Health System Response Research Articles

'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia.

Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.

Housing Instability Screening and Referral Programs: A Scoping Review

Housing instability in the United States is a critical social determinant of health, influencing health outcomes and health care utilization. This scoping review aimed to analyze literature on US health system screening and response programs addressing housing instability, highlighting methodologies, geographic and demographic variations, and policy implications. Adhering to PRISMA-ScR guidelines, the review included studies focusing on US health systems that screen and refer for housing instability. Major scholarly databases, including PubMed and Scopus, were queried. Screening and response program characteristics, methodologies, and outcomes were characterized. Thirty studies published between 2003 and 2023 were included in this study. Included studies were primarily cross-sectional (26.7%) or quality improvement (20.0%), among 9 other designs. Screening programs were predominantly implemented in academic hospital systems (46.7%) and in the Northeast (63.3%). Of the 25 adult population studies, 68.0% were in outpatient settings, and of the 23 studies providing detailed information on their process, 52.2% used electronic health record entry. Of the 22 studies that describe their screening tool, 15 used institution-specific tools, and only 4 of the remaining 7 studies used identical tools. Of the 20 studies that described their response to positive screenings, 13 provided patients with a paper or electronic referral to a collaborating community partner, while only 6 aided the patient in connecting with community resources. This study found significant variability in screening and response programs for housing instability among US health care providers. A lack of standardized definitions and methodologies hampers effective comparison and implementation of these programs. Future research should focus on standardizing screening methods and measurement of interventions and outcomes to address housing instability.

Health systems response to climate change adaptation: a scoping review of global evidence

BackgroundThe health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.MethodsThis review followed the recommendations by Arksey and O’Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.ResultsWe found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.ConclusionEfforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Improving health system responses when patients are harmed: a protocol for a multistage mixed-methods study

IntroductionAt least 10% of hospital admissions in high-income countries, including Australia, are associated with patient safety incidents, which contribute to patient harm (‘adverse events’). When a patient is seriously harmed,...

Engaging primary care professionals in OECD’s international PaRIS survey: a documentary analysis

Healthcare professionals have first-hand experience with patients in clinical practice and the dynamics in the healthcare system, which can be of great value in the design, implementation, data analysis and dissemination of research study results. Primary care professionals are particularly important as they provide first contact, accessible, coordinated, comprehensive and continuous people-focused care. However, in-depth examination of the engagement of health professionals in health system research and planning activities—how professionals are engaged and how this varies across national contexts- is limited, particularly in international initiatives. There is a need to identify gaps in the planning of engagement activities to inform the design and successful implementation of future international efforts to improve the responsiveness of health systems to the changing needs of patients and professionals. The aim of this study was to explore how primary care professionals were engaged in the design and implementation plans of an international health policy study led by the Organisation for Economic Co-operation and Development (OECD). The OECD’s international PaRIS survey measures and disseminates information on patient-reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps) was conducted between January and June 2023. Two reviewers independently performed the screening and data abstraction and resolved disagreements by discussion. We reported the intended target primary care professionals, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisations of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation was found in the timing of engagement activities during the different phases of the study and in the level of engagement, ranging from co-development (half of the countries co-developed the survey together with primary care professionals) to one-off consultations with whom. International guidance facilitated the participation of primary care professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engagement with primary care organisations and individual professionals and enhance meaningful engagement of primary care professionals.

Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia.

Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia. We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis. The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success. The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

Delivering HIV and TB services amidst the COVID-19 pandemic in Indonesia: a qualitative study of challenges and mitigation strategies

Background Indonesia has the second-highest burden of tuberculosis (TB) globally and is experiencing one of the fastest-growing HIV epidemics worldwide. The COVID-19 pandemic disrupted access to essential health services, including those for TB and HIV, due to health system overload, social distancing measures, and negative economic repercussions on the health sector and the population. An in-depth understanding of these challenges and the health system responses to mitigate the negative impact of the pandemic on TB and HIV services is crucial to building health system resilience and preparing for future emergencies. Methods This qualitative study, conducted in two cities in Indonesia, explored the impact of the COVID-19 pandemic on TB and HIV services including mitigation strategies to sustain the provision of testing and treatment in the midst of the pandemic. Between February and June 2022, semi-structured interviews were conducted with 16 healthcare workers and 16 clients at nine health centers (puskesmas), three hospitals, and one Community Center for Lung Health in Bandung and Yogyakarta. Themes were identified from transcripts using open and selective coding and then refined. Results Extraordinary measures were implemented in health facilities to sustain TB and HIV service delivery, and prevent the spread of COVID-19, including testing of clients for COVID-19 before receiving medical care, physical distancing when visiting healthcare facilities, revised schedules for medicine dispensing, involvement of community health workers and peers in community outreach activities such as the home delivery of medicines, and the use of telemedicine. Challenges encountered during the implementation of these strategies included medicine stock-outs, health worker overload, lack of sufficient client-provider interaction and technical difficulties when implementing telemedicine, and the risk or fear of exposure to COVID-19 among the community health workers and peers. Conclusions Significant efforts were made to mitigate disruptions to TB and HIV services during the COVID-19 pandemic. However, some challenges were encountered. Key policy recommendations to strengthen pandemic preparedness include investing in local manufacturing and robust drug supply networks to prevent medicine shortages, and supporting community health workers to alleviate workload issues, reduce the risk of disease exposure, and explore the potential for a financial incentive system. Equally vital is the need to invest in staff training and education, as well as implementing user-friendly telemedicine technologies.

Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study)

BackgroundPrimary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC’s clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC’s role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics.MethodsA mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. Analysis: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development.DiscussionWhile PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC’s role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants’ involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments’ daily dashboards in Europe, often overlooked in media and public debates.

A need to integrate healthcare services for HIV and non-communicable diseases: An Indian perspective.

With the decline in HIV mortality, a concomitant increase in morbidity and death not directly related to HIV has been witnessed. Consequently, many countries especially low- and middle-income countries (LMICs) are now facing the dual burden of HIV and non-communicable diseases (NCDs). 2.3 million people living with HIV in India are at a higher risk of developing NCDs due to ageing, which can be attributed to the additional impact of long-standing HIV infection and the side-effects of antiretroviral therapy. This has led to a rise in demand for a combined health system response for managing HIV infection and co-existing NCDs, especially in LMICs such as India. The health and wellness centres (HWCs) envisioned to provide an expanded range of preventive and curative services including that for chronic conditions may act as a window of opportunity for providing egalitarian and accessible primary care services to these individuals. The reasons for integrating HIV and NCD care are epidemiological overlap between these conditions and the similar strategies required for provision of healthcare services.

Sustaining progress towards universal health coverage amidst a full-scale war: learning from Ukraine.

In the aftermath of Russia's military response to the 2014 Revolution of Dignity, the government of Ukraine implemented a package of health financing reforms underpinned by universal health coverage (UHC) principles. By the time of Russia's full-scale invasion of Ukraine in February 2022, the new systems and institutions envisaged in the reforms were largely established. In this Commentary article, we explain how these attributes strengthened the Ukrainian health system's response to the impacts of the war. Ukraine's experience highlights the role that health financing arrangements, designed in accordance with UHC principles, can play in strengthening health system resilience.

Core health system measures response to COVID-19 among East Asian countries.

The purpose of this study is to summarize the health system response to COVID-19 in four East Asian countries, analyze the effectiveness of their health system response, and provide lessons for other countries to control the epidemic and optimize their health system response. This study investigated and summarized COVID-19 data and health system response in four East Asian countries, China, Japan, Mongolia, and South Korea from national governments and ministries of health, WHO country offices, and official websites of international organizations, to assess the effectiveness of health system measures. As of June 30, 2022, all four countries are in a declining portion of COVID-19. China has two waves, and new cases increased slowly, with the total cases per million remaining within 4, indicating a low level. Japan has experienced six waves, with case growth at an all-time high, total cases per million of 250.994. Mongolia started the epidemic later, but also experienced four waves, with total cases per million of 632.658, the highest of the four countries. South Korea has seen an increasing number of new cases per wave, with a total case per million of 473.759. In containment strategies adopted by China and Mongolia, and mitigation strategies adopted by Japan and South Korea, health systems have played important roles in COVID-19 prevention and control. While promoting vaccination, countries should pay attention to non-pharmaceutical health system measures, as evidenced by: focusing on public information campaigns to lead public minds; strengthening detection capabilities for early detection and identification; using technical ways to participate in contact tracing, and promoting precise judging isolation.

Soft tissue sarcomas: Disease burden and health system response in Peru.

e23557 Background: The management of soft tissue sarcomas (STS) presents a challenge in Peru, with a fragmented health system and few centers specialized in sarcoma care. There is no national cancer registry, which does not allow us to have a real view of the most prevalent types. Our aim was to determine the incidence in Instituto Nacional de Enfermedades Neoplásicas (INEN) and to know the real care capacity of cancer centers nationwide. Methods: A retrospective study was carried out in INEN between 2009 and 2015 to know the incidence of STS. Also, a survey was carried out to determine the real capacity of diagnosis and treatment care of cancer centers located in different regions of our country. Results: We were able to determine the anatomopathological diagnosis in 1804 (100%) patients. 52,1% were male (n = 899). Median age was 43 years (15-96). The most frequent sarcoma was undifferentiated pleomorphic sarcoma with 482 patients(27.9%), followed by liposarcoma in 269 (15,6%) and leiomyosarcoma in 159 (9%). The most common primary location was the limbs with 892 patients (51.7%), followed by the abdomen and pelvis with 423 (24.5%), and the least common was the head and neck with 207 patients (12%), followed immediately by the thorax with 205 patients (11.9%). According to the region of origin, 551 (31.9%) patients came from the northern region, 175 (10.1%) from the south, 35 (2%) from the east, 308 (17.8%) from the central region, and 658 (38.1%) from Lima and Callao. We obtained responses from 20 oncology centers of the Ministry of Health along 12 regions operating nationwide. Eight (40%) oncology centers are located in Lima and twelve (60%) in the rest of Peru. 100% (n = 20) of centers have medical oncologists, 70% (n = 14) have surgical oncologists, 65% (n = 13) have traumatologist and pathologist. About capacity of resolution: 100% (n = 20) perform direct biopsy of soft tissue tumors and 60% (n = 12) perform image-guided biopsies; regarding pathology, 95% (n = 19) performed morphological approach and 45% (n = 9) immunohistochemistry studies. 100% (n = 20) can perform ultrasound studies, 95% (n = 19) tomography, and 35% (n = 7) magnetic resonance imaging. 90% (n = 17) accomplish radical surgeries and 60% (n = 12) limb sparing surgeries. 85% (n = 17) enforce chemotherapy treatment. Only 50% (n = 10) have a radiotherapy service. 25% (n = 5) hold multidisciplinary meetings continuously while 40% (n = 8) hold them occasionally for complex cases. Only 8 oncology centers (out of a total of 20) have all the services to care for the complexity of a patient with soft tissue sarcoma, the majority (n = 3) located in Lima. Conclusions: Nearly 1,800 patients have been diagnosed in this reference institution in a period of 5 years, however it represents an underestimation of the real incidence. Cancer centers that can provide complete care for patients with soft tissue sarcomas are scarce, creating a gap in care for this pathology.

The impact of the COVID-19 pandemic on the incidence of myocardial infarctions: an overview of current research

Introduction and Purpose: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly impacting the management of critical non-COVID conditions such as myocardial infarction (MI). This review aims to explore the alterations in the management of MI during the pandemic and assess how these changes have influenced patient outcomes. State of Knowledge: Numerous studies have reported delays in MI treatment during the pandemic due to healthcare resource reallocation towards COVID-19 care and patient hesitance in seeking timely medical help. Innovations such as telemedicine have been integrated into patient care to overcome barriers. However, these changes have varied impacts on clinical outcomes, including increased mortality and complication rates among MI patients during the pandemic. This review consolidates findings from recent studies focusing on altered treatment protocols, patient care strategies, and overall health system response during this period. Summary: The management of myocardial infarction during the COVID-19 pandemic has witnessed substantial shifts, leading to both challenges and innovations in cardiac care. While some adjustments have provided temporary solutions, the overall impact on MI outcomes has highlighted the need for more resilient healthcare strategies that ensure the continuity of care for acute cardiac events during global health emergencies.

PERSON-CENTERED CARE MODEL WITH MULTIMORBIDITY

Multimorbidity is a national and global public health problem that causes a deterioration in people’s health and survival. Health system response is fragmented in several programs with low satisfaction and adherence in patients. Therefore, is advisable to move towards a strategy applying the principles of the Model of Comprehensive Community Health, where the focus ison people, who are activated for their health care. The Ancora Health Innovation Center of the “Universidad Católica” and the Metropolitan Southeast Health Service (SSMSO) carried out a pilot project to implement the Person-Centered Care Model with Multimorbidity (MACEP) aiming to prevent complications and reducing demand at secondary and tertiary care levels. Between 2017 and 2019, 20,642 people were intervened and to evaluate intervention impact they were compared with 32,661 people treated in neighboring not intervened Family Health Care Centers (CESFAM). Significant decreases in the risk of dying and hospitalization were found in the intervened population. Percentage level of MACEP implementation in the seven intervened family health care centers was also evaluated,verifying values from 41 to 100%. The economic evaluation of the pilot project showed higher costs in primary and secondary care, as well as significant savings at the tertiary level, witha net saving in the system total cost. In 2019, the Ministry of Health,drawing on MACEP's experience in the SSMSO, described the Strategy for Person-Centered Comprehensive Care in the Context of Multimorbidity (ECICEP) and began its implementation at the national level. In the case of a public policy that it is still very young,it becomes necessary to deepen the changes that ensure its progress and consolidation.

Utilizing disease transmission and response capacities to optimize covid-19 control in Malaysia

ObjectivesPublic Health Social Measures (PHSM) such as movement restriction movement needed to be adjusted accordingly during the COVID-19 pandemic to ensure low disease transmission alongside adequate health system capacities based on the COVID-19 situational matrix proposed by the World Health Organization (WHO). This paper aims to develop a mechanism to determine the COVID-19 situational matrix to adjust movement restriction intensity for the control of COVID-19 in Malaysia.MethodsSeveral epidemiological indicators were selected based on the WHO PHSM interim guidance report and validated individually and in several combinations to estimate the community transmission level (CT) and health system response capacity (RC) variables. Correlation analysis between CT and RC with COVID-19 cases was performed to determine the most appropriate CT and RC variables. Subsequently, the CT and RC variables were combined to form a composite COVID-19 situational matrix (SL). The SL matrix was validated using correlation analysis with COVID-19 case trends. Subsequently, an automated web-based system that generated daily CT, RC, and SL was developed.ResultsCT and RC variables were estimated using case incidence and hospitalization rate; Hospital bed capacity and COVID-19 ICU occupancy respectively. The estimated CT and RC were strongly correlated [ρ = 0.806 (95% CI 0.752, 0.848); and ρ = 0.814 (95% CI 0.778, 0.839), p < 0.001] with the COVID-19 cases. The estimated SL was strongly correlated with COVID-19 cases (ρ = 0.845, p < 0.001) and responded well to the various COVID-19 case trends during the pandemic. SL changes occurred earlier during the increase of cases but slower during the decrease, indicating a conservative response. The automated web-based system developed produced daily real-time CT, RC, and SL for the COVID-19 pandemic.ConclusionsThe indicators selected and combinations formed were able to generate validated daily CT and RC levels for Malaysia. Subsequently, the CT and RC levels were able to provide accurate and sensitive information for the estimation of SL which provided valuable evidence on the progression of the pandemic and movement restriction adjustment for the control of Malaysia.

Infection prevention and control: Qualitative study of the preparedness and response of Christian health Association of Ghana to Marburg virus disease in Ghana

ObjectiveRecent disease outbreaks underscore the importance of robust disease surveillance and infection prevention and control (IPC) programmes to bolster Africa's public health response system. Yet, available evidence shows extensive gaps in the emergency response capacity of faith-based healthcare providers on the continent. Accordingly, this study examines the IPC and surveillance strategies adopted by a faith-based healthcare provider and the challenges encountered during Marburg Virus Disease outbreak (MVD) in Ghana. MethodWe collected data from 15 clinical and nonclinical health workers from the Christian Health Association of Ghana (CHAG) and the Ghana Health Service (GHS). Data was collected through online interviews to examine two pillars of the WHO COVID-19 SPRP-AFR (2021) framework. We analyzed the data using Braun and Clarke's thematic analysis. FindingsThe facility performed creditably well with contact tracing and other quarantine protocols during MVD outbreak in Ghana. However, it also encountered several challenges in the enforcement of IPC protocols, including human resource constraints, the lack of decontamination equipment, and limited infrastructure, among others. Given these limitations, we assessed that the facility cannot handle major outbreaks. ConclusionDue to numerous infectious disease outbreaks in Sub-Saharan Africa in recent years, the government of Ghana and faith-based healthcare providers must resource their facilities with the relevant equipment and qualified human resources against future disease outbreaks.

Improving Healthcare Professionals' Access to Addiction Medicine Education Through VHA Addiction Scholars Program.

The seemingly inexorable rise of opioid-related overdose deaths despite the reduced number of COVID-19 pandemic deaths demands novel responses and partnerships in our public health system's response. Addiction medicine is practiced in a broad range of siloed clinical environments that need to be included in addiction medicine training beyond the traditional fellowship programs. Our objective in this project was to implement a knowledge-based, live virtual training program that would provide clinicians and other healthcare professionals with an overview of addiction, substance use disorders (SUD), and clinical diagnosis and management of opioid use disorder (OUD). The Veterans Health Administration (VHA) Emergency Department Opioid Safety Initiative (ED OSI) offered a four-day course for healthcare professionals interested in gaining knowledge and practical skills to improve VHA-based SUD care. The course topics centered around the diagnosis and treatment of SUD, with a focus on OUD. Additionally, trainees received six months of support to develop addiction medicine treatment programs. Evaluations of the course were performed immediately after completion of the program and again at the six-month mark to assess its effectiveness. A total of 56 clinicians and other healthcare professionals participated in the Addiction Scholars Program (ASP). The participants represented nine Veteran Integrated Service Networks and 21 different VHA medical facilities. Nearly 70% of participants completed the initial post-survey. Thirty-eight respondents (97.4%) felt the ASP series contained practical examples and useful information that could be applied in their work. Thirty-eight respondents (97.4%) felt the workshop series provided new information or insights into the diagnosis and treatment of SUD. Eleven capstone projects based on the information acquired during the ASP were funded (a total of $407,178). Twenty participants (35.7%) completed the six-month follow-up survey. Notably, 90% of respondents reported increased naloxone prescribing and 50% reported increased prescribing of buprenorphine to treat patients with OUD since completing the course. The ASP provided healthcare professionals with insight into managing SUD and equipped them with practical clinical skills. The students translated the information from the course to develop medication for opioid use disorder (M-OUD) programs at their home institutions.

Working towards a paradigm shift in mental health: stakeholder perspectives on improving healthcare access for people with serious mental illnesses and chronic physical illnesses in Jamaica

The Jamaican public health system has incorporated mental health services into community-based primary care to improve healthcare access for people with serious mental illnesses (PWSMI), especially given global concerns about the high rate of comorbidity of chronic physical illnesses (CPI) among this population. Although it has been over twenty years since this strategy was implemented, there is a dearth of research into the views and experiences of stakeholders relating to this health system response. The current study sought to explore stakeholders’ perspectives and recommendations for improving the Jamaican public health system's response to healthcare access for PWSMI & CPI. A constructivist grounded theory approach was used to collect and analyse data from fifty-seven participants across six participant groups: health policymakers, primary care physicians, psychiatrists, mental health nurses, PWSMI & CPI and, their caregivers. The findings of the study identified one overarching category, “a paradigm shift in mental health” supported by six subthemes: (1) prioritise mental health, (2) reduce stigma and discrimination, (3) fill gaps in policies and practice, (4) address workforce issues, (5) improve health infrastructure and operations, and (6) respond to social needs. Findings highlighted a need for strategies that address social determinants of health inequalities such as stigma and discrimination as well as poverty to improve healthcare access. The paradigm shift in mental health will require greater financial and human resource investment in responding to these comorbid conditions and increased involvement of PWSMI and other stakeholders in strategies aimed at improving healthcare access and outcomes.

Inverting social innovation to transform health system responses to climate change adaptation and mitigation in the global south.

Systems thinking is aimed at understanding and solving complex problems that cut across sectors, an approach that requires accurate, timely, and multisectoral data. Citizen-driven big data can advance systems thinking, considering the widespread use of digital devices. Using digital platforms, data from these devices can transform health systems to predict and prevent global health crises and respond rapidly to emerging crises by providing citizens with real-time support. For example, citizens can obtain real-time support to help with public health risks via a digital app, which can predict evolving risks. These big data can be aggregated and visualized on digital dashboards, which can provide decision-makers with advanced data analytics to facilitate jurisdiction-level rapid responses to evolving climate change impacts (e.g., direct public health crisis communication). In the context of climate change, digital platforms can strengthen rapid responses by integrating information across systems (e.g., food, health, and social services) via citizen big data. More importantly, these big data can be used for rapid decision-making,a paradigm-changing approach that can invert social innovation, which we define as co-conceptualizing societal solutions with vulnerable communities to improve economic development with a focus on community wellbeing. However, to foster equitable and inclusive digital partnerships that invert social innovation, it is critical to avoid top-down approaches that sometimes result when researchers in the Global North and South collaborate. Equitable Global South-North partnerships can be built by combining digital citizen science and community-based participatory research to ethically leverage citizen-driven big data for rapid responses across international jurisdictions.

Evaluation of a Multisectoral Health Security Alliance Program Through Perceptions of Member States: African Partnership Outbreak Response Alliance (APORA).

U.S. DoD global health engagements offer opportunities for strategic engagement and building capability in collaboration with foreign military and civilian counterparts. Global health engagement activities can take the form of health security alliances and allow the USA and its allies and partners to prepare for, mitigate, and respond to emerging biothreats and other harmful health events that may negatively impact national security. One such example is the African Partnership Outbreak Response Alliance (APORA), which was designed to expand African Partner Nation militaries' infectious disease outbreak response capabilities. This publication evaluates the development, implementation, and outcomes of APORA to better understand the program's effectiveness in developing Partner Nation medical capabilities and the efficacy of health security alliances more broadly. Key informant interviews, focus groups, and questionnaires were used to collect responses from a sample of participants who attended an in-person APORA event in May 2022. The research team conducted thematic analysis of all responses to identify common themes and sub-themes in participants' perspectives and to elucidate findings and recommendations for future endeavors. The analysis determined that participants attended the APORA event primarily to disseminate and apply knowledge, skills, and abilities gained at the event to their own health system structures. Overall, participants indicated that APORA contributed to their countries' military medical and civilian cooperation, as well as their countries' military medical capabilities. Longer-term partners (i.e., 4+ years of APORA membership) agreed more strongly with these sentiments; newer partners (i.e., 1-3 years of APORA membership) were more likely to be neutral or agree to some extent. Participants also valued the opportunity to solidify global, regional, local, and peer partnerships and considered the ability to create partnerships of great importance to their countries' national health security. Language barriers were often listed as a hindrance to event participation and the overall integration of a regional health system response. Participants also cited resource scarcity, network erosion (particularly because of the coronavirus disease 2019 pandemic), and a lack of disseminating and communicating value-add in how APORA could/is providing to their member countries' health systems as key barriers. As a whole, these findings support APORA's objectives to develop and leverage partnerships to support medical capacity building, promote collaboration between military and civilian sectors, and increase access to opportunities and financial resources. Further evaluation is required to capture additional civilian perspectives while continuing to expand upon military perspectives in order to produce more generalizable findings. That said, this study enables key stakeholders to understand how to strengthen and expand future alliances to improve both health and security outcomes.