Local Health System Research Articles

The prioritisation of curable sexually transmitted infections among pregnant women in Zambia and Papua New Guinea: Qualitative insights.

Curable sexually transmitted infections (STIs) are neglected in public health policy, services and society at large. Effective interventions are available for some STI but seem not to be prioritised at global, regional or local levels. Zambia and Papua New Guinea (PNG) have a high burden of STIs among pregnant women but little is known about the prioritisation of STI treatment and care among this group. We undertook a qualitative study to explore how STIs are prioritised among pregnant women in local health systems in Zambia and PNG. Semi-structured interviews were conducted with 19 key informants-health care workers providing antenatal care, and policy and programme advisers across the two countries. Audio recordings were transcribed and translated into English and stored, managed, and coded in NVivo v12. Analysis used deductive and inductive thematic analysis. Findings were coded against the World Health Organization health system building blocks. Participants spoke about the stigma of STIs at the community level. They described a broad understanding of morbidity associated with undiagnosed and untreated STIs in pregnant women. The importance of testing and treating STIs in pregnancy was well recognised but many spoke of constraints in providing these services due to stock outs of test kits for HIV and syphilis and antibiotics. In both settings, syndromic management remains the mainstay for treating curable STIs. Clinical practice and treatment were not in alignment with current STI guidelines in either country, with participants recognising the need for mentorship and in-service training, as well as the availability of commodities to support their clinical practice. Local disruptions to screening and management of syphilis, HIV and other curable STIs were widely reported in both countries. There is a need to galvanise priority at national and regional levels to ensure ongoing access to supplies needed to undertake STI testing and treatment.

Opening decision spaces: A case study on the opportunities and constraints in the public health sector of Mpumalanga Province, South Africa.

Decentralised and evidence-informed health systems rely on managers and practitioners at all levels having sufficient 'decision space' to make timely locally informed and relevant decisions. Our objectives were to understand decision spaces in terms of constraints and enablers and outline opportunities through which to expand them in an understudied rural context in South Africa. This study examined decision spaces within Mpumalanga Province, using data and insights generated through a participatory action research process with local communities and health system stakeholders since 2015, which was combined with published documents and research team participant observation to produce findings on three core domains at three levels of the health system. Although capacity for decision making exists in the system, accessing it is frequently made difficult due to a number of intervening factors. While lines of authority are generally well-defined, personal networks take on an important dimension in how stakeholders can act. This is expressed through a range of informal coping strategies built on local relationships. There are constraints in terms of limited formal external accountability to communities, and internal accountability which is weak in places for individuals and focused more on meeting performance targets set at higher levels and less on enabling effective local leadership. More generally, political and personal factors are clearly identified at higher levels of the system, whereas at sub-district and facility levels, the dominant theme was constrained capacity. By examining the balance of authority, accountability and capacity across multiple levels of the provincial health system, we are able to identify emergent decision space and areas for enlargement. Creating spaces to support more constructive relationships and dialogue across system levels emerges as important, as well as reinforcing horizontal networks to problem solve, and developing the capacity of link-agents such as community health workers to increase community accountability.

Dynamics of regionalization and repercussions of gaps in care on health marketing in remote rural municipalities

This article analyzed the dynamics of regionalization in municipalities within hinterlands and the possible implications of gaps in care for the marketing of health. This is a multiple case study with a qualitative approach, involving 76 semi-structured interviews with municipal, regional, and state managers. The results show that, particularly in the Northern states, the regional scheme did not reflect the social dynamics of the populations and created inadequate flows and unwanted routes. The municipal political agenda often prioritized interests other than that of regionalization, and rural problems did not mobilize managers to build specific regional planning. Parliamentary amendments were essential for investment in healthcare and the managers pointed to clientelistic relationships to obtain such resources, often conditioned by political-ideological alignment. The scarcity of public services favored dependence on the private sector and the commercialization of health in different situations. The great distances and the lack of public services in municipalities in the hinterland made the local public health system offer eminently dependent on contracts with private providers who negotiated on a retail basis or via service packages. Lastly, in the wake of unmet needs and gaps in care in remote rural municipalities, players in the healthcare market ₋ companies supplying inputs, consultants, healthcare professionals, and transportation services ₋ filled the gaps in public provision, sometimes controlling prices, supply and availability of services.

Electronic health record modification and dashboard development to improve clinical care in pediatric rheumatology.

This report describes our experience in electronic health record (EHR) note modification and creation of an external dashboard to create a local learning health system that contributes to quality improvement and patient care within our pediatric rheumatology clinic. We applied quality improvement methodology to develop a more reliable and accurate system to identify patients with juvenile idiopathic arthritis and track important measures that aide in improving patient care and performance outcomes. From 2019 to 2021, we iteratively modified our outpatient clinic EHR note to include structured data elements to improve longitudinal monitoring. We then validated data transferred to an electronic dashboard external to the EHR and demonstrated utility for identifying an accurate patient population and tracking quality improvement initiatives. Creation of the structured data elements improved the identification of patients with JIA with >99% accuracy and without requiring manual review of the chart. Using the dashboard to monitor performance, we improved documentation of critical disease activity measures that resulted in improvement in those scores across the local population of patients with JIA. The structured data elements also enabled us to automate electronic data transfer to a multicenter learning network registry. The structured data element modifications made to our outpatient EHR note populate a local dashboard that allows real time access to critical information for patient care, population management, and improvement in quality metrics. The collection and monitoring of structured data can be scaled to other quality improvement initiatives in our clinic and shared with other centers.

Organization of local healthcare systems in remote rural Brazilian municipalities to combat the COVID-19 pandemic

During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC's difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health.

Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge.

Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.

Working with the Elite: the Intersection of Social Work and Corporate Foundations - the Case of Zuellig Family Foundation

Social Work draws from various disciplines but is perceived to be the direct opposite of corporate work, however, there is a need to work with the elite for the sake of social development due to their available resources and skills that social workers lack. While Corporate Social Responsibility typically takes the form of dole-outs on a voluntary basis, it has begun to transition into building partnerships with communities. Data from the Local Health System program of Zuellig Family Foundation was examined to (a) describe the developmental principles used by an elite foundation for the development and implementation of their program, (b) determine the intersection of the operations of the program with the Empowerment Theory and Developmental Perspective as practiced by the Social Work profession, and (c) discuss the role of social workers in corporate-led programs. Despite the surface differences of social work and corporate work, foundations of the elite can be effective contributors to social change and development, and can work with the Social Work profession in empowering communities that suffer from inequities. The findings of the study indicate that social work professionals and other humanities professions must explore partnerships with corporate-led foundations to deepen knowledge bases and ensure social development.
 
 Keywords: Social Work profession, Corporate Social Responsibility, Empowerment Theory, Developmental Perspective, Zuellig Family Foundation, Local Health System, partnership

The Covid-19 pandemic as a driver towards integrated health care-learning from the experiences of UK community hospitals

Introduction: Many changes occurred in the UK National Health Service (NHS) during the COVID-19 pandemic-some positive and some negative. We were interested in how the pandemic drove integration of health care in small community hospitals in the UK.
 Method: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded. A total of 20 organisations participated, representing 168 (34%) of community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. Community representation was featured through the membership of our project board and advisory group which includes Hospital Leagues of Friends. 30 case studies were developed from these interviews.
 Results: From our case studies we examine 4 types of integrated care: Multi-Disciplinary Team Working, Community Hospital and Primary Care, Community Hospital and Acute Care, Community Hospital and Local Community. In the interviews staff gave accounts of improved collaborations and partnerships across the local health and care system, and the consequent impact on patients, families, staff and the community. Many staff said that in many cases teamworking and partnerships were already established, so the trust was there to build on even closer joint working.
 Case studies demonstrating enhanced integration of health care at the micro, meso and macro level are described. Examples of micro changes were small but significant local improvements which impacted positively on the patient experience. Examples of meso changes were those that were across a community hospital or hospitals, with partnerships and joint working supporting improved services. We focus particularly on the macro level, where system-wide changes were implemented to embed innovations and integrated working. 
 We pay particular reference to factors that are known to be associated with successful integration as shown in a recently published systematic review, namely: organisational culture, workforce management, inter-organisational collaboration, leadership ability of staff, economic factors and political factors.
 Discussion: We discuss the learning from the case studies that in order to make the most of our community hospitals we need to be: making decisions locally, benefiting from excellent leadership, recognising community hospitals as community assets and looking after our staff. In particular locally devolved decision-making appropriate to local context was viewed as a critical success factor in swiftly making changes and improvements for the benefit of patients and families, and also for staff. Where this was supported by strong leadership, staff reported successful quality improvements. We continue to work with staff in online discussion groups in our Community Hospital Q Community Special Interest Group to build on this learning and share widely across the community hospital network.
 Conclusion: This study shows how the pandemic accelerated integrated care between staff, services and systems, and the improved recognition of the vital role of community hospitals as community services in the local health and care system.
 
 

Innovating Health Governance in Australian Integrated Care

Background: Australia is one of many countries implementing integrated care initiatives to facilitate the Quadruple Aim (the improvement of health outcomes, patient experience, provider experience and health system sustainability). These initiatives can be complex while working within a fragmented and siloed health system. NSW Health has created the Patient Centred Collaborative Commissioning Groups (PCCGs) program facilitating Local Health Districts (LHDs) and Primary Health Networks (PHNs) to co-commission health initiatives targeting local populations and their specific health needs. These PCCGs are unique as they are comprised of stakeholders involved at all levels of government in addition those from the community and private sectors. The LHDs and PNHs collaborate with additional relevant and local stakeholders to co-design new service pathways and ensure collaboration within one local health system.
 The literature evaluating integrated care aims at advancing knowledge of patient and provider experiences. Both areas are vital to understanding the successes and failures of integrated care but are insufficient to understand the ‘how’ and ‘why’ of successful system integration. This study therefore focuses on the under-researched question of ‘is it possible to govern integrated care?’
 In the Australian context, the governance of integrated care needs significant attention. In the context of this research, health system governance is defined as “the norms, structures, actors, institutions, and formal and informal relationships that shape authority and action in a health system”.
 Methods: This qualitative study involves semi-structured interviews with key stakeholders involved in the PCCGs and reviewing the governance documents of each local program. Data collected is thematically analysed and compared to existing governance models to draw out aspects of the individual PCCG governance mechanisms. This is part of a larger study that aims to understand the stakeholders, partnerships, and governance in integrated care in Australia.
 Implications for the future: This study will provide an in-depth understanding of the decision-making processes involved in the development (and subsequent use) of the governance models, as well as determining which actors have what roles and accountabilities within the PCCG. It is vital to determine what contributes to and facilitates each domain of health system governance (as defined above) to truly understand how we can achieve sustainable health care system reform. Traditional governance models are not sufficient to regulate the dynamic nature of integrated care initiatives, so they cannot facilitate the sustainability of these initiatives. As such, the overarching aim of this research is to create an ideal governance framework that can be replicated and applied across various integrated care initiatives.

Towards local health system development in Wallonia: experiences with the HSO toolkit for integrated people centred health systems.

Since 2008 Belgium has been developing a more integrated care system. Today, the Belgian healthcare system is undergoing significant reform at national and sub-national levels. In primary care, at the federal level, the New Deal for general practice aims to improve the organisation of general practice and a new inter-federal plan for integrated care is currently under development. At the regional level, there are many initiatives. In Wallonia several projects are working towards greater inter-professional collaboration and clear territorial delimitations in order to cater for the needs of local populations in a more integrated fashion. 
 The project Proxisanté has been exploring the needs of professionals and patients by conducting consultations and workshops with actors within primary care to feed into a decree which will be presented at the end of 2022. Based on the outcome of this process, actions will be undertaken, starting in 2023, to implement this vision and develop a territorial network of local health systems. Our team is responsible for following and supporting this process of implementation by developing a transdisciplinary and innovative bottom-up methodological approach. For this we intend to rely, among other things, on the Integrated People-Centred Health Systems (IPCHS) Standard developed by the Health Standards Organisation (HSO), as well as the various tools created to facilitate the implementation of this standard. 
 The presentation will describe the preliminary work done to prepare for concrete support for the creation of local networks starting in 2023. Specifically, we will detail the methodology used to identify the priorities that need to be focused on to ensure successful implementation, Finally, we will present the key messages from meetings with different existing subsystems concerning their strengths and weaknesses, and the inspiring practices identified that will allow us to build a regional learning system dynamic.

Community health workers as bridge builders towards integrated care?

In response to COVID-19 pandemic, which exacerbated the access to care challenges for people living in socio-economic vulnerable circumstances, the Belgian Federal Government gave the National Institute for Sickness and Disability Insurance (NIHDI) and the National InterMutualist College (Intermut) the task to introduce community health workers (CHWs) throughout Belgium. CHWs are “frontline public health worker[s] who [are] a trusted member of a community or who has a thorough understanding of the community being served. This relationship allows CHWs to serve as a link between health and social service programs and the community to promote access to services and improve the quality and cultural competence of service delivery” (Centers for Disease Control and Prevention, 2020: p. 50). They share a lived experience with people who live in vulnerable circumstances and are trusted members of local communities. CHWs can improve access to care for people living in vulnerable circumstances and make a valuable contribution to addressing the social determinants of health (Damio et al., 2017). They bring care closer to a patient, their household and community (Peretz et al., 2020, Perry and Hodgins, 2021).
 CHWs occupy a unique position between the community and the health system. This constitutes an essential advantage of their work, but it also demands that CHWs are both embedded in the community and have a functional relationship with actors in the health system (LeBan et al., 2021, Lewin et al., 2021, Perry et al., 2021, Schneider and Lehmann, 2016).
 This is a balancing act, which is an ongoing challenge today in various CHW programs world-wide, as well as in the Federal CHW project in Belgium. Lack of integration and synchronization between CHW programs and local health systems, risks to result in fragmented service delivery (Afzal et al., 2021). In this workshop we will explore together with the participants how to counteract this fragmentation and what the potential role of CHWs could be in integrated care?
 The workshop aims to integrate the vision of various participants: policy makers, researchers, clinicians, citizens, patients and caregivers who are interested in the potential of CHWs in integrated care.
 
 - Introduction (15 minutes): the workshop participants will receive an introduction into the Federal CHW project, framed in the global CHW landscape.
 - Presenting a case study (15 minutes): The role of the CHW in between the community and health system will be presented by different stakeholders involved: CHWs; the Health Kiosk as an example of community engagement; and primary health care providers.
 - Group work (20 minutes): The participants of the workshop will be invited to discuss the potential role of CHWs in integrated care and their embeddedness in the health system. The group will be divided in two smaller groups in which two themes will be discussed in-depth – facilitated by the workshop organizers.
 - Feedback & closing (10 minutes): the small groups will feedback to the plenary group with the most imminent discussion points of their discussion group. The take home message will then be summarized by the workshop organizers.

'You're out on a limb, on your own': Social care personal assistants' (PAs') reflections on working in the Covid-19 pandemic - implications for wider health and care services.

In England, Personal Assistants (PAs) are part of an international trend towards state funded but client-hired or directly employed care workers. The Covid-19 pandemic highlighted and exacerbated pre-existing risks and advantages of this arrangement for both PAs and people with care and support needs. We aim to report PAs' reflections on their experiences of working since the pandemic started in 2020 and highlight the longer-term implications for health and care services. We undertook a large-scale, qualitative study in 2016-17 involving interviews with 104 PAs about their working lives. We re-interviewed PAs from this group twice to ask how the pandemic had affected them, once at the start of the pandemic in Spring 2020 and again in December 2021 -April 2022. This article reports findings from the last set of interviews undertaken with 38 PAs. Thematic analysis was conducted of interviews in which PAs discussed changes in tasks and responsibilities, pay and conditions, training, relationships and plans. This article focuses on the following themes: PAs' perceptions of their outsider status; support and training needs; job security; and whether PAs have an appetite for regulation to provide greater professional standing and connections. Interviews in this study were carried out during the Covid-19 pandemic over the telephone or virtually rather than in person so may have missed certain body language or informal relationship building. The sample may be under-representative of non-British PAs. We were unable to triangulate participants' accounts with others'. This study highlights the importance of national and local government including the PA workforce in planning for national emergencies. Consideration should be given by policy makers and local health and care systems to how PAs can be better supported than currently.

5. KNOWLEDGE, ATTITUDE AND PRACTICE OF PREHOSPITAL EMERGENCY IN VIETNAM, 2023

Objective: Assessing the knowledge, attitude and practice of prehospital emergency in Vietnam in 2023. 
 Subjects and methods: A survey on 10,800 people was implemented to assess the status of prehospital emergency and the capacity of the local health system. 
 Results: Only 33.65% of people knew about emergency calls and 33.20% of people did not know or sure about emergency calls. 49.48% of people believed that ambulances are useful, medical staff are useful in emergency care (50.04%). All residents estimated the ambulance’s time of arrival after calls around 5 - 60 minutes. The majority of people chose to transport emergency patients by taxi, personal car or carrying patients to the hospital, only 32.63% of people chose to call an ambulance when at home and 33.80% when outside. Most people reported to trust emergency medical service workers when the ambulance arrived at the scene or when the patient was hospitalized. 
 Conclusion: Although people’s knowledge and attitude towards prehospital emergency were inadequate, most people trusted medical staff when they arrived at the emergency scene or when taking patients to the hospital.

Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study.

In Cape Town, the under-5 mortality rate has plateaued to 20 per 1000 live births, with 60% of child deaths occurring out of hospital. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths. This study aimed to uncover the access barriers and facilitators underlying this high burden of out-of-hospital deaths. An exploratory mixed-methods case study design employed three data collection strategies: a quantitative survey with randomly sampled community members, semi-structured interviews with purposively sampled caregivers whose children presented critically ill or deceased (January 2017 - December 2020) and a nominal group technique (NGT) to build solution-oriented consensus among purposively sampled health workers, representing different levels of care in the local health system. A total of 62 community members were surveyed, 11 semi-structured caregiver interviews were conducted, and 11 health workers participated in the NGT. Community members (74%) experienced barriers in accessing care. Knowledge of basic home care for common conditions was limited. Thematic analysis of interviews showed affordability, acceptability, and access, household and facility factor barriers. The NGT suggested improvement in community-based services, transport access and lengthening service hours would facilitate access. While multiple barriers to accessing care were identified, facilitators addressing these barriers were explored. Healthcare planners should examine the barriers within their geographic areas of responsibility to reduce child deaths.Contribution:This study uncovers community perspectives on childhood out-of-hospital deaths and makes consensus-based recommendations for improvement.

Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot

Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.

SURVEY OF TRADITIONALLY USED WILD EDIBLE PLANTS IN MANDVI TALUKA OF SURAT DISTRICT, GUJARAT

This study explores the vital role of wild edible plants in the diets of indigenous communities in Mandvi Taluka, Surat district. Selecting eight villages based on their proximity to the forest, the research uncovers the nuanced relationships between geographic location and traditional plant use. These plants, integral to daily meals, offer essential nutrition and contribute to the local health system. Additionally, they play a crucial role in addressing hunger and food security challenges. The findings emphasize the need to preserve and promote these wild edibles for their cultural significance and potential contributions to a resilient local food system.

Lessons learned from the COVID-19 response in Sri Lankan hospitals: an interview of frontline healthcare professionals.

The COVID-19 pandemic revealed the lack of preparedness in health systems, even in developed countries. Studies published on COVID-19 management experiences in developing countries, including Sri Lanka, are significantly low. Therefore, lessons learned from pandemic management would be immensely helpful in improving health systems for future disaster situations. This study aimed to identify enablers and barriers to COVID-19 management in Sri Lankan hospitals through healthcare workers' perceptions. Frontline doctors and nurses from different levels of public hospitals were interviewed online. Both inductive and deductive coding and thematic analysis were performed on the transcribed data. This study identified four themes under enablers: preparing for surge, teamwork, helping hands and less hospital-acquired infections. Seven themes were identified as barriers: lack of information sharing, lack of testing facilities, issues with emergency equipment, substandard donations, overwhelmed morgues, funding issues and psychological impact. These preparedness gaps were more prominent in smaller hospitals compared with larger hospitals. Recommendations were provided based on the identified gaps. The insights from this study will allow health administrators and policymakers to build upon their hospital's resources and capabilities. These findings may be used to provide sustainable solutions, strengthening the resilience of the local Sri Lankan health system as well as the health systems of other countries.

Randomised controlled trial combining vitamin E-functionalised chocolate with physical exercise to reduce the risk of protein–energy malnutrition in predementia aged people: study protocol for Choko-Age

ObjectiveProtein–energy malnutrition and the subsequent muscle wasting (sarcopenia) are common ageing complications. It is knowing to be also associated with dementia. Our programme will test the cytoprotective functions of vitamin...

Temporary impact on medical system and effectiveness of mitigation strategies after COVID-19 policy adjustment in China: a modeling study.

As China amends its "zero COVID" strategy, a sudden increase in the number of infections may overwhelm medical resources and its impact has not been quantified. Specific mitigation strategies are needed to minimize disruption to the healthcare system and to prepare for the next possible epidemic in advance. We develop a stochastic compartmental model to project the burden on the medical system (that is, the number of fever clinic visits and admission beds) of China after adjustment to COVID-19 policy, which considers the epidemiological characteristics of the Omicron variant, age composition of the population, and vaccine effectiveness against infection and severe COVD-19. We also estimate the effect of four-dose vaccinations (heterologous and homologous), antipyretic drug supply, non-pharmacological interventions (NPIs), and triage treatment on mitigating the domestic infection peak. As to the impact on the medical system, this epidemic is projected to result in 398.02 million fever clinic visits and 16.58 million hospitalizations, and the disruption period on the healthcare system is 18 and 30 days, respectively. Antipyretic drug supply and booster vaccination could reduce the burden on emergency visits and hospitalization, respectively, while neither of them could not reduce to the current capacity. The synergy of several different strategies suggests that increasing the heterologous booster vaccination rate for older adult to over 90% is a key measure to alleviate the bed burden for respiratory diseases on the basis of expanded healthcare resource allocation. The Omicron epidemic followed the adjustment to COVID-19 policy overloading many local health systems across the country at the end of 2022. The combined effect of vaccination, antipyretic drug supply, triage treatment, and PHSMs could prevent overwhelming medical resources.

Abstract C109: Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research

Abstract Background: Improving the adoption and integration of cervical cancer screening programs in resource-limited countries requires engaging with many local health system actors. We hypothesize that participatory design workshops co-developed by researchers, health system practitioners, and policy makers, facilitate rapid engagement to identify context-specific priorities and tailor strategies to improve implementation processes. Methods: With the Peruvian Ministry of Health (MOH), we co-designed a week-long workshop with health system actors (planners, providers, lab technicians) from the North District of Lima city. Through facilitated dialogue, participants engaged in self-reflection to map the cervical cancer screening and follow-up system, visualize system barriers, and identify potential solutions. As research partners, we analyzed findings from the workshop using the Consolidated Framework for Implementation Research, a framework from implementation science that identifies multilevel contextual factors that influence program implementation and guides the tailoring of strategies for improvement. Results: We identified three key context-specific challenges including 1) power hierarchies between specialists and midwives that obstruct the efficiency of screening services, 2) the complexities around communicating screening results, appointments, and referrals, are burdensome for patients and cause loss to follow up, and 3) implementation plans are not adequately matched to resources and workforce capacity. We identified feasible implementation strategies to address these challenges including 1) develop relationships between midwives and specialists through facilitated discussions to surface assumptions and align screening goals, 2) co-create counseling tools to help patients understand results and follow up steps for early detection and treatment of precancerous lesion that also reduce patients’ burden, and 3) Apply design workshops with key actors to develop an implementation plans to guide processes, acceptable adaptations, clinical workflows, and planning (ordering tests, supplies, training human resources, etc.) to align goals to prevention objectives and resources. Conclusions: Engaging with health systems actors through participatory action research is a strategy that enables collective learning, identifying context-specific priorities, and developing tailored implementation strategies that are likely to accelerate integration of sustainable cervical cancer screening programs globally. Citation Format: Margarita Correa-Mendez. Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C109.