Structure Of Health System Research Articles

ПРОЕКТ-ПРОГРАММА ПО УПРАВЛЕНИЮ РЕГИОНАЛЬНОЙ СИСТЕМОЙ ЗДРАВООХРАНЕНИЯ ДЛЯ ПОВЫШЕНИЯ ЕЕ СОЦИАЛЬНО-ЭКОНОМИЧЕСКОЙ ЭФФЕКТИВНОСТИ (НА ПРИМЕРЕ РЕСПУБЛИКИ ТАТАРСТАН)

Updating the available methods of cost management with all its tools, their qualitative extrapolation to the field under study and implementation into it will fully solve the problems facing the domestic healthcare sector due to internal and external factors of influence. A project has been developed to improve the working conditions of medical workers, the level of professionalism of which has sharply increased the requirements for the implementation of government programs. The implementation of the Project is aimed at improving the socio-economic efficiency of medical care, managing achievable goals, internal relations and structures of the regional health system as an open system in which external and internal socio-economic environments are distinguished. The strategy of the project “Program for improving the social protection of medical workers” is the management of internal relations and elements of the healthcare sector at the regional level as an open system in which external and internal socio-economic environments are distinguished to increase its social effectiveness. All elements of this system are interconnected with each other and when choosing the directions of strategic changes in healthcare, it is necessary to take into account that limited financial resources determine the modernization of the healthcare system at all its levels. It requires updating and modernizing the management of internal and external relations, relationships, structures, and costs within them. At the same time, it becomes important to determine the forms of interaction: business models, norms of cooperation, cooperation.

Generating Political Priority for the Health Needs of the 21st Century: A Qualitative Policy Analysis on the Prioritization of Rehabilitation Services in Uganda.

Few low- or middle-income countries (LMICs) have prioritized the expansion of rehabilitation services. Existing scholarship has identified that problem definition, governance, and structural factors are influential in the prioritization of rehabilitation. The objective of this study was to identify the factors influencing the prioritization and implementation of rehabilitation services in Uganda. A case study design was utilized. The Prioritization of Rehabilitation in National Health Systems framework guided the study. Data sources included 33 key informant interviews (KIIs) with governmental and non-governmental stakeholders and peer-reviewed and grey literature on rehabilitation in Uganda. A thematic content analysis and concept map were conducted to analyze the data. Rehabilitation is an unfunded priority in Uganda, garnering political attention but failing to receive adequate financial or human resource allocation. The national legacy of rehabilitation as a social program, instead of a health program, has influenced its present-day prioritization trajectory. These include a fragmented governance system, a weak advocacy coalition without a unified objective or champion, and a lack of integration into existing health systems structures that makes it challenging to scale-up service provision. Our findings highlight the interactive influences of structural, governance, and framing factors on prioritization and the importance of historical context in understanding both prioritization and implementation. Our findings demonstrate challenges in prioritizing emerging, multi-sectoral health areas like rehabilitation. Strategic considerations for elevating rehabilitation on Uganda's policy agenda include generating credible indicators to quantify the nature and extent of the population's need and uniting governmental and non-governmental actors around a common vision for rehabilitation's expansion. We present opportunities for strengthening rehabilitation, both in Uganda and in similar contexts grappling with many health sector priorities and limited resources.

Global Mental Health Considers the Structure of the Mental Health System in the World

The World Health Organization defines mental health as a state of well-being in which each person realizes their potential and can cope with the normal stresses of life, work productively and fruitfully, and can contribute to their community. Global mental health refers to the international perception of different aspects of mental health. Taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of the mental health system, and mental health human resources and human rights issues. The general goal of the field of Global Mental Health is to strengthen mental health throughout the world, providing information on the mental health situation in all countries and identifying mental health needs in order to develop economic procedures that will address these specific needs.

Evaluation of Health Sector in the 5-year Socioeconomic and Cultural Cevelopment Plans of Iran

Background: Development is a mainstream that enhances the improvement and promotion of the socio-economic structure and system of a country. Maintaining and improving the level of community health is considered necessary for any action in the economic and social planning. Health has been one of the most basic human needs since its social life. Accordingly, the constitution of the Islamic Republic of Iran, as the main upstream document, regards health as a "universal right" and obliges the governments of the Islamic Republic of Iran to plan for the realization of this right.
 Method: In this qualitative study, using the adaptive method and content analysis technique, each of Iranian six development plans approved after Islamic Revolution has investigated.
 Results: Health played very limited roles in the first and second development plans. The mainstream health policy in the first and second plans was the development of public health through the development of healthcare centers. Sections related to the health sector were enhanced in the third development plan. The main orientation of this plan was to increase the efficiency and reform of health system structure. In the fourth and fifth development plans, health sector policies aimed at promoting justice in access to health services and improving fairness of financial contribution. The quantitative and qualitative development of health insurance and the implementation of stratification & referral system are the major goals of the sixth plan.
 Conclusion: In the first three development plans, there is no comprehensive overview of the plan, and most of the articles have service aspects and have not promoted to the policy level. In the later development plans, the approach of the plan has changed, and it is aimed at achieving equity in access to health services and improving the fairness of financial contribution.

Lessons from the Netherlands for Australia: cross-country comparison of trends in antidepressant dispensing 2013-2021 and contextual factors influencing prescribing.

There is concern internationally about increasing antidepressant use. Most antidepressants are prescribed in general practice. The aim of this study was to compare trends in antidepressant dispensing in Australia and the Netherlands over the 9years from 2013 to 2021, and to explore reasons for differences. A convergent mixed methods study including analysis of publicly available antidepressant dispensing data obtained from Australia's Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme and the Dutch Foundation for Pharmaceutical Statistics and a search of relevant literature to compare contextual factors influencing prescribing were undertaken. In 2013, antidepressant dispensing rates in Australia were nearly twice as high as those in the Netherlands (82.5 versus 44.3DDD/1000/day) and increased to be more than twice as high by 2021 (115.6 versus 48.8DDD/1000/day). Antidepressant dispensing increased by 40% in Australia over the nine study years, but by only 10% in the Netherlands. Our scan of the literature confirms that while population factors, health system structure, and clinical guideline recommendations are largely consistent across the two countries, a multifaceted approach in the Netherlands involving improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing, and tight regulation of pharmaceutical industry influence on prescribers, has successfully curtailed increasing antidepressant use. Australia may learn from the Netherlands' approach to redress increasing antidepressant use.

Targeting systems not individuals: Institutional and structural drivers of absenteeism among primary healthcare workers in Nigeria.

Universal Health Coverage (UHC) can only be achieved if people receive good quality care from health workers, yet in Nigeria, as in many other low- and middle-income countries (LMICs), many health workers are absent from work. Absenteeism is a well-known phenomenon but is often considered as the self-serving behaviour of individuals, independent from the characteristics of health systems structures and processes and the broader contexts that enable it. We undertook a qualitative inquiry among 40 key informants, comprising health facility heads and workers, community leaders and state-level health policymakers in Nigeria. We employed a phenomenology approach to examine their lived experiences and grouped findings into thematic clusters. Absenteeism by health workers was found to be a response to structural problems at two levels -midstream (facility-level) and upstream (government level) - rather than being a result of moral failure of individuals. The problems at midstream level pointed to an inconsistent and unfair application of rules and regulations in facilities and ineffective management, while the upstream drivers relate mainly to political interference and suboptimal health system leadership. Reducing absenteeism requires two-pronged interventions that tackle defects in the upstream and midstream rather than just focusing on sanctioning deviant staff (downstream).

Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study

BackgroundConflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022.MethodsThis descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables.ResultsThe findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies.ConclusionThe Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals.

Saudi Health System and Health Security Structure: A Scope Review Study Addressing the National Need for Governing the Health Security.

Health security has gained significant attention at the national and global levels, "security" is not a simple term; instead, it is "essentially contested" - that is, it induces debates about what it means and how to use it. This study aimed to define three terms frequently used in health security discussions. These terms are national health security, Global Health Security, and public health. The research method was a scoping review performed in three stages. The first stage was electronic searching based on selection criteria among multiple sources at various time points during the year 2023. These sources included online literature searches, websites of non-governmental organizations (NGOs), and other governmental health agencies. The second stage involved determining the relevance of the selected papers to the study's objectives; the selected papers had moderate to high relevance to the study's objectives. The third stage was to evaluate the methodological quality of a study; we selected peer-reviewed published papers and websitesrecognized as trustworthy sources of information.The search yielded 143 articles; five met the inclusion criteria and were subjected to the definition of health security. Despite proposed definitions, agreement has yet to be reached on the content and scope of health security. Another main finding is that health security requires more state and international collaboration efforts to reach Global Health Security. To the best of our knowledge, no known government body or organization is responsible for governing health security in Saudi Arabia. However, the current study presents a definition of health security and differentiates it from the public health approach, in addition to emphasizing the importance of governing the related health sectors within each country in order to improve health security and have a positive impact on overall Global Health Security.

Assessment of the Impact of Caregivers Complementary Feeding Knowledge on Undernutrition among Children 6 to 36 Months in Borno State, Nigeria

This paper is an assessment of the impact of Caregivers complementary feeding Knowledge on undernutrition among children 6-36 Months in Borno state. Large-scale renewables raise new challenges and provide new opportunities across Health systems. The paper considers the barriers faced by health workers and caregivers in Maiduguri Metropolitan Council in providing nutritional services to infants. We review the current state of knowledge in relation to nutrition. This paper then explores key issues in health and nutrition system structure, the main challenges to the uptake of renewables, and the various existing fiscal and policy approaches to encouraging health services. We also highlight possible ways of moving forward to ensure more widespread health management systems. Keywords: Caregivers, Feed Knowledge. Maiduguri Metropolitan Council, Undernutrition.

Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability.

To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons learned across countries and provide recommendations for future research. A narrative review of each nation's HIE policy frameworks, current state, and future HIE strategy. Key themes that emerged include the importance of both central decision-making as well as local innovation, the multiple and complex challenges of broad HIE adoption, and the varying role of HIE across different national health system structures. HIE is an increasingly important capability and policy priority as electronic health record (EHR) adoption becomes more common and care delivery is increasingly digitized. While all five case study nations have adopted some level of HIE, there are significant differences across their level of data sharing infrastructure and maturity, and each nation took a different policy approach. While identifying generalizable strategies across disparate international systems is challenging, there are several common themes across successful HIE policy frameworks, such as the importance of central government prioritization of data sharing. Finally, we make several recommendations for future research to expand the breadth and depth of the literature on HIE and guide future decision-making by policymakers and practitioners.

Underreporting contextual factors preclude the applicability appraisal in primary care randomized controlled trials

ObjectivesTo assess applicability reporting in randomized controlled trials (RCTs) conducted in primary care (PC). Study Design and SettingWe used a random sample of PC RCTs published between 2000 and 2020 to assess applicability. We extracted data related to setting, population, intervention (including implementation), comparator, outcomes, and context. Based on data availability, we assessed whether the five predefined applicability questions were adequately addressed by each PC RCT. ResultsAdequately described elements that were reported frequently (>50%) included the responsible organization for intervention provision (97, 93.3%), study population characteristics (94, 90.4%), intervention implementation including monitoring and evaluation (92, 88.5%), intervention components (89, 85.6%), time frame (82, 78.8%), baseline prevalence (58, 55.8%), and the type of setting and location (53, 51%). Elements that were often underreported included contextual factors, that is, evidence of differential effects across sociodemographic or other groupings (2, 1.9%), intervention components tailored for specific settings (7, 6.7%), health system structure (32, 30.8%), factors affecting implementation (40, 38.5%) and organization structure (50, 48.1%). The proportion of trials that adequately addressed each applicability question ranged between 1% and 20.2%, while none RCT could address all of them. ConclusionUnderreporting contextual factors jeopardize the appraisal of applicability in PC RCTs.

Functionality of technical working groups in enabling evidence-informed decision-making within Malawi's Ministry of Health: a cross-sectional qualitative study

BackgroundThe roles and functionality of technical working groups (TWGs) in the health sectors vary across countries, still they aim to support government and ministries in formulating evidence-informed recommendations for policies and facilitate dialogue and alignment of activities among stakeholders within the health sector. Thus, TWGs have a role in enhancing the functionality and effectiveness of the health system structure. However, in Malawi, the functionality of TWGs and how they utilize research evidence to contribute to decision-making is not monitored. This study sought to understand the TWGs' performance and functionality in enabling evidence-informed decision-making (EIDM) in Malawi's health sector.MethodsA cross-sectional descriptive qualitative study. Data were collected through interviews, documents review and observation of three TWG meetings. Qualitative data were analysed using a thematic approach. The WHO-UNICEF Joint Reporting Form (JRF) was used to guide the assessment of TWG functionality.ResultsTWG functionality varied in the Ministry of Health (MoH) in Malawi. The reasons for those perceived to be functioning well included meeting frequently, diverse representation of members, and that their recommendations to MoH were usually considered when decisions were made. For the TWGs that were perceived as not functioning well, the main reasons included lack of funding, periodic meetings and discussions that needed to provide clear decisions on the actions to be taken. In addition, evidence was recognized as important in decision-making, and research was valued by decision-makers within the MoH. However, some of the TWGs lacked reliable mechanisms for generating, accessing and synthesizing research. They also needed more capacity to review and use the research to inform their decisions.ConclusionsTWGs are highly valued and play a critical role in strengthening EIDM within the MoH. Our paper highlights the complexity and barriers of TWG functionality in supporting pathways for health policy-making in Malawi. These results have implications for EIDM in the health sector. This suggests that the MoH should actively develop reliable interventions and evidence tools, strengthen capacity-building and increase funding for EIDM.

Abstract 84: The Process of Setting Up an Inter-Country Cancer Care Program in Low-And-Middle-Income Countries: A Case of International Cancer Institute’s Uganda Blueprint for Innovative Healthcare Access Program

Abstract Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with the rising cancer burden causing a strain on the already weak health care and economic infrastructures. The extrapolation of the experiences of cancer control programs in High Income Countries (HICs) to LMICs is often inappropriate requiring a regional scale up of successfully implemented cancer programs across LMICs. Methods: International Cancer Institute (ICI) is a non-governmental, not-for-profit organization whose main purpose is to expand education and training opportunities in cancer care, education and research across Sub-Saharan Africa through multisectoral corroborations and partnerships. ICI successfully implemented two Blueprint programs in Kenya thus sought to scale up the program to Western Uganda. An online search of key players in Cancer care in Uganda was conducted that identified six potential partners including Ministry of Health – Uganda, Uganda Cancer Institute (UCI), Uganda Cancer Society (UCS), Uganda Non-communicable Diseases Alliance (UNCDA), Mbarara Regional Referral Hospital and Mbarara University of Science and Technology. Virtual meetings were held with two of them with a site visit scheduled for face-to-face meetings. Results: ICI team met with UCS and UNCDA teams in Uganda where contacts of other potential partners were obtained resulting in face-to-face meetings with UCI; Mbarara Regional Referral Hospital; Ministry of Health Western Uganda; District leadership of Western Uganda; Kampala International University Teaching Hospital; and Kampala International University, Western Campus. An assessment of the scope of districts of focus, distribution of facilities and the health system structure was done. A technical working group with representatives from ICI and the identified partners will then be formed to guide program design, implementation, monitoring and evaluation. Conclusion: The process of setting up a cancer care program in LMICs applies not only new innovations but also resource appropriate interventions. Leveraging on existing partner expertise maximizes positive program outcomes. Citation Format: Gloria Kitur, Kevin Makori, Chite Asirwa. The Process of Setting Up an Inter-Country Cancer Care Program in Low-And-Middle-Income Countries: A Case of International Cancer Institute’s Uganda Blueprint for Innovative Healthcare Access Program [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 84.

A QUALITATIVE STUDY ON THE IMPROVEMENT OF DISEASE MANAGEMENT POLICIES IN DIABETES IN TURKEY

This study, it was aimed to determine the need for disease management in diabetes in Turkey and to reveal the recommendations for diabetes disease management policies as part of the identified needs. In this study, the research design was planned as a case study and, the snowball sampling method was used as part of the scope of qualitative research. A total of 21 individuals, 6 doctors, 3 diabetic nurses, 6 academics, and 6 adult diabetics were actualized using semi-structured forms with a thorough interview technique. The data collected were evaluated with descriptive analysis and content analysis methods. In the analysis of the data, the “Nvivo 12. Program” was used. The findings were discussed based on the relevant literature, and conclusions and recommendations were reached in line with the research purposes. The participants stated that the practices related to disease management in diabetes have improved compared to the past, but that the development process should continue. The participants stated that there is a need for a multidisciplinary systematic process structuring that will prioritize the patient and their needs and that will help patients to live their lives healthy and free from complications. In terms of the burden of disease, diabetes is a significant issue that affects both Turkey and the rest of the world. We propose that the health policy, health service delivery, health system structure, and multidisciplinary work related to the disease management approach in diabetes in Turkey should be determined and steps should be taken to improve it.

The Pediatrician Workforce in the United States and China.

From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.

Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study.

Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.

Barriers Towards Obstetric Care Service Utilization in Ethiopia: An Explorative Qualitative Study.

Obstetric care has been at the center of both global and national agendas. More than 50% of pregnant mothers are still preferring to give birth at home with some even after having full antenatal care. However, a few literatures looked at contributing factors for this problem but they are not conclusive and do not consider different sociocultural context of Ethiopia and different health service related barriers. Hence, the aim of this study was to explore barriers to obstetric care service utilization in Ethiopia using the socio-ecological model. Explorative qualitative study was employed involving key-informant interviews, in-depth interviews, and focus group discussions between October and December 2021; Individual, community, health system, and contextual barriers were explored. Atlas ti. Version 9 was used for analysis. Lack of awareness, unfavorable perception, lack of partner involvement, cultural barrier, shortage of supplies, poor infrastructure, provider-related factors, poor monitoring, and evaluation system, challenging topography, and conflict were the major barriers that hinder mothers from receiving obstetrics service in Ethiopia. Lack of awareness, unfavorable perception, conflict, problems with health system structure and process, and cultural and geographical conditions were major barriers in Ethiopia. Therefore, packages of intervention is important to avail essential equipment, strengthening follow up system, create awareness, and increase access to health facilities is very important for service improvement by the government and non-governmental organizations. Additionally, implementing conflict resolution mechanism is important for addressing better obstetric service.

Pandemic preparedness and response regulations in Finland: Experiences and implications for post-COVID-19 reforms

The COVID-19 pandemic has plagued health systems in an unprecedented way and challenged the traditional ways to respond to epidemics. It has also revealed several vulnerabilities in countries’ health systems and preparedness. In this paper we take the Finnish health system as an example to analyse how pre-COVID-19 preparedness plans, regulations, and health system governance were challenged by the pandemic and what lessons can be learned for the future. Our analysis draws on policy documents, grey literature, published research, and the COVID-19 Health System Response Monitor. The analysis shows how major public health crises often reveal weaknesses in health systems, also in countries which have been ranked highly in terms of crisis preparedness. In Finland, there were apparent regulative and structural problems which challenged the health system response, but in terms of epidemic control, the results appear to be relatively good. The pandemic may have long-term effects on the health system functioning and governance. In January 2023, an extensive health and social services reform has taken place in Finland. The new health system structure needs to be adjusted to take on board the legacy of the pandemic and a new regulatory frame for health security should be considered.

A quality improvement approach in co-developing a primary healthcare package for raising awareness and managing female genital schistosomiasis in Nigeria and Liberia.

Girls and women living in endemic areas for urogenital schistosomiasis may have lifelong vulnerability to female genital schistosomiasis (FGS). For >2decades, the importance of FGS has been increasing in sub-Saharan Africa, but without established policies for case detection and treatment. This research aimed to understand the level of FGS knowledge of frontline health workers and health professionals working in endemic areas and to identify health system needs for the effective management of FGS cases and prevention of further complications due to ongoing infections. Workshops were conducted with health workers and stakeholders using participatory methods. These workshops were part of a quality improvement approach to develop the intervention. Health workers' and system stakeholders' knowledge regarding FGS was low. Participants identified key steps to be taken to improve the diagnosis and treatment of FGS in schistosomiasis-endemic settings, which focused mainly on awareness creation, supply of praziquantel, development of FGS syndromic management and mass administration of praziquantel to all eligible ages. The FGS intervention component varies across countries and depends on the health system structure, existing facilities, services provided and the cadre of personnel available. Our study found that co-developing a new service for FGS that responds to contextual variations is feasible, promotes ownership and embeds learning across health sectors, including healthcare providers, NTD policymakers and implementers, health professionals and community health workers.

A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities.

Tuberculosis (TB) is a leading cause of death globally. In 2015, the World Health Organization hailed patient-centred care as the first of three pillars in the End TB strategy. Few examples of how to deliver patient-centred care in TB programmes exist in practice; TB control efforts have historically prioritised health systems structures and processes, with little consideration for the experiences of people affected by TB. We aimed to describe how patient-centred care interventions have been implemented for TB, highlighting gaps and opportunities. We conducted a scoping review of the published peer-reviewed research literature and grey literature on patient-centred TB care interventions between January 2005 and March 2020. We found limited information on implementing patient-centred care for TB programmes (13 research articles, 7 project reports, and 19 conference abstracts). Patient-centred TB care was implemented primarily as a means to improve adherence, reduce loss to follow-up, and improve treatment outcomes. Interventions focused on education and information for people affected by TB, and psychosocial, and socioeconomic support. Few patient-centred TB care interventions focused on screening, diagnosis, or treatment initiation. Patient-centred TB care has to go beyond programmatic improvements and requires recognition of the diverse needs of people affected by TB to provide holistic care in all aspects of TB prevention, care, and treatment.