Non-health Sectors Research Articles

Advancing global health and the sustainable development goals through transdisciplinary research and equitable publication practices

Advancing global health and the sustainable development goals through transdisciplinary research and equitable publication practices

Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal.

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.

Not for us, without us: examining horizontal coordination between the Ministry of Health and other sectors to advance health goals in Uganda.

The Ministry or Department of Health (M/DoH) is the mandated government agency for health in all countries. However, achieving good health and wellbeing requires the health sector to coordinate with other sectors such as the environment, agriculture and education. Little is known about the coordination relationship between MoH and other sectors to advance health and development goals in low- and middle-income countries (LMICs). Our study examined the coordination relationship between MoH and other government ministries, departments and agencies (MDAs) at the national level in Uganda. This was an embedded case study nested in a study on intragovernmental coordination at the central government in Uganda. A qualitative approach used document review and key informant interviews with government officials and non-state actors. Data were analysed thematically using a multitheoretical framework. The coordination relationship was characterized by interdependencies generally framed lopsidedly in terms of health sector goals and not vice versa. Actor opportunism and asymmetrical interests interacted with structural-institutional factors contributing to variable influence on internal and external coordination within and beyond MOH. Supportive mechanisms include (a) diverse health sector legal-institutional frameworks, (b) their alignment to broader government efforts and (c) the MOH's agency to leverage government-wide efforts. Constraints arose from (a) gaps in the legal-institutional framework, (b) demands on resources due to the 'broad' MOH mandate and (c) the norms of the MOH's professional bureaucracy and the predominance of medical professionals. This study underlines critical actions needed to improve coordination between the health and non-health sectors. Introspection within the MOH is vital to inform efforts to modify MOH's internal functioning and positioning within the broader government to strategically advance MOH's (development) aspirations. The nature of MoH's role in multisectoral efforts should be contingent. Consideration of mutual sectoral interdependencies and interactions with and within broader government systems is critical.

Democracy and fiscal support during the COVID-19 pandemic: an empirical investigation

ABSTRACT Democracies are expected to implement expansionary fiscal policies to accelerate economic recovery in crisis times. However, as experienced in the 2008 global financial crisis, democratic countries sometimes tend to adopt austerity measures during crises. This paper examines the relationship between democracy and fiscal support during the COVID-19 pandemic. The empirical findings confirm the positive impact of democracy on fiscal support. As we unbundle the effects, democracy has a significant effect for the non-health sector, but the effect is insignificant for the health sector.

Implementation of Convergence Action to Accelerate Stunting Reduction in Labuhan Batu Regency, North Sumatra

Indonesia has set a target in accordance with the SDGs Program in 2030 in the health sector, namely through efforts to improve nutrition and health quality in combating the prevalence of stunting. The achievement of the SDGs goals must be prepared from now on in cross-sectoral coordination. Over the last 20 years, the handling of the stunting problem has been very slow, globally, the percentage of children whose growth is stunted has decreased by only 0.6% per year since 1999. It is predicted that if this continues, 15 years later it is estimated that 450 million children will experience growth retardation or stunting. The contributing factor is thought to be the lack of cross-sectoral roles in preventing stunting, so it is necessary to strengthen the role through convergence action to accelerate stunting reduction. This research is a descriptive study with a qualitative approach using source triangulation, where researchers get data from different sources using the same technique, namely open and in-depth interview techniques. There were 5 informants involved in this study, namely 2 OPD KB Officers, 1 Provincial PIC, 1 Regency PIC and 1 Nutrition Manager. The instruments used for primary data collection were observation, field documentation and interview guides. The results of the study are the factors that encourage the implementation of convergence actions to accelerate stunting reduction are the government's commitment, as well as the involvement of various parties both from the health and non-health sectors, but still need to be further improved. Lack of awareness related to stunting handling and stunting reduction program management that is not well organized because it only considers that it is only the task of nutrition managers so that there is no synergy with others.

Situation Analysis as a Effort to Accelerate Stunting Reduction in Labuhan Batu Regency in 2022

Indonesia has set a target in accordance with the SDGs Program in 2030 in the health sector, namely through efforts to improve nutrition and health quality in combating the prevalence of stunting. The achievement of the SDGs goals must be prepared from now on by coordinating cross-sectoral. Over the last 20 years, the handling of the stunting problem has been very slow, globally, the percentage of children whose growth is stunted has decreased by only 0.6% per year since 1999. It is predicted that if this continues, 15 years later it is estimated that 450 million children will experience growth retardation or stunting. The contributing factor is suspected to be the lack of cross-sectoral roles in preventing stunting, so it is necessary to strengthen the role through convergence action to accelerate stunting reduction. The role of Universities as the Regency/City Assistance Implementation Team through the Stunting Reduction Acceleration Program in 10 loci in Labuhan Batu Regency with a 5-pillar approach, namely; (1) increasing commitment and leadership of the Village/Urban Government; (2) System strengthening and development, data, information, research and innovation; (3) communication of behavior change and community empowerment in terms of nutrition, healthy behavior, mutual cooperation and independence; (4) convergence of specific and sensitive interventions through a family approach caring for stunting; (5) food security at the level Individuals, Families and Communities through optimizing the use of local food ingredients. The factors that encourage the implementation of convergence actions to accelerate stunting reduction are the government's commitment, as well as the involvement of various parties, both from the health and non-health sectors.

The Effect of Emotional Intelligence, Intellectual and Discipline on Employee Performance with Work Stress as a Moderating Variable at Prima Indonesia University

This study aims to determine the effect of emotional intelligence, intellectual intelligence, discipline, and how work stress moderates its effect on employee performance at Prima Indonesia University. Performance as the dependent variable. This research was conducted at the University of Prima Indonesia with a population of 60 employees in the non-health sector. This research method uses a quantitative method with an associative approach that uses an analytical model of Structural Equation Modeling (SEM) with a Partial Least Square (PLS) approach. Data were collected by using a questionnaire that had been tested for validity and reliability. The results showed that partially Emotional Intelligence, Intellectual Intelligence, Discipline had a positive effect on performance. Then work stress significantly moderates the influence of Economic Intelligence and Intellectual Intelligence on Performance, but does not significantly moderate work discipline on Performance. UNPRI employees either directly or indirectly Keywords: Emotional Intelligence, Intellectual Intelligence, Discipline, Work Stress, Employee Performance

Creating a Functional Health System for Nigeria

Background: Health systems are more than static health facilities. The World Health Organization has identified six building blocks of the health system namely: human resources for health, service delivery, medicines, vaccines and technology, health information, health financing and leadership and governance. This paper examines the Nigerian health system and posits that it is not functional.Discussion: The dysfunctional state is a result of chronic neglect of both the building blocks of the health system and the wider determinants of health such as education, sanitation, and food security in addition to the lack of synergy between the health and non-health sectors.Conclusion: Creating a functional health system in Nigeria does not require fresh policies rather the political will and commitment of resources to improve the quality of life of the citizens in the non-health sector and the implementation of the numerous policies and strategies in the health sector. Adequate attention should be paid to primary health care.

Bacteriophages Can Make a Difference in Water Quality: Evidence From a Community-Based Study From North India.

Background and objectivesDiarrhoea is a preventable and treatable faecal-oral disease. Despite significant inputs from the health and non-health sector in the treatment and prevention of diarrhoea, it remains a significant contributor to under-five-years children mortality and exerts profound effects on their growth and development. Bacteriophage has the potential to prevent diarrhoea. Bacteriophage status may influence the extent of diarrhoea. The objectives of the study were a) to assess the bacteriophage status and quality of water based on the Most Probable Number (MPN) count in the drinking water of under-five years children, and b) to find the association of the extent of diarrhoea with the bacteriophage status and quality of drinking water of under-five-years children in rural areas of Varanasi.MethodsThis is a community-based cross-sectional study done in the Chiraigaon community development block in a rural area of Varanasi. Water samples were collected and analysed in the Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.ResultsThe result of the study was that bacteriophage is present in 118 samples of water, whereas bacteriophage for Escherichia coli (E. coli), Klebsiella, and Vibrio were present in the drinking water of 81.1%, 53.8%, and 25.8% of under-five-years children, respectively. The water quality was highly satisfactory in 41.7% of samples and unsatisfactory in 15.2% of samples (p<0.004). All samples with highly satisfactory water quality had bacteriophages. Diarrhoea was present in 57.14% of samples without bacteriophage and 24.5% in samples with bacteriophage (p<0.01). The unadjusted odds ratio is 4.09.Interpretation and conclusionsThe odds of diarrhoea are four times higher in the water sample without bacteriophage than in the water sample in which bacteriophage is present. Bacteriophage study in preventing diarrhoea in children under five and health risk assessment call for focus.

Cross-Sector Collaborations Between Health Care Systems and Community Partners That Target Health Equity/Disparities in Diabetes Care.

Evidence shows that social determinants of health (SDOH) are key drivers of diabetes outcomes and disparities in diabetes care. Targeting SDOH at the individual, organizational, and policy levels is an essential step in improving health equity for individuals living with diabetes. In addition, there is increasing recognition of the need to build collaboration across the health care system and the communities experiencing inequities to improve health equity. As a result, partnerships between health and nonhealth sectors have emerged as a crucial component for increasing health equity in diabetes care and achieving health equity. The purpose of this article is to discuss cross-sector collaborations between health care systems and nonhealth partners that target health equity in diabetes care.

Evaluation of stunting policy in Enrekang Regency in 2022

Stunting is a global nutritional problem, including in Indonesia. To overcome stunting, the government has carried out an acceleration program for stunting prevention in 100 priority city regencies involving the health and non-health sectors through specific and sensitive nutrition interventions. This study aimed to evaluate stunting policy in Enrekang Regency in 2022. This study is a quasi-qualitative exploring the evaluation of stunting policy through in-depth interviews, observation and documentation. The data collection technique used was in-depth interviews in which respondents were selected through snowball sampling and obtained 10 informants consisting of 3 respondents as regular informants, 6 respondents as supporting informants and 1 respondent as a key informant. The results showed that the legality of the program issued by the Enrekang Regency Government in supporting efforts to accelerate and control stunting is the Regent's Regulation Number: 107/KEP/II/2018 concerning Gerakan Masyarakat Peduli Stunting (GEMPITA) (or translated, the Stunting Care Community Movement). The availability of human resources and facilities and infrastructure to support the Regent's Regulation on the prevention and control of Stunting in Enrekang Regency is sufficient.

The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States

BackgroundMultisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector.MethodsSHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey’s post hoc tests were used to assess differences in collaborator heterogeneity between programme areas.ResultsA total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas.ConclusionsWhile collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.

Norms, rules and policy tools: understanding Article 5.3 as an instrument of tobacco control governance

IntroductionArticle 5.3 of the WHO Framework Convention on Tobacco Control, elaborated via its implementation guidelines, can be understood as a policy instrument comprising norms, rules and policy tools designed to...

Situating Health Within the 2030 Agenda-A Practical Application of the Sustainable Development Goals Synergies Approach.

Background: The Sustainable Development Goals (SDGs) are integrated, indivisible and interdependent and interact and affect each other directly and indirectly. However, the 2030 Agenda does not attempt to identify or characterise these interactions. Evidence: The SDG Synergies approach was developed to enable the investigation of the strength and nature of interactions between SDGs based on the perception of a multistakeholder group. Two examples are given to concretely demonstrate how this approach overcomes present challenges and can be applied to situate health within the 2030 Agenda. Policy Options and Recommendations: There are clear benefits to situate desired health policy outcomes within the 2030 Agenda, and the SDG Synergies approach can be used as lever for including health aspects in traditional non-health sectors. Although focusing on specific health policies cannot be substituted with multisectoral policies alone, utilizing tools and methods such as the SDG Synergies approach can help policy makers put health at the centre of the SDGs. Conclusion: SDG Synergies is an impactful approach for policy makers to gain a systemic understanding of how broader sustainable development shape the health and well-being of people and vice versa.

US hospital engagement in cross-sector partnerships for population health improvement in socioeconomically distressed counties

ObjectivesThis study identifies the internal characteristics of hospitals located in counties with poor socioeconomic conditions that develop collaborative partnerships with a wide range of community organizations, including non-health organizations. Study designCross-sectional study that conducted Chi-square and logistic regression analyses. MethodsChi-square tests and logistic regression analyses were performed in this cross-sectional research to identify the internal hospital characteristics associated with non-health sector partnership development for hospitals located in U.S. counties in the worst quartile of performance across three socioeconomic conditions. The 2015 American Hospital Association Population Health Survey provided data on hospitals’ collaborative arrangements and internal characteristics, including hospital size, teaching status, ownership type, and system affiliation (n = 1,238). The 2014 County Health Rankings were used to identify counties in the worst quartile of performance on educational attainment, unemployment, and child poverty. ResultsChi-square analyses show that larger hospitals, teaching hospitals, hospitals that belong to a system, and not-for profit hospitals are significantly and positively correlated with non-health sector collaborative partnerships across one or more of the county indicators of poor socioeconomic conditions. Logistic regression results show that the only significant internal hospital characteristic associated with such partnerships is hospital size, in counties with poor educational attainment and those with high child poverty. ConclusionLarger hospitals are more likely to have the resources and strategic perspectives to address community health in counties with poor socioeconomic conditions.

Analyzing the Implementation of Policies and Guidelines for the Prevention and Management of Type 2 Diabetes at Primary Health Care Level in Nepal.

BackgroundNepal, in recent years, is witnessing an increasing problem of type 2 diabetes that has resulted significant premature deaths and disability. Prevention and management of non-communicable diseases (NCDs) including diabetes have been prioritized in the national policies and guidelines of the Nepal Government. However, research looking at the overview of the implementation of the existing policies and guidelines for diabetes prevention and control is scarce. Hence, this study reviewed diabetes related existing policies and its implementation process at the primary health care level in Nepal.MethodsThis study involved two phases: Phase I: situation analyses through review of documents and Phase II: qualitative exploratory study. In phase I, four databases (Medline, Web of Science, Embase and PubMed) were systematically searched using key search terms related to diabetes care and policies between January 2000 and June 2021. Also, relevant gray literature was reviewed to understand the trajectory of policy development and its translation with regards to diabetes prevention and management at primary health care level in Nepal. Following the phase I, we conducted in-depth interviews (IDI) and key informant interviews (KII) with health care providers, policy makers, and managers (IDI = 13, and KII = 7) at peripheral and central levels in Kavrepalanchowk and Nuwakot districts of Nepal. The in-depth interviews were audio recorded, transcribed, and coded. The triangulation of data from document review and interviews was done and presented in themes.ResultsFour key themes were identified through triangulating findings from the document review and interviews including (i) limited implementation of policies into practices; (ii) lack of coordination among the different levels of service providers; (iii) lack of trained human resources for health and inadequate quality services at the primary health care level, and (iv) inadequate access and utilization of diabetes care services at primary health care level. Specifically, this study identified some key pertinent challenges to the implementation of policies and programs including inadequate resources, limited engagement of stakeholders in service design and delivery, lack of trained health care providers, lack of financial resources to strengthen peripheral health services, fragmented health governance, and weak reporting and monitoring systems.ConclusionThis study revealed that the policies, plans, and strategies for prevention and management of NCDs in Nepal recognized the importance of diabetes prevention and control. However, a major gap remains with adequate and lack of clarity in terms of implementation of available policies, plans, strategies, and programs to address the problem of diabetes. We suggest the need for multisectoral approach (engaging both health and non-health sectors) at central as well as peripheral levels to strengthen the policies implementation process, building capacity of health care providers, ensuring adequate financial and non-financial resources, and improving quality of services at primary health care levels.

Antimicrobial Resistance Situation in Indonesia: A Challenge of Multisector and Global Coordination.

High levels of antimicrobial resistance (AMR) in Indonesia are caused by the use of inappropriate antimicrobials (AM) in healthcare services and the livestock and fisheries sector. The available data and information about overused antibiotics and the AMR threat in Indonesia are limited. The aim of the study is to describe the AMR situation in Indonesia based on perceptions of government officials, health professionals, and the community to determine actions needed to develop AMR-related strategy and policy. The study was done in eight provinces in Indonesia and included reviewing AMR-related policy, collecting antibiotic use reports in primary health care from health offices and hospitals, and conducting in-depth interviews and focus group discussions with informants from health and nonhealth sectors. The results of the study show that AM misuse happens not only in healthcare facilities but also in communities. Medical officers are unfamiliar with AMR-related policy, as are officers in the livestock and fisheries sectors. There is limited coordination between sectors regarding the AMR situation in Indonesia. The government has to take stronger measures to oversee better implementation of AMR policies.

A multi-sectoral intervention model to scale up family planning services utilization at the primary health care level: evidence from a priority district, Fayoum governorate, Egypt

&#x0D; Background: Egypt is one of the most populous countries in the Middle East and Africa. Evidence from developing countries revealed that increasing family planning use is associated with substantial declines in fertility and population growth. The objective of this study was to assess the impact of implementing a multisectoral intervention model on the family planning utilization at the Primary Health Care (PHC) level in a priority district, Fayoum governorate, Egypt. &#x0D; Methods: A quasi-experimental design was conducted from July 2016 to September 2016. The model targeted 10 PHC units out of 23 at Tamia district, with two types of interventions; health sector and non-health sector related interventions carried out in the intervention units and their catchment areas. The family planning utilization of the intervention units (n=10) was compared to the control units (n=13). Additionally, the overall family planning utilization at the district level was measured. &#x0D; Results: Following the implementation of the interventions, the overall family planning utilization at the district level showed a significant increase in mean ± Standard Error of the Mean (SEM) of new family planning clients (44.4±11.0vs. 63.3±13.8; P= 0.006) recording 43% change. The mean ± SEM of intrauterine devices dispensed from the intervention units significantly increased by 391% (3.5±1.0 vs. 17.2±3.3; P=0.002). Findings from the control units didn't reveal significant increase regarding the dispense of any family planning method. &#x0D; Conclusion: Mobilizing and optimizing resources use, empowering district authorities and strengthening collaboration across sectors were key drivers of the success of this model in scaling up family planning services utilization. &#x0D; &#x0D;

Utility, Limitations and Opportunities for Using Linked Health Administrative Data to Study Homelessness in Ontario.

Homelessness is a significant social issue within Canada but is difficult to quantify at the population level. In this paper, we discuss the development and use of a case ascertainment algorithm that identifies people experiencing homelessness through health administrative data. We highlight the appropriateness of various uses of this method given its key strengths and limitations. Finally, we discuss plans to improve this methodology and broaden its use through the addition of linkable administrative data from non-health sectors, such as emergency shelters and social services organizations.

Bentuk dan Peran Kapital Sosial dalam Percepatan Penurunan Stunting di Desa Pandawangi, Lombok Timur

The Poor nutritional status of children under five years of age remains a major concern in Indonesia. Based on RISKESDAS (Basic Health Survey) 2018, NTB province was listed as one of the 10 provinces with the highest stunting rates in Indonesia with 33,49 children are stunted, and Lombok Timur district was the highest stunting in NTB with prevalence reached 43, 5 %. Considering the long-lasting effects of child malnutrition, the district government of Lombok Timur put stunting reduction program as a priority. In 2017, Pandanwangi village was selected as one pilot village for implementing the national strategy to accelerate stunting prevention and reduction. Pandanwangi village successfully implemented integrated approach dealing with stunting reduction through specific and sensitive nutrition intervention. The aim of the study was to identify the form and role of social capital on stunting reduction program activities in Pandanwangi village. This was a qualitative study on collecting information from informants the health and non-health sector. Data were collected through in-depth interviews, observation and focus group discussion. The results showed that several forms of social capital included in social bonding, bridging, linking and played a role in the acceleration of the decline in stunting. Based on the research results, each type of social capital plays an important role in creating a enabling environment in stunting reduction efforts. The results of the study also showed a synergy between various forms of social capital that allowed the community to accelerate stunting reduction in Pandawangi Village.