National Health Agenda Research Articles

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

Policy influential research: setting, informing and decoding our national health and social policy agenda and activities

Policy influential research: setting, informing and decoding our national health and social policy agenda and activities

Spatial-temporal distribution of neglected tropical diseases burdens in China from 2005 to 2020

BackgroundOut of the 21 neglected tropical diseases (NTDs) listed by the World Health Organization, 15 affect the People’s Republic of China. Despite significant achievements in controlling NTDs, comprehensive assessments of the disease burden based on actual case data and detailed information on spatial and temporal dynamics are still lacking. This study aims to assess the disease burden and spatial–temporal distribution of NTDs in China from 2005 to 2020, to provide a reference for the formulation of national health agendas in line with the global health agenda, and guide resource allocation.MethodsThe number of cases and deaths of major NTDs in China from 2005 to 2020 were downloaded from the China Public Health Science Data Center (https://www.phsciencedata.cn/Share/index.jsp) of the Chinese Center for Disease Control and Prevention and relevant literatures. Simplified formulas for disability-adjusted life years (DALYs) helped estimate the years of life lost (YLLs), years lived with disability (YLDs), and total DALYs. Spatial autocorrelation analysis of the average NTDs burden data for the years 2005 to 2020 was evaluated using Moran's I statistic.ResultsChina's overall NTDs burden decreased significantly, from 245,444.53 DALYs in 2005 to 18,984.34 DALYs in 2020, marking a reduction of 92.27%. In 2005, the DALYs caused by schistosomiasis and rabies represent a substantial proportion of the total disease burden, accounting for 65.37% and 34.43% respectively. In 2015, Hunan and Sichuan provinces had the highest diversity of NTDs, with 9 and 8 number of different NTDs reported respectively. And the highest disease burden was observed in Sichuan (242,683.46 DALYs), Xizang Zizhiqu (178,318.99 DALYs) and Guangdong (154,228.31 DALYs). The “high-high” clustering areas of NTDs were mainly in China's central and southern regions, as identified by spatial autocorrelation analysis.ConclusionsChina has made unremitting efforts in the prevention and control of NTDs, and the disease burden of major NTDs in China has decreased significantly. Using the One Health concept to guide disease prevention and control in the field to effectively save medical resources and achieve precise intervention.Graphical abstract

Development and psychometric testing of a questionnaire for the Korea Youth risk behavior survey to assess physical activity behaviors

BackgroundPhysical activity is essential for physical, mental, and cognitive health. Providing evidence to develop better public health policies to encourage increased physical activity is crucial. Therefore, we developed an in-depth survey as part of the Korea Youth Risk Behavior Survey to assess the current status and determinants of physical activity among Korean adolescents.MethodsWe developed an initial version of the questionnaire based on a review of validated questionnaires, recent trends and emerging issues related to adolescent physical activity, and the national public health agenda pertaining to health promotion. Content validity was confirmed by a panel of 10 experts. Face validity was confirmed through focus group interviews with 12 first-year middle school students. The test-retest reliability of the questionnaire was evaluated by administering it twice, approximately two weeks apart, to a sample of 360 middle and high school students. Additionally, the frequency or average number of responses was analyzed in a sample of 600 students who participated in the initial test-retest reliability evaluation of the questionnaire developed in this study.ResultsThrough item pool generation and content and face validity test, the final 15 questionnaire items were developed across five themes: levels of physical activity, school sports club activities, transportation-related physical activity, physical activity-promoting environments, and factors mediating physical activity. The test-retest reliability ranged from fair to substantial. Results from the newly developed survey reveal that only a minority of adolescents engage in sufficient physical activity, with only 17.2% and 21.5% participating in vigorous and moderate-intensity activities, respectively, for at least five days per week. Among school-based activities, 44.3% of students do not participate in school sports clubs due to reasons including absence of clubs and disinterest in exercise. The major motivators for physical activity are personal enjoyment and health benefits, whereas preferences for other leisure activities and academic pressures are the predominant barriers.ConclusionsThis study developed valid and reliable in-depth survey items to assess physical activity among Korean youths. It will hopefully enhance our understanding of adolescent physical activity, offering essential preliminary evidence to inform the development of public health strategies aimed at promoting adolescent health.

The need for economic evaluations for neuro-oncology in low- and middleincome: the Pakistan perspective.

The incidence and prevalence of brain tumours have steadily increased within low- and middle-income countries, similar to patterns seen in high-income countries. In addition to the epidemiological landscape of brain tumours in Pakistan, it is important to consider the economics of brain tumour diagnosis and management to inform policy on neuro-oncological healthcare service delivery. The challenges associated with conducting economic evaluations in LMICs include the ability to receive funding for country-specific estimates, dearth of existing data and methodological development, and the need for investment in economic evaluations of health. Economic evaluations are most useful when funding support is given to country-specific initiatives to allocate resources. Cost and cost components must also be meticulously collected to enable accurate calculations of economic evidence for the decision-making process. To put neuro-oncological care at the forefront of the national health agenda, it is crucial for vigorous epidemiological and economic evidence to be available for policymakers.

Sustainable Dengue Prevention and Management: Integrating Dengue Vaccination Strategies with Population Perspectives.

The GEMKAP study (2023) unveiled consistent knowledge, attitude, and practice (KAP) levels across Asia-Pacific (APAC) and Latin America (LATAM) countries regarding dengue, with variations in the willingness to vaccinate. Despite an overall KAP parity, the disparities within and between the countries indicated the need for both overarching and tailored strategies. Population-wide gaps in dengue awareness result in suboptimal vaccination priorities and preventive measures. This commentary delves into identifying the drivers and barriers for implementing a multi-pronged dengue prevention and management program, emphasizing the pivotal role of vaccination alongside education and vector control. Drawing on expert interviews in APAC and LATAM, informed by the Consolidated Framework for Implementation Research (CFIR), four key themes emerged: prioritizing and continuously advocating for dengue on national health agendas, fostering stakeholder collaboration, incorporating population perspectives for behavioral change, and designing sustainable dengue prevention and management programs. Successful implementation requires evidence-based decision making and a comprehensive understanding of population dynamics to design adaptive education tailored to diverse population views. This commentary provides actionable strategies for enhancing dengue prevention and management, with a pronounced emphasis on dengue vaccination, advocating for a holistic, population-centric approach for sustained effectiveness.

Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps.

Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensivelyassess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems.We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI).Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairmentsignificantly increased worldwide (average annual percentage change: 0.23 [95% confidenceinterval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance. Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.

A bird's eye view of the mental health systems in India.

A staggering 85% of the global population resides in low- and middle-income countries (LAMICs). India stands as an exemplary pioneer in the realm of mental health initiatives among LAMICs, having launched its National Mental Health Program in 1982. It is imperative to effectively evaluate mental health systems periodically to cultivate a dynamic learning model sustained through continuous feedback from mental healthcare structures and processes. The National Mental Health Survey (NMHS) embarked on the Mental Health Systems Assessment (MHSA) in 12 representative Indian states, following a pilot program that contextually adapted the World Health Organization's Assessment Instrument for Mental Health Systems. The methodology involved data collection from various sources and interviews with key stakeholders, yielding a set of 15 quantitative, 5 morbidity, and 10 qualitative indicators, which were employed to encapsulate the functional status of mental health systems within the surveyed states by using a scorecard framework. The NMHS MHSA for the year 2015-16 unveiled an array of indices, and the resultant scorecard succinctly encapsulated the outcomes of the systems' evaluation across the 12 surveyed states in India. Significantly, the findings revealed considerable interstate disparities, with some states such as Gujarat and Kerala emerging as frontrunners in the evaluation among the surveyed states. Nevertheless, notable gaps were identified in several domains within the assessed mental health systems. MHSA, as conducted within the framework of NMHS, emerges as a dependable, valid, and holistic mechanism for documenting mental health systems in India. However, this process necessitates periodic iterations to serve as critical indicators guiding the national mental health agenda, including policies, programs, and their impact evaluation.

Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future.

The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.

Digital public health in Romania

Abstract The Romanian digital public health story is far from the end or its highest point. As in all cases, the digital public health advancements were led by the COVID-19 pandemic and the need to move everything into a digital format. This came, of course, with its hiccups and trials and errors, but in the end, it all led to considerable advancements in the public health system. One of the most significant achievements in recent years is the settlement of telemedicine services for family doctors. Initially, this was approved for the duration of the lockdown as a measure to limit the spread of the virus. Still, this measure was extended after pressure from professional associations and civil society. Another national digital public health agenda point is using electronic health records. The project was launched several years ago with the National Health Insurance House insurance card. It was now continued, with the work underway for its development. This would be a significant achievement as it would alleviate the public health system quite a lot, and it would allow health surveillance for chronic conditions with longitudinal data. Additionally, it could potentially reduce health spending as it would reduce unnecessary or doubled investigations and tests. Romania presented numerous initiatives on digital public health, but unfortunately, many were limited or renounced. A characteristic of the Romanian digital public health ecosystem is the presence of grass-root initiatives led by innovators and system disruptors, small private entities with a strong desire to solve systemic issues. This presentation will highlight how the COVID-19 pandemic enabled Romania to move forward with its digitalization and will advocate for continuous and sustainable future development of the national digital public health system.

A sweet deal for domestic industry: the political economy and framing of Vanuatu’s sugar-sweetened beverage tax

IntroductionThe Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO’s Best Buys recommendations for addressing non-communicable diseases (NCDs),...

'The solution is we need to have a centre': a study on diabetes in Liberia.

In Liberia, one of the poorest nations in sub-Saharan Africa, the burden of diabetes is a growing concern. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and society at large. The aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. We recruited 10 participants from Monrovia, Liberia to partake in this study. Photovoice, a well-established participatory data collection approach was used to gather images and stories that represented participants' everyday experiences of living with diabetes. Three major themes were uncovered, highlighting the strengths, challenges and solutions related to living with diabetes in Liberia: strengths-engagement in diabetes self-management practices, focused on participants' commitment to engage in diabetes self-management practices despite the socioeconomic challenges they experienced; challenges-lack of social and economic support, focused on limited access to food, diabetes medications and supplies and diabetes education; and solutions-centre for diabetes education, care and support, focused on participants' recommendations for a community-based diabetes centre, a single point of access for meeting the needs of people with diabetes. A strong commitment to prioritize diabetes on Liberia's national health agenda and increased resources for diabetes care is needed to address the challenges experienced by people living with this chronic disease in Liberia.

Comprehensive measurement of the prevalence of dementia in low- and middle-income countries: STRiDE methodology and its application in Indonesia and South Africa.

A core element of the Strengthening Responses to Dementia in Developing Countries (STRiDE) programme was to generate novel data on the prevalence, cost and impact of dementia in low- and middle-income countries, to build better health policy. Indonesia and South Africa are two middle-income countries in need of such data. To present the STRiDE methodology and generate estimates of dementia prevalence in Indonesia and South Africa. We conducted community-based, single-phase, cross-sectional studies in Indonesia and South Africa, randomly sampling participants aged 65 years or older in each country. Dementia prevalence rates for each country were generated by using the 10/66 short schedule and applying its diagnostic algorithm. Weighted estimates were calculated with national sociodemographic data. Data were collected between September and December 2021 in 2110 people in Indonesia and 408 people in South Africa. The adjusted weighted dementia prevalence was 27.9% (95% CI 25.2-28.9) in Indonesia and 12.5% (95% CI 9.5-16.0) in South Africa. Our results indicate that there could be >4.2 million people in Indonesia and >450 000 people in South Africa who have dementia. Only five participants (0.2%) in Indonesia and two (0.5%) in South Africa had been previously diagnosed with dementia. Despite prevalence estimates being high, formal diagnosis rates of dementia were very low across both countries (<1%). Further STRiDE investigations will provide indications of the impact and costs of dementia in these countries, but our results provide evidence that dementia needs to be prioritised within national health and social care policy agendas.

A roadmap for using DHIS2 data to track progress in key health indicators in the Global South: experience from sub-saharan Africa

High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas. We aimed to (i) identify the most relevant health indicators captured by DHIS2 for tracking progress towards the Sustainable Development goals in sub-Saharan African countries and (ii) present a clear roadmap for improving DHIS2 data quality and consistency, with a special focus on immediately actionable solutions. We identified that key indicators in child and maternal health (e.g. vaccine coverage, maternal deaths) are currently being tracked in the DHIS2 of most countries, while other indicators (e.g. HIV/AIDS) would benefit from streamlining the number of indicators collected and standardizing case definitions. Common data issues included unreliable denominators for calculation of incidence, differences in reporting among health facilities, and programmatic differences in data quality. We proposed solutions for many common data pitfalls at the analysis level, including standardized data cleaning pipelines, k-means clustering to identify high performing health facilities in terms of data quality, and imputation methods. While we focus on immediately actionable solutions for DHIS2 analysts, improvements at the point of data collection are the most rigorous. By investing in improving data quality and monitoring, countries can leverage the current global attention on health data to strengthen HMIS and progress towards national and international health priorities.

Prevalence and outcomes of pediatric surgical conditions at Connaught Hospital in Freetown: a retrospective study

BackgroundSub-Saharan Africa experiences a disproportionate amount of pediatric surgical disease, with 80% of children lacking access to timely, affordable, and safe surgical care. This study aims to characterize the burden...

Accelerating the Control and Prevention of Non-communicable Diseases in Ghana: the Key Issues

NCDs were particularly prominent in the global, regional and national public health agenda in 2011. Globally, the "First global ministerial conference on healthy lifestyles and non-communicable disease control" was held in Moscow on 28-29 April 2011 and theUN High-level Meeting of the General Assembly on Non-Communicable Diseases in September 2011. Regionally, the WHO African Regional Consultation on the preparation for the Moscow Ministerial Meeting and the UN High Level Summit on NCDs was held inBrazzaville on 4-6 April 2011 . Nationally, the University of Ghana fifth College of Health Sciences’ Annual Scientific Conference had “The increasing burden of NCDs in Ghana” on 21 - 2 3 September as its theme. The Health Summit of the health sector in Ghana reviewed the national response to NCDs on 24 November 2011.

Promoting Techno-Scientific Biomedical Communication in Russia: Pro-government Non-profit Organizations

The rapidly expanding e-health market tends to reinvent the roles of science, entrepreneurship, and state. However, the results of such reinvention remain unclear. This study investigates the decade-long history (2011–2021) of the promotion of techno-scientific biomedical communication by pro-government non-profit organizations in Russia. In 2021, the World Bank pointed out that digital technologies have played a critical role in the pandemic in Russia and Russia's economic recovery is gathering pace. Thus, Russia tends to correspond to many other emerging health markets. We compare texts from non-profit organizations' websites and Facebook accounts with official state actions and the national mass media health agenda. The instruments that were used for text mining were topic modeling with latent Dirichlet allocation and an algorithm for keyphrase relationship visualization. The results revealed that promotion started no later than 2011 as a general private initiative in health. Throughout the state reforms and geopolitical crisis of 2014, in 2017–2019 digitalization was finally chosen as a model for the healthcare system. Simultaneously, the idea of digital reform for the health system was disseminated by the mass media. The pandemic drew attention to this communication, but it did not create significant change. Pro-government non-profit organizations continue to promote new directions for biomedical communication in Russia.

The potential of conditional cash transfers for the control of neglected tropical diseases

Neglected tropical diseases (NTDs) are a group of poverty-related diseases that particularly affect vulnerable communities in resource poor settings. Even though NTDs affect over 1·7 billion people globally, they have long been ignored in global and national health agendas and in budget allocations. To rectify such neglect, a global response was mounted in the early 2000s with the launch of the first WHO NTD road map and the London Declaration on NTDs whereby partners pledged strong support for its delivery.

Mental health among the general population and healthcare workers during the COVID-19 pandemic: A meta-analysis of well-being and psychological distress prevalence

The COVID-19 pandemic has constituted a global health crisis that has threatened the mental health of individuals worldwide. The present paper sought to systematically review and meta-analyze studies reporting the prevalence during the COVID-19 pandemic of well-being and psychological distress as defined by the dual-continua model, which includes (absence of) psychological distress and (presence of) well-being among the general population and healthcare workers. Systematic searches were conducted in various databases: PubMed, PsycINFO, Scopus, and Web of Science from inception until 6 December 2020. From a total of 158 studies (N = 880,352) included in the meta-analysis, only seven reported the prevalence of well-being. A random-effect model was used to estimate the pooled prevalence among the general population and healthcare workers on depression (25%; 31%), anxiety (27%; 31%), stress (35%; 32%), and well-being (52%; 45%), respectively. Sub-group analyses based on region, income, percentage of women, preparedness of country to respond to COVID-19, and economic vulnerabilities were conducted in order to examine sources of heterogeneity in psychological distress. Results revealed differences among the two groups and indicated that disparities in terms of preparedness to fight the pandemic can distinctly affect mental health in the general population and healthcare workers. Addressing mental health during and after a health crisis should be in the spotlight of the international and national public health agenda. Considering the protective role of well-being to minimize psychological symptoms, mental health policies during the COVID-19 should include strategies to combat the psychological consequences of the pandemic by promoting well-being practices.

Neoliberalism and mental health education

In 2017, the Departments of Health and Education in the United Kingdom initiated a national mental health agenda that includes new curriculum interventions and mandatory training courses for teachers. While the stated goal is to support children and young people with mental health difficulties, there are deeper economic and political forces driving these policy decisions. Both the underlying socio-structural causes of mental health problems and the conception of schools as ‘optimal’ sites for mental health support can be understood adequately only against the backdrop of neoliberalism. To make my case, I focus specifically on the ‘Government Response to the Consultation on Transforming Children and Young People's Mental Health Provision’, which discusses public feedback on the proposed initiative. An examination of this response reveals that the initiative contributes to the responsibilisation of young people and their families, neglects underlying economic sources of distress and ignores how neoliberalism fosters mindsets and social orientations that contribute to widespread anxiety and depression.