Sustained Political Commitment Research Articles

Progress Toward Poliomyelitis Eradication - Pakistan, January 2023-June 2024.

Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy.

Interprofessional education in cardiothoracic surgery: a narrative review.

Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.

Mosquitoes: The Long-term Effects of Malaria Eradication in West Africa

Malaria has been a critical public health issue in West Africa for centuries, resulting in widespread morbidity and mortality, especially among vulnerable groups like children and pregnant women. Recent eradication efforts, bolstered by insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), and antimalarial drugs, have significantly reduced the disease burden. This review examines the long-term socio-economic impacts of malaria eradication in West Africa, including improved public health, enhanced productivity, economic growth, and better access to healthcare. The reduction of malaria-related healthcare costs has led to increased investments in education, infrastructure, and other essential services. However, challenges persist, such as insecticide resistance among mosquitoes, financial constraints, and emerging public health concerns. Ecological effects of mosquito eradication, including impacts on biodiversity and the evolution of insecticide-resistant mosquitoes, raise important considerations for future control strategies. The role of climate change in shaping mosquito ecology and malaria transmission dynamics is also explored. This review underscores the need for sustained political and financial commitment, regional collaboration, and innovation to ensure the continued success of malaria eradication in West Africa. Integrating these efforts with broader Sustainable Development Goals (SDGs) and addressing ecological sustainability are essential for achieving long-term health and socio-economic benefits. Keywords: Malaria eradication, West Africa, public health, insecticide resistance, socio-economic impact, mosquito ecology.

Public-private partnerships in health sector innovation: Lessons from around the world

Public-Private Partnerships (PPPs) have emerged as a crucial mechanism for fostering innovation in the health sector globally. This review encapsulates the lessons learned from diverse PPP models worldwide, highlighting their significance and impact. PPPs in healthcare innovation entail collaboration between governmental bodies, private enterprises, and sometimes non-profit organizations to address challenges, such as limited resources, expertise, and infrastructure, while leveraging the strengths of each sector. The success of PPPs relies on effective governance structures, clear objectives, and mutual accountability. One notable example is the United Kingdom's NHS Innovation Accelerator, which partners with industry leaders to fast-track the adoption of innovative healthcare technologies within the National Health Service (NHS). Through this initiative, pioneering solutions, ranging from digital health platforms to medical devices, have been implemented, enhancing patient care and operational efficiency. Similarly, in low-resource settings like sub-Saharan Africa, PPPs have played a pivotal role in improving access to essential healthcare services. Projects such as the Medicines for Malaria Venture (MMV) collaborate with pharmaceutical companies, governments, and research institutions to develop affordable antimalarial drugs tailored to the region's needs. In the realm of medical research and development, partnerships like the Coalition for Epidemic Preparedness Innovations (CEPI) have demonstrated the power of international collaboration in addressing global health threats. CEPI brings together governments, philanthropic organizations, and the private sector to expedite the development of vaccines against emerging infectious diseases, as witnessed during the COVID-19 pandemic. However, challenges persist in PPP implementation, including complex regulatory frameworks, funding uncertainties, and divergent interests among stakeholders. Lessons from successful PPPs underscore the importance of transparent communication, stakeholder engagement, and sustained political commitment. In conclusion, PPPs in the health sector represent a dynamic avenue for catalyzing innovation and driving transformative change. By drawing insights from diverse experiences worldwide, policymakers and practitioners can refine existing frameworks and foster sustainable partnerships to tackle evolving health challenges effectively.

Approaching the SDG targets with sustained political commitment: drivers of the notable decline in maternal and neonatal mortality in Morocco

BackgroundBetween 2000 and 2017/2018, Morocco reduced its maternal mortality ratio by 68% and its neonatal mortality rate by 52%—a higher improvement than other North African countries. We conducted the Exemplars...

Strengthening Health Systems in Conflict: Evidence-Based Policies for Quality Care in Yemen

Yemen’s health system has faced formidable obstacles due to the enduring conflict since 2014, resulting in compromised infrastructure, disrupted services, and exacerbated vulnerabilities. This discourse meticulously analyzes the primary health system challenges in Yemen within the framework of the World Health Organization’s six pillars. It subsequently presents evidence-based policy recommendations to enhance Yemen’s health system and ensure the provision of high-quality and equitable care. In terms of service delivery, it suggests augmenting the presence of community health workers, leveraging mobile health technology, rehabilitating facilities, and improving emergency obstetric care. Regarding the health workforce, it proposes financing mechanisms for adequate remuneration, task-shifting strategies, embracing telemedicine, and fostering partnerships with universities. To strengthen information systems, it advocates for the enhancement of facility reporting, the implementation of national surveys, the utilization of mobile phone surveys, and the adoption of robust health information software. Regarding essential medicines, it recommends reorganizing regulations pertaining to selection, procurement, storage, and distribution. For health financing, it highlights the importance of increasing domestic budget allocation, implementing user fee exemptions, adopting performance-based financing mechanisms, and strengthening financial management systems. Last, in terms of governance, it emphasizes the need for transparent and accountable leadership, effective coordination mechanisms, and inclusive policy-making processes. Yemen requires sustained political commitment and adequate resources to facilitate the comprehensive reconstruction of its health system.

Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain)

BackgroundThe COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19.MethodsA realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method.ResultsThe analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented.ConclusionsThe findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

The United Nations Security Council and Global Health Threats

Abstract covid-19 has prompted a range of new suggestions to reform the existing international system. One recommendation garnering political support has been to create a new Global Health Threats Council, comprised of heads of state, to facilitate sustained political commitment and investment in pandemic preparedness and response. A question that currently remains unanswered, however, is how and where this new body aligns to existing governance arrangements. Some observers have suggested the new body should report the United Nations Security Council on the basis it is charged with maintaining international peace and security. This paper evaluates the UN Security Council’s engagement with health crises over recent decades to consider the legal, political, and practical feasibility of the body assuming a larger role in responding to future disease events, and the appropriateness of the proposed Global Health Threats Council falling under the authority of the UN’s principal organ for international security.

India’s sustaining challenges to combat rabies elimination: a comprehensive review

Rabies is one of the fatal zoonotic diseases wreaking havoc on humanity since antiquity. India continues to suffer the greatest rabies burden of any country, both in terms of annual human deaths and disability-adjusted life years. While modern rabies management emphasizes the importance of achieving zoonotic disease control and prevention through a One Health approach, the disease remains challenging as its persistence is invariably multifaceted. Therefore, it is imperative to examine the enduring reasons for the increasing incidence of rabies in India. Between 2012- 2022, a systematic search of scientific publications, popular search engines like Google, as well as in the grey literature regarding rabies was carried out. Since rabies elimination boils down to addressing the reasons, it is first seen related to the large and unvaccinated stray dog population, where 97% of cases are by dog bites. A second finding is that many bite victims resorted to indigenous treatment practices due to insufficient awareness and knowledge about the disease. Incomplete treatment practices also led to some deaths, especially because rabies vaccines are not affordable or accessible to poverty-stricken populations. Rarely, vaccine failures were caused by a lack of vaccine potency, a wound type, or ineffective administration methods. Even with all these data incorporated, there was no information on prevalence/incidence estimates of dog bites in recent years through national data. Therefore, without intensified surveillance, sustained political commitment, enormous mobilization of resources, and rabies education, the epidemic waves of this fatal disease will continue in India.

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023.

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

Democracy, Agony, and Rupture: A Critique of Climate Citizens’ Assemblies

Stymied by preoccupation with short-term interests of individualist consumers, democratic institutions seem unable to generate sustained political commitment for tackling climate change. The citizens’ assembly (CA) is promoted as an important tool in combatting this “democratic myopia.” The aim of a CA is to bring together a representative group of citizens and experts from diverse backgrounds to exchange their different insights and perspectives on a complex issue. By providing the opportunity for inclusive democratic deliberation, the CA is expected to educate citizens, stimulate awareness of complex issues, and produce enlightened and legitimate policy recommendations. However, critical voices warn about the simplified and celebratory commentary surrounding the CA. Informed by agonistic and radical democratic theory, this paper elaborates on a particular concern, which is the orientation toward consensus in the CA. The paper points to the importance of disagreement in the form of both agony (from inside) and rupture (from outside) that, it is argued, is crucial for a democratic, engaging, passionate, creative, and representative sustainability politics.

Does democracy fuel corruption in developing countries? Understanding Ghanaians’ perspectives

ABSTRACT Whether democratic governance breeds corruption, especially in developing countries that practice democracy, is highly debatable. Using primary data from interviews and relevant secondary data from media reports and scholarly work, this article aims to address a fundamental question: Does democracy fuel corruption in Ghana’s Fourth Republic? Although 20% of participants believed that democracy breeds corruption, about 80% disagreed. The study indicates that democracy does not necessarily bring about corruption; rather, what fuels corruption is how democracy is practiced. Based on the stage/age of democracy thesis, this study does not suggest less corruption in a dictatorship compared to democracy. Instead, the study indicates that despite its democracy being over 29 years old, corruption is still prevalent because Ghana has a flawed democracy that has failed to establish and implement robust accountability mechanisms to control corruption effectively. The theoretical and policy implication is to avoid a lengthy period of the flawed/electoral democracy phase and move to the mature democracy phase by, for example, ensuring a sustained political commitment to combatting corruption and strengthening the rule of law and accountability institutions such as the judiciary. This study extends the theoretical and empirical understanding of the relationship between democracy and corruption.

Facing global transitions in water management: Advances in knowledge and capacity development and towards adaptive approaches

AbstractThe significance, approaches, and instruments of knowledge and capacity development (KCD) in water management are reviewed, and priorities for the future are proposed. These concepts have become more mainstream, critical in helping water organisations decide on and implement policies, and generating economic returns. Their application still tends to be often limited to education or ‘training’. KCD requires an understanding of the physical world, how institutions must be strengthened to manage it, and how pedagogical and knowledge-management tools, in turn, strengthen the institutions. The private sector first applied knowledge management. The international development theory highlighted the deficiency of governments in implementation capacity. The health and environmental communities are developing an ‘implementation science’ to enhance the capacity to operationalise know-how faster. Advances in KCD include the following: (1) knowledge and capacity converging in nested levels (individual, organisational, institutional, and societal) to cause effective action; (2) six arenas/contexts of KCD application; and (3) pedagogy and knowledge-management through which learning occurs and knowledge is imparted. KCD is a ‘sticky’, slow process. Policy analyses tend to overlook the role of KCD. The water sector is facing acute challenges: a new one of building resilient water-and-land systems and adapting to climate change, and the outstanding one of achieving Sustainable Development Goals (SDGs). Thus, the current KCD must be scaled up, and also structured with a longer-term perspective to support change and reform at policy and organisational levels building on iterative adaption. Policies should become pro-active shaped by modelled forecasts; and organisations more able to change and adapt to future scenarios that are complex, uncertain, and evolving rapidly. Enhancing the capacity to implement policies, establish ‘learning organisations’, and design iterative adaptive pathways requires sustained political commitment. While adopting a long-term programme, supportive KCD activities should stay realistic and manageable.

Challenges for Programmatic Implementation of Oral Cholera Vaccine in India.

Cholera remains a major contributor of diarrheal diseases and leads to substantial morbidity and mortality, particularly in low socioeconomic settings. Nonavailability of a national cholera control plan in India, compounded by underreporting of cholera cases and deficient accurate cholera hotspot estimates, has made cholera control a challenge. Obstacles in the programmatic introduction of oral cholera vaccine (OCV) lie within the infrastructure—stockpile, costing, distribution system, cold-chain mechanism, vaccine logistics, and lack of strengthened surveillance systems for adverse events following immunization. Sustained political commitment along with collaboration of people working in the media will also determine the policy outcome of OCV introduction in India.

Discouraging the use of tobacco among men globally

Reduction in the incidence of tobacco use and the attributed health consequences has been acknowledged as one of the important international public health priorities. The available global estimates suggest that in the last two decades, the use of tobacco has declined, and this has been mainly because of the decrease in the number of females using the same. However, for the very first time in 2019, a major shift in the tobacco epidemic has been highlighted owing to the reduction in the number of males using tobacco or its products. This reported decline is a clear marker of the fact that sustained political commitment and implementation of the evidence-based targeted strategies can deliver encouraging outcomes. In conclusion, the reported trend of decline in tobacco use among men is an important milestone in our battle against the global tobacco epidemic. However, the national policymakers should not reduce the intensity of the efforts and should strive hard to meet the set global targets.

Humanitarian diplomacy in ASEAN

Progress on regional cooperation in Southeast Asia is often punctuated by decades rather than years. The exposure of the wider Asia-Pacific to natural hazards renders it the world’s most disaster prone. Since the Indian Ocean earthquake and tsunami in 2004, there have been three significant broad trends that have shaped humanitarian diplomacy, namely ASEAN as a platform for engagement, sectoral approaches and a diversifying multi-stakeholder environment creating a multi-level regionalism in Southeast Asia. States and societies in Southeast Asia have demonstrated a commitment to building humanitarian capacity which is often termed ‘nationally led, regionally supported and international as necessary’ so that they can lead response to natural hazards. The experience of natural hazards offers an important reference for humanitarian work in other areas, notably health emergencies and conflict settings. However, the localization of the global humanitarian system beyond the regional and national levels to local communities remains far from certain, and progress made in this arena may yet come undone without sustained and substantive political commitment from ASEAN member states.

Expression of Conflict Communication in the Discourse of Presidential Election in Lithuania (2019)

The subject matter of the article is different linguistic means of political conflict communication proper to the presidential discourse in Lithuania (2019). The research deals with the conflict communication of the three most popular candidates (according to sociological surveys) – G. Nausėda, S. Skvernelis, and I. Šimonytė. The political discourse of all three candidates is aimed at а positive self-representation; direct or indirect imputations of lack of sustained political commitment from the former president or their political opponents; accusation of pursuing their personal interests, or even making detrimental actions to the state and the society. The most prevalent meaning field in Nausėda’s discourse is welfare – detriment where THEY (former presidents, political parties and their representatives) are granted negative nominations, which are contrasted to positive nominations related to the latter candidate. The most prevailing meaning field in Skvernelis’s discourse is active and responsible state – inactive and irresponsible state which is expressed with the help of two sets of oppositions I – SHE (Grybauskaitė) and I – THEY (Parliamentary opposition and former political majority). The most popular meaning field in Šimonytė’s discourse is welfare – detriment, expressed with the help of I – THEY (members of the Lithuanian Farmers and Greens Union) opposition.

The role of leadership in driving change in cancer survival outcomes in seven high income countries

Abstract Background There is well-established variation in cancer survival across high-income countries with seemingly-similar health systems. There is much research on reasons for these differences, but the role of leadership has been under-researched despite being one of the WHO 'building blocks' that underpin a functioning health system. Leadership is variously defined as including governance, stewardship, responsibility and accountability. As part of the International Cancer Benchmarking Partnership, this study looked at these diverse aspects of leadership to identify drivers of change and improvement across a range of high-income countries. Methods Cancer strategy documents were analysed from 22 jurisdictions: Australia (3 states), Canada (10 provinces), Denmark, Ireland, New Zealand, Norway, and UK (4 countries). Key informants in 15 of these jurisdictions, representing a range of stakeholders, were recruited through a combination of purposive and 'snowball' strategies, and invited to participate in semi-structured interviews. Documents and interview transcripts were analysed using a thematic approach. Results Different facets of leadership emerged: diffused vs centralised (including the central role of a cancer agency in some places); national, regional and local leadership structures; links between primary and secondary care. This study, however, demonstrated a central role for sustained leadership and political commitment, crucial for initiating and maintaining progress, as was a coherent vision that supported the implementation of national policies locally. Clinical leadership emerged as vital for translating policy into action. Conclusions Improving cancer outcomes is challenging and complex but is unlikely to be achieved without effective leadership and sustained political commitment that can create effective co-ordination of care. Key messages Different facets of leadership of the cancer care system emerged as important when exploring the reasons for variations in cancer outcomes in high-income countries. The persistence of these variations is unacceptable. Change will require political commitment and effective leadership, especially by clinicians.

Navigating COVID-19 and Brexit Uncertainties for the 2030 Challenge of Nuclear Renaissance in the UK

Maintaining the electricity supplies reliably is vital in the lock-down as well as the long-term combat against the Corona-virus (COVID-19). Among the energy-supplying efforts, nuclear plays a big part. With unremitting endeavors to delivering a prosperous nuclear future and becoming a leading nuclear nation, the nuclear renaissance in the UK calls for creating a safe and cost-effective 20 GWe nuclear fleet by 2030, whilst satisfying the constraint concerning radioactive waste. As the new build is about to kick into life, this work conducts a critical analysis of the issues facing the industry in the Brexit and COVID-19 contexts to predict the 2030 goal attainment. An in-depth assessment is provided in multi-dimensions, evaluating whether the new generation could fit in with an eye on a series of concerns centering upon technological maturity, safety performance, licensability, cost-effectiveness, waste disposability, public perception, and the potential talent bottleneck. Arguably, the percentage of new build completions in the medium-term perspective would be heavily influenced by the sustained political commitment, the industry’s ambition, the triumph of the first new-build, subsequent diminution in costs through better knowledge and experience, growth in investors’ confidence, and the final realization in economies of scale. This paper intends to bridge the gap between the current status and the next stage's challenge impacted by COVID-19 and Brexit, which will probably slow down the deployment of the planned original programme and re-adjust the budget that is currently under reconsideration.

Identifying the path and the areas of focus to accomplish malaria eradication

Malaria is a life-threatening infectious disease presenting an enormous burden on the health care delivery system, in terms of cases and the attributed deaths. The epidemiological analysis of the trends of the disease and the mortality rates since 2015, it has been reported that we have not succeeded in reducing them. However, the encouraging fact is that since 2010, 8 nations have succeeded in eliminating the disease. Obviously, we are aiming for the global eradication of the disease in the long run, as it won't only play a role in saving human lives, but also in strengthening of the national economy. On a bright note, we have succeeded in developing new tools for diagnosis, medications, passive immunization and even the first malarial vaccine. In conclusion, the time has come to rise to the challenge of malaria eradication and it will essentially require sustained political commitment, financial support and adoption of new tools & a strategic approach.