Health System Development Research Articles

Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

Continuing professional development for pharmacists in three countries with developing health systems

IntroductionThe role of pharmacists in healthcare is undergoing transformation throughout the world. The continuing professional development (CPD) model has motivated pharmacists in developed countries to adopt lifelong learning. This is vital to improve competence and to optimize patient care. This study aimed to explore the existence and understanding of CPD in Ghana, Pakistan, and Trinidad and Tobago, the barriers faced in development of a CPD model, and probable policies needed to build/improve such a model. MethodsAudiotaped qualitative in-depth interviews were conducted, transcribed, and coded with pharmacy stakeholders, including academics, community pharmacists, and regulatory professionals. A thematic analysis of the transcribed data led to the extraction of the main themes. ResultsThe findings showed a process of establishment of CPD for pharmacists in Ghana, whereas in Pakistan, Trinidad, and Tobago there was no CPD model. ConclusionsThese findings indicate the need for a realistic, relevant, and mandatory program of CPD in these countries.

The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study.

BackgroundThe need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems.ObjectiveThis study aims to examine the relationship between individual coping and the need to have and seek health information among older adults.MethodsQuestionnaires and semistructured interviews investigated the health information need (HIN) and health information–seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans.ResultsThe mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=−0.37895; bias-corrected and accelerated bootstrap 95% BCa CI −0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals.ConclusionsIndividual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance.

Implementation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial in a US health system\u2014lessons learned and recommendations

BackgroundThe Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial is a global adaptive platform trial of hospitalized patients with COVID-19. We describe implementation at the first US site, the UPMC health system, and offer recommendations for implementation at other sites.MethodsTo implement REMAP-COVID, we focused on six major areas: engaging leadership, trial embedment, remote consent and enrollment, regulatory compliance, modification of traditional trial management procedures, and alignment with other COVID-19 studies.ResultsWe recommend aligning institutional and trial goals and sharing a vision of REMAP-COVID implementation as groundwork for learning health system development. Embedment of trial procedures into routine care processes, existing institutional structures, and the electronic health record promotes efficiency and integration of clinical care and clinical research. Remote consent and enrollment can be facilitated by engaging bedside providers and leveraging institutional videoconferencing tools. Coordination with the central institutional review board will expedite the approval process. Protocol adherence, adverse event monitoring, and data collection and export can be facilitated by building electronic health record processes, though implementation can start using traditional clinical trial tools. Lastly, establishment of a centralized institutional process optimizes coordination of COVID-19 studies.ConclusionsImplementation of the REMAP-COVID trial within a large US healthcare system is feasible and facilitated by multidisciplinary collaboration. This investment establishes important groundwork for future learning health system endeavors.Trial registrationNCT02735707. Registered on 13 April 2016.

Treating pediatric and congenital heart disease abroad? Imperatives for local health system development

Over one million children are born with congenital heart defects each year, whereas four million children live with with rheumatic heart disease. Although a majority of these patients will eventually require surgical or interventional care, most live in areas without access to safe, timely, and affordable cardiac surgical care. Countries with limited or no local cardiac surgical care spend up to over 10% of their health budgets on sending patients abroad to receive cardiac care. Similarly, billions of dollars are spent each year on international medical tourism, notably including seeking cardiac surgical care abroad. Some low- and middle-income countries have successfully invested in domestic cardiac surgical services, saving tens of millions of dollars over time whilst strengthening local health systems. In this article, we describe international medical tourism for pediatric and congenital heart disease, and present an analysis on whether expenditure in seeking foreign care for cardiovascular patients is worth the cost in light of a neglect of investments in local cardiac services in countries with growing health systems.

Factors affecting the emergence of diplomacy in Iranian nurse managers: a qualitative study.

To explore the factors affecting the emergence of diplomacy in Iranian nurse managers. Today, with the development of complex health systems, diplomacy in health care can take place at organizational, national and international levels. Diplomacy's role is to convince others peacefully to achieve goals. Diplomacy in nursing can facilitate professional development and direct policy and decision-making process towards the development of a healthcare system. The study used a qualitative descriptive approach. The sampling method was purposeful, and data were collected via in-depth, unstructured and face-to-face interviews with 16 participants. The interviews were digitally recorded, transcribed verbatim and analysed through conventional content analysis based on Graneheim and Lundman's work. In total, 212 codes were generated, which were grouped into three main categories, namely paradigmatic socio-political changes (two subcategories), nurses' dissatisfaction with their status in healthcare system (two subcategories) and multidimensional development of the nursing profession (four subcategories). Socio-political changes, development of the nursing profession and nurses' dissatisfaction with the health system have led to the emergence of diplomacy roles in nurse managers, the recognition and development of which can improve the effectiveness of nurse managers in policymaking. The recent COVID-19 pandemic outbreak has demonstrated the urgent need to use diplomacy to solve health problems and adjust or develop policymaking at the national and international levels. Strengthening their role in diplomacy, nurse managers can play an important role as diplomats at various levels of policymaking and in health crisis management.

Historical roots of hospital centrism in Catalonia (1917-1980)

The aim of this article is to analyse the roots of the Catalonia health reform, whose first projects on reform have been documented since 1917. This historical process set-up, in Catalonia, a hospital-centric model involving three sets of regenerating and mutually reinforcing institutions: financial resources were being disproportionally distributed to hospitals, high-quality medical professionals were largely concentrated in hospitals and large outpatient departments were incorporated in hospitals, which functioned as a first point of care for many patients. Based on these premises, the intention is to contribute to the understanding of the initiatives that, during much of the 20th century, took place in Catalonia with the aim of bringing access to hospital services to the population. These same organising principles also had decisive influence on hospital planning in the rest of Spain. As such, we develop an historical approach to public policies that have been shaping the current imbalance between hospitals and primary care providers in Catalonia by combining two methodologies. On the one hand, an overview of the existing literature on this topic. On the other, an accumulation of case studies –which does not claim to be exhaustive– the result of this very research and that of other specialists in the object of study.As Catalonia still has a hospital-centric health system seeded throughout the 20th century, these findings can inform the framing of contemporary options for primary care strengthening. Without addressing these deep regenerating causes using a whole-system approach, Catalonia is unlikely to achieve a primary care orientation for health system development.

Extreme Weather and Climate Change: Population Health and Health System Implications.

Extreme weather and climate events, such as heat waves, cyclones, and floods, are an expression of climate variability. These events and events influenced by climate change, such as wildfires, continue to cause significant human morbidity and mortality and adversely affect mental health and well-being. Although adverse health impacts from extreme events declined over the past few decades, climate change and more people moving into harm's way could alter this trend. Long-term changes to Earth's energy balance are increasing the frequency and intensity of many extreme events and the probability of compound events, with trends projected to accelerate under certain greenhouse gas emissions scenarios. While most of these events cannot be completely avoided, many of the health risks could be prevented through building climate-resilient health systems with improved risk reduction, preparation, response, and recovery. Conducting vulnerability and adaptation assessments and developing health system adaptation plans can identify priority actions to effectively reduce risks, such as disaster risk management and more resilient infrastructure. The risks are urgent, so action is needed now.

Organizational and methodological providing of management of territorial centers of public health according to the concept of public health system development

Organizational and methodological providing of management of territorial centers of public health according to the concept of public health system development

Research for universal health coverage: setting priorities for policy and systems research in Uganda

ABSTRACT Background There is international consensus on the need for countries to work towards achieving universal health coverage (UHC) whereby the population is given access to all appropriate promotive, preventive, curative and rehabilitative services at affordable cost. The World Health Organisation (2013) urges all countries to undertake research to customise UHC within national development agendas. Objective To describe the process used to prioritise UHC within the health systems research and development agenda in Uganda. Methods Two national consultative workshops were convened in May and August 2015 to develop a UHC research agenda in Uganda. The participants included multisector representatives from local, national, and international organisations. A participatory approach with structured deliberations and multi-voting techniques was used. Stakeholders’ views were analysed thematically according to health systems building blocks, and multi-voting was used to assign priorities across themes and sub-themes. The priorities were further validated and disseminated at national health sector meetings. Results Of the 80 invited stakeholders, 57 (71.3%) attended. The expressed priorities were: 1) health workforce; 2) governance; 3) financing; 4) service delivery, and 5) community health. The participants also recommended crosscutting research themes to address the social determinants of health, multisectoral collaboration, and health system resilience to protect against external shocks and disease epidemics. Conclusion Discussions that capture the diverse perspectives of stakeholders provide a way of exploring UHC within health policy and systems development. In Uganda, attention should be paid to the principal challenges of mobilising financial and technical capabilities for research and strengthening the link between evidence generation and policy actions to achieve UHC.

Acute Lymphoblastic Leukaemia Survival in Children Covered by Seguro Popular in Mexico: A National Comprehensive Analysis 2005–2017

The aim of the study was to measure survival of children with acute lymphoblastic leukemia (ALL) under Mexico’s public health insurance for the population treated under Seguro Popular. A retrospective cohort study using claims data from Mexico’s Seguro Popular program, covering cancer treatment from 2005 to 2015 was conducted. Overall 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this program was estimated. From 2005 to 2015, 8,977 children with ALL initiated treatment under Seguro Popular. Under this financing scheme, the annual number of treated children doubled from 535 in 2005 to 1,070 in 2015. The estimates for 5-year overall survival of 61.8% (95%CI 60.8, 62.9) remained constant over time. We observed wide gaps in risk-standardized 5-year overall survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-pediatric specialty hospital (Hazards Ratio, HR = 1.18; 95%CI 1.09, 1.26), facilities without a pediatric oncology/hematology specialist (HR = 2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR = 1.22; 95%CI 1.13, 1.32). In a decade Mexico’s Seguro Popular doubled access to ALL treatment for covered children and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year overall survival did not improve over time and did not achieve levels found in comparable countries. Our results provide lessons for Mexico’s evolving health system and for countries moving toward universal health coverage.

Study on the Influence of Intelligent Pre Triage System on Emergency Quality

In order to improve the emergency quality of domestic hospitals and promote the rapid development of medical and health system, the impact of intelligent pre triage system on emergency quality is studied. Through the analysis of the feedback from the pilot hospitals, it is found that the system has an important impact on the collection and transmission of patients' information, early warning of patients' condition, grading of patients' condition and arrangement of triage order, promotion of flexible scheduling system, and improvement of rescue effectiveness. This study affirms the practicability and advanced nature of the intelligent system of preview triage, so as to promote the system in all hospitals in China and improve the quality of emergency.

ОЦЕНКА ПРОФЕССИОНАЛЬНЫХ РИСКОВ ЛИЧНОГО СОСТАВА МЧС РОССИИ

Purpose. The article presents the results of the studies carried out in the course of the research work on the development of Model Regulations on health and safety protection management system in EMERCOM of Russia, in particular, identifying personnel hazards and compiling a list of them, assessing occupational risk level and elaborating measures aimed at their reduction, in order to decrease injury, disability, morbidity rates and death toll of EMERCOM of Russia personnel during the official duties performance. Methods. In the study, risk assessment matrices (matrix method) have been used in two ways: frequency (probability, prevalence) and severity of consequences (possible damage). The hazards, together with information on personnel posts, specific types of activities for which the hazards are typical, as well as the results of risk assessment associated with the hazards, and measures to reduce these risks, are recorded in a occupational hazard generalized register. Findings. For the first time, a methodology for assessing occupational risks taken by EMERCOM of Russia personnel (hereinafter referred to as the Methodology) has been developed, based on the elaborated list of hazards, taking into account work peculiarities. Research application field. The developed Methodology is approved by the ordinance of EMERCOM of Russia dated March 31, 2021 No. 249 "On approval of Methodical recommendations for the development of health and safety protection management system in EMERCOM of Russia" Conclusions. Matrix method use will allow organizing the risk management process. This method will help identify hazards and assess the levels of occupational risks in units, institutions and organizations of EMERCOM of Russia, and then implement measures aimed at reducing occupational risks levels. The introduction of the methodology for assessing occupational risks of personnel in units, institutions and organizations of EMERCOM of Russia will allow: reducing death toll and injury rate from accidents during official duties performance, as well as occupational diseases; improving working conditions; raising the awareness of the personnel on working conditions during the official duties performance, ensuring their right to safe work.

Confidence in Public Institutions is Critical in Containing the COVID-19 Pandemic

Background There is substantial heterogeneity in COVID-19 prevalence and deaths across countries. Several potential mechanisms have already been revealed behind this phenomenon, and from policy point of view, it is key to find the most important ones to fight pandemics that are expected to occur more often in the future.Methods We employ regression and machine learning methods to identify the most critical predictors of deaths attributed to the pandemic. We control for each type of confounding factors used in the previous articles.Findings We find that confidence in public institutions is one of the most important predictors of deaths attributed to COVID-19, compared to country-level measures of individual health risks, the health system, demographics, economic and political development, and social capital. A one standard deviation increase (e.g., the actual difference between the US and Finland) in confidence is associated with 350·9 (95% CI -531·922 - -169·831, p=0·000) fewer predicted deaths per million inhabitants.Interpretation Our results suggest that effective policy implementation during pandemics requires citizens to cooperate with their governments, and willingness to cooperate relies on confidence in public institutions.Funding Hungarian National Scientific Research Program (PD128850 and FK131422).Declaration of Interest: None to declare.

Therapeutic Development in COVID-19.

Since the outbreak of coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2, the disease has spread rapidly worldwide and developed into a global pandemic, causing a significant impact on the global health system and economic development. Scientists have been racing to find effective drugs and vaccines for the treatment and prevention of COVID-19. However, due to the diversity of clinical manifestations caused by COVID-19, no standard antiviral regimen beyond supportive therapy has been established. Ongoing clinical trials are underway to evaluate the efficacy of drugs that primarily act on the viral replication cycle or enhanced immunity of patients. This chapter will summarize the currently used antiviral and adjuvant therapies in clinical practice and provide a theoretical basis for the future treatment of COVID-19.

НАЦИОНАЛЬНЫЙ ПРОЕКТ «ЗДОРОВЬЕ» В ЮЖНО-СИБИРСКОМ МАКРОРЕГИОНЕ

The article presents and discusses the problems of implementing national projects aimed at strengthening and preserving public health, improving healthcare activities on the example of the South Siberian macroregion, including the Novosibirsk, Omsk, Tomsk, Kemerovo regions, Altai Krai and the Altai Republic; emphasis is placed on a comparative analysis of the state and dynamics of the main health indicators, indicators of the development of health systems of the subjects of the macroregion; open data of state statistics, information posted on the websites of the authorities of the subjects of the Russian Federation, ratings of territories, author's assessments of ongoing processes; conclusions and recommendations are made.

Willingness and determinants of participation in public health research: a cross-sectional study in Saudi Arabia.

Active participation in health research plays an integral role in the development and implementation of evidence-based health interventions and policies. To assess public willingness and determinants of participation in public health research. A cross-sectional survey targeting Saudi residents aged > 16 years from the 13 regions of Saudi Arabia, using computer-assisted telephone interviews. We assessed the sociodemographic of participants, participants' involvement in research, their acceptance to participate, barriers hindering their participation, and their willingness to be involved in future health research. Pearson's χ2 and logistic regression analyses were used to explore determinants. There were 2512 participants in this study. Three hundred and seventy one (14.8%) confirmed that they had been invited previously to participate in research studies and 271 (73%) accepted the invitation. The majority (92%, n = 2319) of participants were willing to participate in future research. Being a young adult, male, college-educated, and employed were the main factors associated with willingness to participate in health research. Those who had previous experience of participation in health research were 3 times more willing to participate in future health research compared with participants with no prior experience (P < 0.001). This study highlighted the key determinants of willingness to participate in health research. Most participants had never been invited to participate in health research, but the majority reported a positive attitude towards participation. With rapid health system development nationally and regionally, Saudi participation levels in health research still need improvement.

A Proposed Evaluation Plan for the Diabetes Prevention and Control Program

Introduction: India is projected to be the diabetes capital by the next decade, and Asians are predisposed to central obesity and visceral adiposity which puts them at additional risk for diabetes. Materials and Methods: The proposed evaluation plan draws reference from the non-communicable disease prevention and control program, implemented by the Karnataka Health Systems Development &amp; Reforms Project (KHSDRP), Directorate of Health Services, Government of Karnataka (GoK) in collaboration with the World Bank, New Delhi, during the period 2012 to 2016. This evaluation will be conducted by an external agency in consultation with the Medical Officer/Investigator. Results: The relevant reports will officially benefit the District Program Officer and District Health Officer of Davangere and Dakshina kannda districts, Karnataka, India, where the program is being implemented. Conclusion: The results of this plan will benefit health promotion planning by the Health Department including building of community advocacy for the promotional initiatives.

ANALYSIS OF MANAGEMENT RISKS IN THE ORGANIZATION OF CORPORATIVE HEALTHCARE SYSTEMS IN THE UNFAVORABLE EPIDEMIC SITUATION IN RUSSIA AND GERMANY (2020-2021)

Risk management in healthcare is studied insufficiently. Risk management will provide more accurate forecasting and planning, it will improve quality of management decisions and increase the efficiency of medical organizations. The necessity of developing health systems has become relevant both in Russia and abroad in the context of the coronavirus pandemic 2020-2021. There is an increased interest in reviving and improving of corporate health management systems of large enterprises. The author was consistently engaged in the organization of health care in 3 large federal companies in Russia, as well as in Germany during the pandemic. The specific tasks of corporate health care in the context of a pandemic, the criteria of management errors and typical management errors were identified and classified, their primary causes were established. General recommendations were given based on the analysis, directions for the development for the further study were formulated.

Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya.

Background:Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework.Methods:A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach.Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces.Conclusion and Global Health Implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.