologies in the eight SEAC. Data were then analyzed descriptively with line chart to describe the trend of NMR. Result: This study found that Indonesia had the highest neonatal mortality rate, yet the trend decreased gradually from 102.700 in 2000 to 60.986 in 2017, followed by Philippines, Vietnam, Myanmar, Cambodia, Thailand, Laos, and Malaysia respectively. On the other hand, the trend of live birth was the lowest in Indonesia and the highest in Philippines . According to the data regarding the leading cause of NMR, preterm birth was the major cause of neonatal mortality followed by birth asphyxia and congenital defects. Conclusion: Indonesia has the highest mortality rate, yet the etiology such as as premature birth, asphyxia, and congenital disorder is similar to the other eight countries.

Answers in search of questions: what does the comparison of COVID19 data among regions in Northern Italy tell us?

Since the outbreak of the COVID-19 pandemic, discussions about the capabilities of health and social systems to control and contain infectious diseases have been reignited. In Resilient Managed Competition During Pandemics: Lessons from the Italian Experience, Costa-Font, Turatti and Levaggi ask whether or not institutional differences between the managed competition (MC) systems in three of Italy's regions may have affected their performance - and hence, population health outcomes - during the pandemic. Fuchs (2000) previously argued that institutional arrangements not only 'matter', but also sometimes 'matter a great deal' (p. 149, emphasis in original) and this may be particularly true in emergencies.

Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare.

Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socio-economic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemic-related healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.

Thoughts on Adaptive Leadership in a Challenging Time.

Thoughts on Adaptive Leadership in a Challenging Time.

Accountability to Population Health in the COVID-19 Pandemic: Designing Health Care Delivery Within a Social Responsibility Framework.

Accountability to Population Health in the COVID-19 Pandemic: Designing Health Care Delivery Within a Social Responsibility Framework.

Forecasting global essential childhood cancer drug need and cost: An innovative model-based approach.

e19078 Background: Childhood cancer outcomes in low-middle income countries (LMICs) have not kept pace with advances in care and survival in high income countries (HICs). A contributing factor to this survival gap is unreliable access to essential cancer drugs. Lack of data on the aggregate need and cost of essential cancer drugs has hampered rational planning and acquisition in many LMICs. Methods: We created a pediatric-specific tool (FORxECAST) that estimates drug quantity and cost for 18 pediatric cancers, customizable to region, regimen, cancer stage distribution, and drug price. We used adapted treatment regimens developed by the International Society of Pediatric Oncology (SIOP), supplemented with input from disease experts, to model treatment approaches reflective of health-system capabilities. FORxECAST incorporates incidence data generated through microsimulation estimates of both diagnosed and undiagnosed (total) cases. Results: We created a pediatric-specific tool (FORxECAST) that estimates drug quantity and cost for 18 pediatric cancers, customizable to region, regimen, cancer stage distribution, and drug price. We used adapted treatment regimens developed by the International Society of Pediatric Oncology (SIOP), supplemented with input from disease experts, to model treatment approaches reflective of health-system capabilities. FORxECAST incorporates incidence data generated through microsimulation estimates of both diagnosed and undiagnosed (total) cases. Conclusions: Our results enable evidence-based forecasting of childhood cancer drug need and cost to inform health system planning in a wide range of countries. The model is adaptable to setting, diagnosis, and treatment approach, allowing decision-makers to generate results specific to their context and needs. Global estimates of essential childhood cancer drug need and cost demonstrate the comparatively small amount of aggregate resources required to treat all cases worldwide, and can help advance innovative procurement strategies with regional and international scale that drive global improvements in childhood cancer drug access.

Toward Semantic IoT Load Inference Attention Management for Facilitating Healthcare and Public Health Collaboration: A Survey

The health of individuals and populations requires concerted and collaborative efforts by healthcare, public health, social care, and personal health management. The inter-sectoral collaborations are more crucial than ever, especially when facing public health crises, including the ongoing pandemic of coronavirus disease-2019 (COVID-19). Although the capabilities of healthcare and public health systems have increased with a dramatic boost in the use of the Internet of Things (IoT), such IoT-enabled systems are often operating in silos. A pressing need, thus, is the seamless integration of those currently incompatible systems. A promising solution is to leverage semantic technologies to increase interoperability among such systems. Therefore, this article aims to: conduct a systematic review on the current state-of-the-art semantic IoT solutions used in health domain; identify the associated challenges; propose a federated edge-cloud semantic IoT architecture to facilitate the healthcare and public health (HC-PH) collaborations for the health and well-being of the individuals and populations.

What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare

BackgroundEffective patient engagement has been associated with high quality health care. There is a dearth of evidence around effective engagement with consumers from ethnic minority backgrounds; specifically in relation to the role of cultural competence amongst healthcare professionals in effective engagement with consumers from ethnic minority backgrounds. To address this knowledge gap, we analysed the role of cultural competence in the consumer engagement approaches taken by community healthcare professionals working with consumers from ethnic minority backgrounds.MethodsSemi-structured individual interviews were conducted with 21 healthcare professionals employed across four community healthcare and affiliated services in four local government areas in Australia.ResultsAdopting patient-centric approaches (that seek to understand and be responsive to the patient as an individual) featured as an underpinning theme that transcended other emerging themes. Recognition of diversity within communities and individuals in those communities, all with their own story, was described as pivotal to effective engagement. This was encapsulated in the theme of Cultural standpoints and personal context that contained four further themes of: (1) Build foundations of trust and respect; (2) Diversify communication channels; (3) Generate system, service and community partnerships; (4) Take the time.ConclusionOur findings indicate that cultural competence and effective consumer engagement are closely linked in ethnic minority populations. Embedding cultural competence as a health system, service and professional capability is therefore critical to ensure equitable healthcare quality for consumers from all ethnic backgrounds.

Resource-Stratified Diagnostics in India: Current Practices and Aspirations for a National Standard

Purpose As international health systems set goals to improve and expand access to cancer care services, the global health community has applied evidence-based principles to develop resource-stratified pathways for cancer detection, diagnosis, and treatment. The Breast Health Global Initiative (BHGI) defines four detailed sets of infrastructure at the levels of basic, limited, enhanced, and maximal. Operationalizing these pathways to improve and expand breast cancer care requires an assessment of current resource availability and use, as well as an understanding of how clinical stakeholders value and prioritize various modalities. This study adapted the BHGI framework for breast cancer diagnostics to characterize the natural state of health system capabilities in India. This work aims to contribute to the validation of the resource stratification schema while collecting implicit practitioner impressions of an aspirational resource level, as would be codified by a national standard. Methods We interviewed oncologists at public and private hospitals in six urban areas throughout India with a multisection survey tool about the effects of cancer care infrastructure on patient care. In this section, respondents filled out a grid representation of 30 BHGI 2.5 diagnostic modalities divided into clinical tools, imaging and laboratory tests, and pathology. Respondents indicated whether they currently used each modality, and whether they would recommend that this should be included in a national standard of breast cancer care for India. Results At least three fourths of respondents indicated that they personally use 21 of the diagnostic modalities (n = 52), but only recommended 15 modalities for the national standard (n = 50). The top 11 modalities currently used included six basic, three limited, and two enhanced, whereas the top 11 modalities recommended for the national standard included four basic, one limited, three enhanced, and three maximal. Conclusion Diagnostic modalities consistently used by urban oncologists are not fully congruent with the group’s collective vision for a national standard of care, nor do the oncologists recommend a consistently more basic or limited national approach compared with urban practice. These heterogeneous results indicate that expanding breast cancer care in India will likely require dynamic recalibration of goal resource level definitions across the nodes of each regional referral network. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs for the author.

How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review.

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’.

Service robots in hospitals: new perspectives on niche evolution and technology affordances

Changing demands in society and the limited capabilities of health systems have paved the way for robots to move out of industrial contexts and enter more human-centered environments such as health care. We explore the shared beliefs and concerns of health workers on the introduction of autonomously operating service robots in hospitals or professional care facilities. By means of Q-methodology, a mixed research approach specifically designed for studying subjective thought patterns, we identify five potential end-user niches, each of which perceives different affordances and outcomes from using service robots in their working environment. Our findings allow for better understanding resistance and susceptibility of different users in a hospital and encourage managerial awareness of varying demands, needs, and surrounding conditions that a service robot must contend with. We also discuss general insights into presenting the Q-methodology results and how an affordance-based view could inform the adoption, appropriation, and adaptation of emerging technologies.

‘Is someone going to saw off the plank behind me?’ – Healthcare managers priorities, challenges and expectations for service delivery and transformation during economic crisis

Objectives: To appraise health system capability for transformation during economic crisis by exploring the impact of health service managers’ priorities, challenges and expectations. Methods: Survey of health service manager priorities and content analysis of health service manager semi-structured interviews with a final analysis of expectations using an organisational readiness lens. Results: Government priorities for health reform, even when shared by healthcare managers, are afforded little managerial time due to the pressures of ensuring service delivery during economic crisis as well as managing multiple organisational changes. In this situation managers are challenged by negative impacts on patient care, organisational fragmentation and the weak implementation of change. Manager expectations for organisational transformation are low. Conclusions: Health system transformation is unlikely given the range of complex priorities requiring attention from managers during economic crisis. Managers have little expectation of organisational transformation as they face considerable service delivery challenges while feeling under-resourced and unsupported. Adequate resourcing of communication and leadership for change is critical.

Estimating indices of health system readiness: an example from rural northern Ghana

Abstract Background There is growing recognition that stronger health systems are necessary to accelerate progress towards the Millennium Development Goals (MDGs). However, a departure from disease-specific programmes and interventions requires the development of a new empirical framework for programme evaluation that focuses on indicators of health system strengthening. Service provision assessment (SPA) surveys provide a wealth of data about health system resources, but they often include too many indicators to provide useful insight into general systems strength or service readiness. To improve the usefulness of such data, we have applied multidimensional statistical data reduction techniques to SPA data with the aim of developing robust measures of health system capabilities. Methods Data for the construction of indices were derived from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey published by the Ghanaian Ministry of Health. This survey included a saturated sample of 147 health facilities in the Upper East Region. The instrument assessed facility readiness and performance using 3872 service and outcome indicators of: infrastructure; human resources; availability of drugs, equipment, and supplies; and knowledge of essential procedures. Of those indicators, 872 were identified as corresponding to one of the six WHO health system building blocks. Dimensionality reduction was done using principal component analysis. Where appropriate, we reorganised binary indicators into ordinal categorical variables, as is commonly done in the socioeconomic status literature. We also assessed the external validity of the new index. Findings Results from the principal component analysis of the 872 health systems indicators suggest that a single component (PC1) explains more than 30% of the common variance among the health facilities surveyed. An index composed of the factor loadings from PC1 showed marked variation between facilities (SD 13·077) with easily identifiable clusters of facility type (hospital, health centre, clinic, community compound). The distribution of PC1 also suggested concentration of resources among a few high-level facilities (Gini 0·508). Compared with EmONC signal functions, the index scores were better predictors of the number of deliveries (R 2 0·61 vs R 2 0·31) and the number of low birthweight babies (0·68 vs 0·26) as well as maternal deaths (0·81 vs 0·34) and neonatal deaths (0·79 vs 0·36). Interpretation Our findings suggest that an index of health system readiness that captures a large portion of facility variance can be constructed from SPA data using principal component analysis. In practice, such an index could be used to monitor progress towards stronger health systems. However, further research is needed to determine how an increase in index score which is input-focused, affects population health. Particular attention must also be paid to the performance determinants that maximise the efficient use of health system inputs. Funding Support for this study was provided by the African Health Initiative with funding from the Doris Duke Charitable Foundation.

Muscle symptoms in statin users, associations with cytochrome P450, and membrane transporter inhibitor use: A subanalysis of the USAGE study

Drug interactions have been identified as a risk factor for muscle-related side effects in statin users. The aim was to assess whether use of medications that inhibit cytochrome P450 (CYP450) isozymes, organic anion transporting polypeptide 1B1 (OATP1B1), or P-glycoprotein (P-gp) are associated with muscle-related symptoms among current and former statin users. Persons (n = 10,138) from the Understanding Statin Use in America and Gaps in Education (USAGE) internet survey were categorized about whether they ever reported new or worsening muscle pain while taking a statin (n = 2935) or ever stopped a statin because of muscle pain (n = 1516). Univariate and multivariate logistic regression models were used to assess associations between use of concomitant therapies that inhibit CYP450 isozymes, OATP1B1, P-gp, or a combination and muscle-related outcomes. In multivariate analyses, concomitant use of a CYP450 inhibitor was associated with increased odds for new or worse muscle pain (odds ratio [OR] = 1.42; P < .001) or ever having stopped a statin because of muscle pain (OR = 1.28; P = .037). Concomitant use of medication known to inhibit both OATP1B1 and P-gp was also associated with increased odds (OR = 1.80; P = .030) of ever having stopped a statin because of muscle pain. Concomitant use of medication(s) that inhibit statin metabolism was associated with increased odds of new or worse muscle pain while taking a statin and having previously stopped a statin because of muscle symptoms. These data emphasize the importance of enhancing the capabilities of clinicians and health systems for identifying and reducing statin drug interactions.

Authors' Response

To the Editor: We thank Hansen et al for their comments and agree that the arbitrary categorization of Kasai procedure caseload (<5 vs >5 cases per year) by McKiernan et al (1) does not allow for complete statistical analysis, nor can it determine the precise volume cutpoint for optimal outcomes. Categorization of continuous variables can result in loss of information, reduced statistical power, and increased risk of statistical error (2). In addition, categorization establishes arbitrary cutpoints, which can be problematic when the volume–outcome relation is not linear (as demonstrated by Hansen et al in their reevaluation of cutpoints). We suspect that surgical expertise and specialized medical therapy play a role in improving outcomes; however, to this point the biliary atresia literature has not adjusted for the strong effect of clustering. The similarities of patients and care provision in a single centre or from the same region results in statistical clustering of outcomes, and correction of this effect is crucial to reduce the likelihood of error in volume–outcome research (3). In addition, raw volume of procedures at a centre does not tell the full story; it does not account for individual surgeon volume, surgeon and other health care provider education and experience, the resources in that centre, or the associated health system capability to address postoperative complications. All of these could affect Kasai success and should be addressed in an analysis of the volume–outcome relation. We would encourage further large, well-designed epidemiologic research to determine the role of surgeon and centre volume on the outcomes of patients with biliary atresia.

A global perspective on the education and training of primary care and public health professionals.

Background There is a critical shortage of health workers globally, which is not just a problem for low- and middle-income countries, but needs to be tackled through shared action. At the same time, public policy around the world is responding to changing health needs, social trends and technological possibilities by placing ever greater emphasis on primary care and public health, the interconnections between them and their relationships with other disciplines. All these themes mean that a new approach to the education and training of health workers is required. Setting Global, but with relevance to the UK. Question The education and training of professionals in public health and primary care need to adapt to the changing epidemiological, social, technological and policy environment, as well as to health worker shortages and resource constraints. Methods This article brings together the results of reviews undertaken by the Global Health Workforce Alliance taskforce on scaling up the education and training of the health workforce and the Lancet Commission 'Health professionals for a new century - transforming education to strengthen health systems in an interdependent world' (of both of which the author was a member) with the author's own experiences working in Africa, Asia and North America as well as in the UK. Results There are obvious differences in the needs and capabilities of health systems in different countries, but whatever the context - and whether they are high-, low- or middle-income countries - there are many similarities in the approach that is needed to educate and train professional and non-professional health workers, and a great deal that all countries can learn from each other. Conclusion/discussion As the NHS enters a new phase in the continuing development of general practitioners as commissioners and providers there is a need to look for insights from around the world and to develop a new approach to educating and training primary care and public health professionals which takes account of this global perspective and global learning.

Global Public Health Security: Inequality, Vulnerability and Public Health System Capabilities.

Assessment of: The World Health Report 2007: A Safer Future: Global Public Health Security in the 21st Century. Geneva: World Health Organization, 2007. 72 pp.

Maternity referral systems in developing countries: Current knowledge and future research needs

A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers’ performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

Differences in curable STDs between HIV and non-HIV populations in Spain.

The pandemic impact of HIV has changed the clinical spectrum of STDs all over the world. The incidence and frequency of STDs in the different global geographic areas demonstrate the diagnostic and treatment capabilities of various local and national health systems and is simultaneously informing about the sexual behaviours of the population. The purpose of this study was to determine the frequency of curable STDs (herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis) in a hospital-based STD clinic in Madrid, Spain during a 4-year period. Patients were referred mainly from the emergency department, gynecological wards, and family planning (61%) as well as from the HIV-hospital unit (31 beds) and outpatient department (39%). The total number of patients seen was 952 (243 men, 709 women) with an annual average of 238 patients per year. Of these, 139 (14.6%) were HIV-patients and 813 (85.4%) non-HIV patients. In non-HIV patients, STDs were identified in 493 cases (54.2%). In HIV-patients, STDs were diagnosed in 108 cases (77.7%; p < or = 0.001). Two or more STDs were more prevalent in HIV than non-HIV patients. The frequency of STDs in both HIV and non-HIV patients were vulvovaginal candidiasis, 47.8%:57.2%; syphilis, 11.7%:1.4% (p < or = 0.05); gonorrhea, 5.3%:3.9%; Gardnerella vaginosis, 6.3%:4.8%; genital chlamydia, 6.3%:9.06%; trichomoniasis, 17%:6.5% (p < or = 0.05); and genital herpes, 20.2%:5.3% (p < or = 0.05).

Assessment of primary health care access status: an analytic technique for decision making.

Access to health care is an issue that has caught the attention of health care providers, policy formulators, and policy analysts, with particular emphasis on access to primary care, which affords all people a viable portal into the health care system. This paper proposes an analytical approach to the assessment of relative primary care access status, measured as the capability to deliver basic primary care services within specific geographic civil areas, or parishes, within the state of Louisiana. An additive multiattribute utility method is employed to develop a scoring system to rank parishes according to a primary care access, or health system capability, numerical score. Routinely collected parameters are used to measure each parish's current capability to provide primary care services. These parameters include demographic, mortality, morbidity, and resource data. A group of experts was used to give weight to each parish's parameter values, resulting in a relative score for each. Thus, parishes (or other geographic areas) can be ranked according to their primary care access status. This information can then be used to allocate resources, to distribute funds for health care services, and to guide policy formulation and implementation.