Health System Response Research Articles

Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil.

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.

Migrant dentists, health system responses and future challenges: a case study of the United Kingdom and Australia

ABSTRACT Dentists, managing highly prevalent oral disease are in demand across the world and hence potentially highly mobile. Both the United Kingdom and Australia, continue to be favourable destinations for migrant dentists. This paper undertakes a comparative analysis of the professional integration of migrant dentists in the UK and Australia, and health system responses, while explicating implications for future health workforce governance. In doing so, the paper adopts a system-thinking approach to analyse interactions between the migration system and other societal systems. This is the first multi-country study to analyse the professional integration of migrant dentists through the lens of health workforce and migration governance. The study draws on semi-structured qualitative interviews with migrant dentists in both countries, together with national systems registration and examination data and relevant policies, together with data from government and global datasets. Both countries are high-income countries with a relatively large dentist-to-population ratio maintained through reliance on migrant dentists. The health systems and migration governance have responded by increasing the number of local graduates with limited success in the UK, potentially due to organisational demands, and the multifactorial complex mutual influences between higher education systems, labour market, feedback loops and dentist migration systems creating a nexus.

Integrated Care: A Person-Centered and Population Health Strategy for the COVID-19 Pandemic Recovery and Beyond.

The COVID-19 pandemic has mandated a re-imagination of how healthcare is administered and delivered, with a view towards focusing on person-centred care and advancing population health while increasing capacity, access and equity in the healthcare system. These goals can be achieved through healthcare integration. In 2019, the University Health Network (UHN), a consortium of four quaternary care hospitals in Ontario, Canada, established the first stage of a pilot program to increase healthcare integration at the institutional level and vertically with other primary, secondary and tertiary institutions in the Ontario healthcare system. Implementation of the program was accelerated during the COVID-19 pandemic and demonstrated how healthcare integration improves person-centred care and population health; therefore serving as the foundation for a health system response for the COVID-19 pandemic recovery and beyond.

Healthcare workers' experiences with COVID-19-related prevention and control measures in Tanzania.

The ability of a health system to withstand shocks such as a pandemic depends largely on the availability and preparedness of health-care workers (HCWs), who are at the frontline of disease management and prevention. Despite the heavy burden placed on HCWs during the COVID-19 pandemic, little is known regarding their experiences in low-income countries. We conducted a web-based survey with HCWs in randomly selected districts of Tanzania to explore their experiences with COVID-19-related prevention and control measures. The survey assessed implementation of COVID-19 control guidelines in health facilities, HCW perceptions of safety, well-being and ability to provide COVID-19 care, and challenges faced by frontline workers during the pandemic. We used multivariate regression analysis to examine the association between HCW and health facility characteristics, a score of guideline implementation, and challenges faced by HCWs. 6,884 Tanzanian HCWs participated in the survey between December 2021 to March 2022. The majority of respondents were aware of the COVID-19 guidelines and reported implementing preventive measures, including masking of both HCWs and patients. However, HCWs faced several challenges during the pandemic, including increased stress, concerns about infection, and inadequate personal protective equipment. In particular, female HCWs were more likely to report exhaustion from wearing protective equipment and emotional distress, while physicians were more likely to experience all challenges. While most HCWs reported feeling supported by facility management, they also reported that their concerns about COVID-19 treatment were not fully addressed. Notably, perceptions of protection and well-being varied widely among different HCW cadres, highlighting the need for targeted interventions based on level of exposure. In addition, various factors such as HCW cadre, facility ownership and COVID-19 designation status influenced HCWs' opinions about the health system's response to COVID-19. These findings highlight the importance of consistent implementation of guidelines and social and emotional support for HCWs.

The First Statewide Implementation of a Regional Disaster Teleconsultation System to Expand Critical Care Surge Capacity: A Case Study in Vermont.

Background: In December 2021, the Region 1 Disaster Health Response System, the state of Vermont, and the National Emergency Tele-Critical Care Network partnered to provide statewide access to disaster teleconsultations during COVID-19 surge conditions. In this case report, we describe how a disaster teleconsultation system was implemented in Vermont to provide access to temporary tele-critical care consultations during the Omicron COVID-19 surge. Methods: We measured the time from request of service to implementation and calculated descriptive statistics. Results: Seven of Vermont's 14 hospitals requested the service. Despite a technology solution capable of providing services within hours, mean time to service implementation was 27 days (interquartile range 20-41 days). Conclusions: Integration of disaster teleconsultation systems into state and local emergency management plans are needed to bring administrative start-up times in line with technical readiness.

Development of an Evidence-Based Tool to Assess the Relative Vulnerability of Different Communities to Tuberculosis

Identifying specific tuberculosis (TB) vulnerabilities in populations based on their geographical, demographic, and epidemiological characteristics is an essential yet challenging requirement to help reduce and eliminate TB. Assessment tools that can accurately quantify the risks associated with key factors could be used to measure TB vulnerability efficiently and indicate the most appropriate range of interventions. This study aimed to develop TB vulnerability assessment tools based on a TB vulnerability assessment conceptual framework developed with Leximancer. Three steps to produce the tools were facet analysis, interpreting the facet to create a list of questions, and expert judgment to confirm the suitability of the questionnaire. The “everything is data” principle was used to identify the data sources and build the tools. The data came from multiple primary data sources, with a questionnaire survey and observational form, and secondary data from various governmental statistical departments in Indonesia to collect data related to demography, health indicators, climate, temperature, and air quality. These tools will be optimized at scale next year to evaluate their utility for prioritizing and prescribing health system responses to TB in different communities in Central Java Province.

Marburg virus outbreak in Tanzania: A threat to global health security

AbstractThe current Marburg virus (MARV) outbreak in Tanzania served as a stark reminder of the ongoing threat posed by emerging infectious diseases and the urgent need for global health security. The Tanzanian Ministry of Health (MoH) officially declared the outbreak on March 21, 2023. Eight cases in all, five of which included fatalities, have been reported in the country at present. The virus is a member of the Filoviridae family closely related to the widely known Ebola virus. Similar to other filoviruses, MARV causes acute and lethal hemorrhagic fever in both human and nonhuman primates with high case fatality rates ranging from 24% to 90%. The outbreak has highlighted the need for improved disease surveillance and response systems, as well as increased funding for research into emerging infectious diseases. The Tanzanian MoH has deployed a response team to investigate and monitor the transmission in the Kagera Region. The team works closely in collaboration with other organizations, such as the World Health Organization and the Africa Centre for Disease Control and Prevention, to ensure the effective control of the situation. Although there is no vaccine or treatment approved for Marburg virus disease (MVD), supportive management improves survival. Existing infection prevention and control protocols for Ebola and other viral hemorrhagic fevers such as isolation and use of appropriate personal protective equipment can be used to prevent transmission of MVD. The global community must work together to strengthen health systems, enhance research efforts, and build resilient and responsive health systems to prevent future outbreaks of this kind. In this article, we have analyzed the MVD outbreak in Tanzania, specifically in the Bukoba district of the Kagera Region, and provided recommendations for the management of the current outbreak and future outbreaks.

Resilience in childhood vaccination: analysing delivery system responses to shocks in Lebanon

IntroductionDespite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better...

Contested and Evolving Pandemic – A Follow-up Study on National Policymakers’ Interpretations

Abstract Background The prolongation of the COVID-19 pandemic has shown that perceptions of the crisis change over time. In this follow-up study we explore how national level policymakers interpret COVID-19 pandemic as a past, present, and future event and crisis. By doing so the contested nature of pandemic governance reveals, i.e. that the interpretations of the on-going crisis shape the policy choices and health system response. National policymakers have been demanded to make sense of emergent and ambiguous events and to form public health actions accordingly. Different interpretations on pandemic have been in core of pandemic governance and have influenced public policy and pandemic responses. Methods We applied a qualitative follow-up research design. Study informants were identified by purposive sampling by their position as central government pandemic policymakers in Finland. The semi-structured interviews were collected in 2021 (n = 21) after the first two pandemic waves, and in winter 2022-2023 (n = 16) after full vaccinations of the population. Results Three interpretations of COVID-19 were identified: Underlining the hard work needed to overcome the crisis, pandemic as a past event was framed through undeniable success. As an ongoing crisis, pandemic was discussed as having become mundane and less important on the public health agenda. As future crisis the pandemic was merged into a continuum of other (non-public health related) crises instead of being reflected solely from health perspectives. Conclusions The way of interpreting a crisis has significant influence on public policy. Prolonged pandemic showed contested nature of public health crisis in general public policy agenda; and its’ ending was not represented as clear cut, as it dissolved and was entwined into other crises and agendas. Crisis interpretations effect on future, since they profoundly affect how crises responses, future pandemic preparedness, policies or evaluation of effects are framed and formed. Key messages • Conceptions on COVID-19 crisis evolve in time and they effect policies to be formed. • Contested nature of pandemic draws attention from solely public health policies into continuum of crises on public policy agenda.

Years Lived with Disability due to COVID-19 in the capital of Serbia in 2020 and 2021

Abstract Background Valid estimates of the national disease burden often lack during crises. They need to be improved to help assess the effectiveness and efficiency of the national public health system. To determine the magnitude of acute COVID-19 in Belgrade in 2020 and 2021, we estimated the total, age and sex-disaggregated Years Lived with Disability (YLD). Methods YLD and YLD/100,000 population due to acute COVID-19 were calculated for Belgrade (Serbia) in 2020 (March 6 - December 31) and 2021 (January 1 - December 31) within the EU COST Action 18218 and the BoCO-19 study. The City Institute of Public Health Belgrade provided surveillance numbers of cases of ICD-X: U07.1 and U07.2 (unknown age cases were proportionally redistributed) and population estimates. Severity weights and length of the disease were taken from the German National Burden of Disease study. Results In 2020, 33,842 acute COVID-19 cases (50.04% were men) had 73.0 YLD (men: 40.6 YLD or 5.1 YLD /100,000; women: 32.4 YLD or 3.6 YLD/100,000). In 2021, 65,020 COVID-19 cases (54.5% were women) had 130.3 YLD (men: 65.1 YLD or 8.2 YLD /100,000; women: 65.2 YLD or 7.3 YLD/100,000). Mild cases were more often among men 10-19 years and women 35-44 years. Moderate cases were more often among persons 35-44 years. Critical cases were more often among the men. More YLD were estimated for severe cases among women in 2021 than in 2020. Conclusions In Belgrade, the YLD burden of acute COVID-19 in 2021 was almost double that of 2020. Women had more often severe forms of acute COVID-19 and more YLD in 2021 than in 2020. Men often had moderate and critical cases of acute COVID-19 and higher YLD rates than women. The COVID-19 pandemic demonstrates the importance of having disease burden metrics to help contextually assess the health system's response to crises. Belgrade-level estimates can also be used for national estimates because of the same case definitions, treatment protocols, and data collection methods. Key messages • The YLD burden of the COVID-19 pandemic in 2021 was almost double that of 2020 for population of Belgrade. • In 2020, higher YLD had men due to critical cases, in 2020, women due to severe cases in 2021 indicating greater exposure of men and greater vulnerability of women.

Socioeconomic characteristics and COVID-19 infection in Belgium: the mediating role of vaccination

Abstract Background Evidence suggests that people from lower socioeconomic status are at higher risk of infectious disease impact, owed to virus exposure, susceptibility and incomplete or delayed vaccination. However, It is unknown whether COVID-19 incidence disparities is due to social inequalities or social vaccination inequalities. The aim of this research is to determine whether socioeconomic characteristics are associated with COVID-19 infections in Belgium by measuring its direct effect, and to quantify the indirect role of socioeconomic determinants on COVID-19 infections by examining the role of vaccination as a mediator in this association. Methods In this retrospective cohort, all patients tested for COVID-19, at least once, in Belgium between 1 September 2021 and 1 September 2022 will be included in our analysis. A survival analysis will be conducted to compare time to the endpoint defined as COVID-19 infection according to socioeconomic characteristics. Mediation analysis for vaccination status will be conducted to assess the role of vaccination in the association between socioeconomic factors and COVID-19 infection. Results Expected results would give us an understanding of the impact of socioeconomic characteristics on COVID-19 infections in Belgium using on a population-based approach and considering the mediating effect of vaccination. Conclusions Mediation analysis is a novel approach for better understanding virus exposure and susceptibility in a context marked by socioeconomic inequalities. Understanding these patterns will allow better health-system preparedness for future pandemics. Key messages • Understanding social inequalities is essential for better health-system preparedness and response. • Mediation analysis allows to understand the direct effect of socioeconomic inequalities on COVID-19 infections and the indirect effect mediated through vaccination.

3.L. Round table: Vaccine Literacy and vaccination uptake for newly arrived migrants and people living in prisons

Abstract Health systems are complex and health organisations are often structured and operate in ways that make access to vaccination services difficult and inequitable for some marginalized populations. In addition, professionals may not be equipped to identify and address the cultural and social needs of these groups of people. The concept of vaccine literacy (VL) emphasizes that VL is not simply knowledge of vaccines, but also development of a less complex health system for communicating and offering vaccines as a conditions of a functioning health system (Ratzan, 2011). Newly arrived migrants (NAM) and people living in prisons (PLP) are two populations with overall low vaccination rates compared to the general population. Efforts to change this situation must emphasize activities not only geared toward increasing individual vaccine literacy, but more importantly supporting the system to become more vaccine literate. The general aim of the “Access to Vaccination for Newly Arrived Migrants -AcToVax4NAM” project is to improve the responsiveness of health systems in terms of vaccination literacy, making the conditions for access to vaccinations more equitable and guaranteed. Similarly, the “Reaching the hard-to-reach: increasing access and vaccine uptake among the prison population in Europe -RISE-Vac” aims to improve the health of people living in prisons in Europe by promoting staff and prisoners’ VL, enhancing vaccine offer and increasing vaccine uptake. During the workshop, AcToVax4NAM and RISE-Vac will discuss strategies and tools developed within these two EU co-funded projects (3rd EU Health Programme) to address vaccine literacy at the organizational and individual level for the particular target groups. Key messages • Individual and organisational vaccine literacy are equally important to increase vaccine uptake and vaccination coverage among disadvantaged communities. • Intersectoral and multidisciplinary approaches are needed to tackle inequalities in access to prevention services including vaccination services.

4.N. Round table: Policy options for fixing the global and European health and care workforce-crisis

Abstract Globally and within Europe, health systems are plagued by health and care workforce (HCWF) shortages, regional maldistribution, and skill-gaps. Insufficient training pipelines for health and care workers (HCW), attrition, discouraging working conditions and, in Europe, the demographics are contributing factors to the HCWF-crisis. This situation has been aggravated by the impact of COVID-19 and its immense burden on HCW's resulting in a further thinning of the HCWF. Despite these challenges, there are also many lessons to be learned from the various COVID-19 health systems responses in countries on improving the situation for the HCWF. National responses to COVID-19 showed that the health and care workforce is capable of hugely positive change. The lessons generated offer powerful evidence on how best to develop a sustainable workforce that is equipped to deliver on the ambitions of universal health coverage (UHC), health security and the sustainable development goals (SDGs). There is, however, no simple solution or silver bullet that can resolve the crisis. The response needs to be multi-faceted. Therefore, in this roundtable discussion, we will review policy options bundled in three sets: The first set focuses on the working conditions, which include: changing the scope of practice and introducing team-based roles; increasing the use of technology and digital tools; allowing for more flexible regulations; ensuring the physical, mental, and social protection of HCW. The second set of policy options focuses on the better alignment between health system demands and the education, employment, and finance sectors. The policy options presented will included investment in intersectoral relationships; strengthened intersectoral mechanisms; reliable data and forecasting; identifying the co-benefits for other sectors of investment in the HCWF. The third set of policy options focuses on smart investments and resource mobilization. This includes investing in the oversupply of HCW; investing in education; protecting investments by protecting HCW; securing sufficient and sustained investment through solidarity and cooperation at the multilateral, regional and domestic levels. Finally, as a cross cross-cutting lesson learned from COVID-19 health system responses the role of political leadership will be demonstrated both at the top level as well as also across governments, civil-society and the private sector. The evidence for the roundtable discussion is based on three policy briefs developed for the 5th Global Forum for Human Resources for Health. The roundtable discussion will be highly interactive. After a brief keynote, which will set the scene, we will instantly engage the audience through active facilitation interacting with senior researchers and senior WHO officials. Key messages • The Global and European health and care workforce-crisis must be addressed and requires a multi-faceted response supported by political leaderships at all levels. • The lessons generated from COVID-19 responses offer powerful evidence on how best to develop a sustainable workforce to deliver on the ambitions of universal health coverage. Speakers/Panelists Margaret Caffrey Liverpool School of Tropical Medicine, Liverpool, UK Jim Campbell WHO, Geneva, Switzerland Tomas Zapata WHO/Europe, Copenhagen, Denmark Gemma Williams European Observatory on Health Systems and Policies, London, UK

Lessons from the health system resilience testing pilot in Finland

Abstract Finland is a Nordic welfare state with universal access to health care. The health system has recently undergone a major reform and health care and social and rescue services are organized by 21 well-being service counties, the city of Helsinki and Helsinki-Uusimaa Hospital district which all get funding from the state. Publicly funded health services are mainly provided by public health centers and hospitals. The resilience testing tool developed by the European Observatory on Health Systems and Policies and the OECD was piloted in Finland in the early April 2023. The participants (n = 17) represented e.g. the key ministries, the Prime Minister's Office, Ombudsman for children, well-being service counties, municipalities, and the university hospitals. The tool was piloted by using a pandemic scenario in which those most seriously affected are small children with substantially increased hospitalizations and mortality. The adults are mainly asymptomatic. At population level the spreading of the disease is rapid and overwhelms the service system in waves. The scenario was chosen because it is difficult to predict the onset and cause of the next pandemic, or its effects on the health system. The Covid-19 pandemic placed health systems around the world to a test, but it is important that preparedness to the next pandemic is not developed solely based on the experiences from Covid-19. In this presentation we describe the main lessons learned from the Finnish resilience testing pilot. These include both lessons related to the tool itself and its further development as well as lessons from the discussions based on the pandemic scenario. The discussions by the multi-stakeholder group reflected well the health system subfunctions presented in the resilience testing tool framework. However, the discussions also captured themes that are not currently visible in the framework such as ethical considerations, values, and political determinants of health system response.

Burden of T1DM and T2DM among adolescents in Western Europe, 1990-2019: results from the GBD 2019

Abstract Background Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are major causes of global morbidity and mortality. As little is known about the burden of DM in adolescents in Western Europe (WE), we aimed to explore the epidemiology of T1DM and T2DM among 10-24-year-olds, including temporal trends. Methods Estimates were retrieved from the Global Burden of Diseases study 2019 (GBD 2019). We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for incidence, prevalence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results In 2019, prevalence and YLDs estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM incidence rates per 100,000 population were 3.5 times higher than T1DM. T2DM showed a greater increase in prevalence and YLDs than T1DM in the 30-year observation period in all WE countries. The highest prevalence rate of T1DM was in Finland (542.7 [402.9-681.0]), while the United Kingdom had the highest prevalence for T2DM (751.0 [501.2-1063.3]). Prevalence increased with age, while only minor differences were observed between sexes. In 2019, HBMI accounted for 28.8 (12.6-54.9) of the attributable YLD rates for T2DM in age group 20-24 years in WE. Conclusions The findings show the substantial burden posed by DM among adolescents in WE. The study can help inform the development and implementation of appropriate infrastructure and healthcare frameworks for adolescent-centred diabetes care. It highlights the need for transition services, and adolescent-oriented education programs, as well as investments in data systems to improve the availability and quality of data for T1DM and T2DM in 10-24-year-olds. Finally, it can be used to guide policymakers towards prevention of obesity and broader policy actions on the social and commercial determinants of health across the life course. Key messages • Adolescent-oriented health system responses on transition services, data collection systems, education, and complications’ prevention are needed to achieve targets for NCDs within the 2030 UN SDGs. • T2DM should not only be considered as an adult-onset disease, implying a paradigm shift for paediatric DM services and a strengthening of interventions on social and commercial determinants of health.

Adjusting expected deaths for mortality displacement during the COVID-19 pandemic: a model based counterfactual approach at the level of individuals

BackgroundNear-real time surveillance of excess mortality has been an essential tool during the COVID-19 pandemic. It remains critical for monitoring mortality as the pandemic wanes, to detect fluctuations in the death rate associated both with the longer-term impact of the pandemic (e.g. infection, containment measures and reduced service provision by the health and other systems) and the responses that followed (e.g. curtailment of containment measures, vaccination and the response of health and other systems to backlogs). Following the relaxing of social distancing regimes and reduction in the availability of testing, across many countries, it becomes critical to measure the impact of COVID-19 infection. However, prolonged periods of mortality in excess of the expected across entire populations has raised doubts over the validity of using unadjusted historic estimates of mortality to calculate the expected numbers of deaths that form the baseline for computing numbers of excess deaths because many individuals died earlier than they would otherwise have done: i.e. their mortality was displaced earlier in time to occur during the pandemic rather than when historic rates predicted. This is also often termed “harvesting” in the literature.MethodsWe present a novel Cox-regression-based methodology using time-dependent covariates to estimate the profile of the increased risk of death across time in individuals who contracted COVID-19 among a population of hip fracture patients in England (N = 98,365). We use these hazards to simulate a distribution of survival times, in the presence of a COVID-19 positive test, and then calculate survival times based on hazard rates without a positive test and use the difference between the medians of these distributions to estimate the number of days a death has been displaced. This methodology is applied at the individual level, rather than the population level to provide a better understanding of the impact of a positive COVID-19 test on the mortality of groups with different vulnerabilities conferred by sociodemographic and health characteristics. Finally, we apply the mortality displacement estimates to adjust estimates of excess mortality using a “ball and urn” model.ResultsAmong the exemplar population we present an end-to-end application of our methodology to estimate the extent of mortality displacement. A greater proportion of older, male and frailer individuals were subject to significant displacement while the magnitude of displacement was higher in younger females and in individuals with lower frailty: groups who, in the absence of COVID-19, should have had a substantial life expectancy.ConclusionOur results indicate that calculating the expected number of deaths following the first wave of the pandemic in England based solely on historical trends results in an overestimate, and excess mortality will therefore be underestimated. Our findings, using this exemplar dataset are conditional on having experienced a hip fracture, which is not generalisable to the general population. Fractures that impede mobility in the weeks that follow the accident/surgery considerably shorten life expectancy and are in themselves markers of significant frailty. It is therefore important to apply these novel methods to the general population, among whom we anticipate strong patterns in mortality displacement – both in its length and prevalence – by age, sex, frailty and types of comorbidities. This counterfactual method may also be used to investigate a wider range of disruptive population health events. This has important implications for public health monitoring and the interpretation of public health data in England and globally.

Policies and Management Interventions to Enhance Health and Care Workforce Capacity for Addressing the COVID-19 Pandemic: Protocol for a Living Systematic Review.

Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers' safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. The objective of this protocol review is to identify countries' range of experiences with policies and management interventions that can improve health and care workers' capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization's COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. PROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327041. RR1-10.2196/50306.

Epidemiology of tuberculosis in Kazakhstan: data from the Unified National Electronic Healthcare System 2014–2019

ObjectivesThis study aims to estimate tuberculosis (TB) incidence, mortality rates and survival HRs in Kazakhstan, using large-scale administrative health data records during 2014–2019.DesignA retrospective cohort study.SettingsData for patients with TB...

Medical Assistance in the De-Occupied Ukrainian Territory.

The Russian invasion of Ukraine in 2022 has affected more people and destroyed a local public health facility. When some territories in Ukraine were de-occupied, national and international mobile clinics (MCs) were involved for medical assistance to local inhabitants. Knowledge about population health, medical, and humanitarian needs after they have been de-occupied has to improve planning for health system response. The aim of this study was to summarized the MC experience at the first month after the area was de-occupied, as well as to show out-patient visits and to identify a need for medicines and medical equipment in the MC. The information related to the missions was obtained by direct observation and estimation on empirical data gathering in the field during a twelve-day mission in April-May 2022. All patients were divided by age, sex, and diseases according to the International Classification of Diseases-10 (ICD-10). During the twelve-day MC mission, medical assistance was provided for 478 out-patients. Descriptive statistical methods were undertaken using Microsoft Office 2019, Excel with data analysis. All out-patients were evaluated clinically. Personal medical cards were completed for each patient. Glucose testing as well as tests for coronavirus disease 2019/COVID-19 had been done, if it was necessary. All sick persons were treated for their disease. The priority needs for emergency and primary medical care, medicines, and hygienic and sanitation supplies after the area was de-occupied were fixed. The most frequent reasons for visiting the МС were: hypertension (27.6%), musculoskeletal-related (arthritis) diseases (26.9%), heart and peripheral vascular diseases (12.1%), upper gastrointestinal disorder (5.4%), upper respiratory infection (5.0%), and diabetes Type-2 (3.7%). Other diagnoses such as lower respiratory tract infection, diagnoses of the digestive system (hemorrhoids and perianal venous thrombosis), chronic obstructive pulmonary disease/COPD or asthma, eye diseases, gynecology-related condition, menstrual condition, and urinary tract disorder were distributed almost equally (0.21%-2.51%) among the patient population. In the de-occupied territories, a health responder could be ready for medical assistance to patients with noncommunicable diseases (NCDs) as well as to support a person with psychological reactions who asked for sedatives and sleep-inducing medicines. These data clearly demonstrate that MCs must be equipped by blood pressure (BP) monitor, stethoscope, pulse oximeter, and diabetes testing kit glucose with essential medicines. This study improves health response planning for local civilian populations in de-occupied territory.

Health System Response to Refugees' and Migrants' Health in Iran: A Strengths, Weaknesses, Opportunities, and Threats Analysis and Policy Recommendations.

Objective: Iran is one of the main hosts of Afghan refugees. This study aims to provide comprehensive evidence to increase Afghan migrants' access to healthcare services in Iran. Methods: To assess the health system's response to Afghan migrants in Iran, we conducted three phases for SWOT analysis, including: 1-developing a review and comprehensive analysis of documents, laws, and, programs, 2-conducting semi-structured interviews with policymakers and experts, and 3-mapping the results through the Levesque's conceptual framework for healthcare access. Results: We evaluated the response of the health system to Afghan migrants' health needs in three domains: 1-Approachability and ability to perceive migrants; 2-Ability to reach, engage, and availability and accommodation and appropriateness; 3-The ability to pay and affordability. For each of the three domains, we identified strengths, weaknesses, opportunities, and threats, complemented with evidence-based suggestions to improve migrants' access to needed healthcare services. Conclusion: Given the rising trend of immigration and deteriorating financial crises, we recommend appropriate strategies for the adoption of specialized focus services, gateway services, and restricted services. Also simplifying financial procedures, and implementing innovative insurance mechanisms are essential.