WHO Health Systems Framework Research Articles

Die Bevölkerungsperspektive in der Bewertung der Leistungsfähigkeit des deutschen Gesundheitssystems: Ergebnisse einer Querschnittsbefragung GKV-Versicherter

IntroductionSince the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO’s Health Systems Framework, and to identify strengths and needs for improvement. MethodsIn 2018, 32,000 people insured with the German sickness fund ‘AOK Nordost’ were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy). ResultsThe sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%). DiscussionThe survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard. ConclusionStrengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.

Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East.

Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.

3D Printing Approach in Maxillofacial Surgery in Iran: An Evaluation Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework

The integration of 3D printing technology in maxillofacial surgery in Iran represents a significant advancement in medical practice, offering unprecedented precision and efficiency in surgical procedures. Employing the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework and the WHO Health Systems Framework, this study analyzes the complex impact and challenges of 3D printing adoption within the Iranian healthcare sector. Maxillofacial surgery has seen transformative progress with 3D printing’s ability to produce accurate surgical models and customized implants. The results indicate a notable improvement in surgical precision and patient recovery times, alongside combatting identified barriers including technological access, cost, and skill acquisition. This conclusion underscores the critical need for targeted educational programs, policy support, and infrastructure development to overcome these obstacles. This paper highlights 3D printing’s potential to revolutionize maxillofacial surgery in Iran, provided that comprehensive strategies are implemented to address the current limitations and fully leverage this innovative technology’s benefits.

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

IntroductionThe COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience...

Politics and implications on the health systems preparedness to COVID-19 pandemic response: The Malawian experience.

The spread of the COVID-19 disease to Africa has raised concerns around the resultant effects on the fragile and non-resilient health systems. Malawi reported its first COVID-19 cases in early April 2020 at the time of the country's political turmoil, as the courts ruled for a re-run of presidential elections in July 2020 due to irregularities observed in the May 2019 elections. Therefore, assessing the implications of politics on the COVID-19 health systems preparedness is critical to design health systems strengthening efforts during the pandemic. We applied the WHO health systems framework to assess the implications of politics on the COVID-19 on the Malawi health systems preparedness. There was the population's lack of trust in government hampering government efforts, which posed as a huge concern for Malawi to navigate through the pandemic including the health systems preparedness for the pandemic. This, coupled with mass demonstrations by the public disagreeing with the Lockdown and health service providers put across their COVID-19 related demands. The political environment and the trust people have in the government determines a country's response to a pandemic. In a pandemic situation like COVID-19, the government's ability to coordinate the various key stakeholders while instilling trust in people remain critical in strengthening health systems to contain and mitigate the pandemic. However, the Malawi political turmoil highlighted in this paper derailed the process and efforts to contain the and timely prepare the health systems to manage the pandemic whilst maintaining its core functions of delivering essential health services. Therefore, governments should consider the effects of political challenges in supporting a country's health system to prepare for pandemics.

Task shifting healthcare services in the post-COVID world: A scoping review.

Task shifting (TS) is the redistribution of healthcare services from specialised to less-qualified providers. Need for TS was intensified during COVID-19. We explore what impact TS had on service delivery during the pandemic and examine how the pandemic affected TS strategies globally. We searched five databases in October 2022, namely Medline, CINAHL Plus, Elsevier, Global Health and Google Scholar. 35 citations were selected following the PRISMA-ScR guidelines. We analysed data thematically and utilised the WHO health systems framework and emergent themes to frame findings. We uncovered instances of TS in countries across all income levels. 63% (n = 22) of the articles discussed the impact of TS on healthcare services. These encompassed services related to mental healthcare, HIV, sexual and reproductive health, nutrition and rheumatoid diseases. The remaining 37% (n = 13) focused on how the pandemic altered strategies for TS, particularly in services related to mental healthcare, HIV, hypertension, diabetes and emergency care. We also found that studies differed in how they reported TS, with majority using terms "task shifting", followed by "task sharing", "task shifting and sharing" and "task delegation". Our analysis demonstrates that TS had a substantial impact across healthcare systems. Modifying roles through training and collaboration strengthened workforce and enhanced diagnostic services. Strategic leadership played a crucial role in the process. More research on the financial aspects of TS during pandemics is required. Stakeholders generally accepted TS, but transferring staff between healthcare programs caused unintended disruptions. The pandemic reshaped TS, moving training, patient care and consultations to digital platforms. Virtual interventions showed promise, but digital access remained a challenge. Healthcare organisations adapted by modifying procedures, pathways and staff precautions. We recommend refining strategies for TS, and expanding on it to address workforce shortages, improve access, and enhance services, not only during crises but also beyond.

Assessment of needs and gaps in public health cadre in India - a situational analysis

BackgroundA structured and organized public health set up with systematically trained personnel to manage and deliver public health services from grassroot levels to higher administrative levels with separate public health directorate is the need of the hour. The objective of this study was to conduct a situational analysis of public health cadre in select states in India to gain an in-depth understanding of the progress and explore the gaps and challenges in its implementation.MethodsFour states from the country were selected based on stages of implementation of the cadre. The WHO health systems framework was the basis of assessment. In-depth interviews of 78 stakeholders from public health system across various categories and levels were conducted.ResultsEvery state has a dedicated cadre for public health in the form of a separate hierarchical structure and Directorate. There are deficits in human resources skilled enough to manage and implement public health across all levels. Its penetration below districts level is limited. There are limited opportunities available for contractual staffs in terms of remuneration and job progression. The respondents strongly emphasized on having personnel with training in public health, especially at leadership positions. Funding was not reported to be a problem although some challenges in the timeliness of release of funds were reported. Under the existing Health Management Information System, duplication of data exists and there is underutilization of data for policy making.ConclusionA dedicated public health cadre is under evolution in India. The main challenge is inadequate workforce skilled in public health management. States are committed to finding solutions to overcome these barriers.

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health...

Assessing HIV Care Services in Nigeria: A Comparative Study of the North-East and South-South regions of Nigeria

This study conducted a comparative case study analysis of the HIV program in Nigeria’s South-South and North-East regions of Nigeria to determine the access and quality of HIV care and treatment services. Service delivery is an essential component of the WHO Health systems framework. Data were collected from 385 respondents using structured questionnaires and analysed using descriptive and inferential statistics. The study found that the North-East region of Nigeria had significantly lower numbers of primary healthcare facilities and inpatient beds per 10,000 population compared to the South-South region. The North-East region had an average of 0.02 inpatient beds per 1,000 population, significantly below the WHO standard, while the South-South region had an average of 0.18 inpatient beds per 1,000 population, relatively closer to the WHO standard. The general service readiness score for delivering HIV program services was at least 94% in all health facilities in both the North-East and South-South regions. The HIV service readiness index for the North-East region was higher than that of the South-South region, with some disparities in the availability of national ART guidelines, national HIV counselling and testing guidelines, staff training, and availability of HIV prevention services. HIV testing and counselling services were described as readily available and accessible in both regions, with some communities taking ownership of promoting the availability of these services. However, both regions had a relatively high service readiness score for delivering HIV program services, with some disparities in the availability of national guidelines and training of staff. These findings demonstrate extensive investment of government and donor agencies in delivering quality HIV services with areas to improve to ensure alignment with WHO system strengthening framework. Keywords: Health systems, HIV, North-East, Service delivery, South-South, WHO.

Examining HIV Essential Medicines Access in Nigeria: A Comparative Study of South-South and North-East Regions through WHO Health Systems Framework

Availability and accessibility of essential medicines for HIV recipients of care varies across regions in Nigeria. This study seeks to compare access and availability of medicines for HIV in the South south and Northeast regions of Nigeria. Data were collected from 120 health facilities and 385 respondents using structured questionnaires and analysed using descriptive statistics and thematic analysis. The study methodology included an exploratory sequential mixed of quantitative and qualitative methods, including facility assessments, in-depth interviews, client satisfactory questionnaire conducted amongst HIV program stakeholders and HIV recipients of care. The study found that the HIV program in the regions have made progress in improving the accessibility of essential medicines for HIV patients. The North-East had an average access rate of 87.1%, while the South-South had a slightly higher average access rate of 85.6%. The North-East had a prescription rate of 100% for antiretroviral therapy (ART) for adolescents and for the preventive treatment for tuberculosis (INH + Pyridoxine). On the other hand, access to micronutrient supplementation was higher in the South-South region at 94.7%, compared to the North-East region with a rate of 74.2%. In conclusion, this study highlights that the availability of essential medicines such as ART drugs, micronutrients and prophylaxis for opportunistic infections, medicine supply, storage and documentation has improved overtime with support from donor agencies, though still challenged with electronic management systems and need for adequate procurement, quantification, additional technical assistance, funding and supply chain infrastructure is recommended to be addressed towards achievement of HIV epidemic control in Nigeria. Keywords: Essential medicines, Health systems, HIV, North-East, South-South.

An overview of Iran's actions in response to the COVID-19 pandemic and in building health system resilience.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. The considerable human, social, and economic impacts of COVID-19 have demonstrated a global lack of health system resilience, highlighting gaps in health system capacities due to fragmented approaches to health system financing, planning, and implementation. One of the key actions for ensuring equitable essential health services in all countries in normal situations as well as emergencies is through strengthening the primary healthcare (PHC) system. In the context of the unfolding pandemic, the Iranian Ministry of Health and Medical Education (MoHME) undertook a variety of strategic actions to ensure the sustainability of health services during the current health emergency and to promote health system resilience against future shocks. Right after the Alma-Ata declaration in 1978, MoHME pursued the PHC philosophy incorporating the principles within the WHO health system framework and its six building blocks. In response to the evolving pandemic, MoHME put in place several interventions to ensure the maintenance of essential health services in addition to the provision of response. Some interventions were new, informed by global experience with COVID-19, while others leveraged existing strengths within the existing health system. Those were taking a whole-of-government approach; leveraging the PHC capacity; supporting the workforce; strengthening preparedness and response; improving access to medicines, vaccines, and health products; and leveraging the health information system into the pandemic response. Health system strengthening that promotes resilience is imperative for governments as health systems are fundamental to sustainable socioeconomic development. In recognition of this, the WHO Eastern Mediterranean Regional Office (EMRO) has recently outlined regional priorities for advancing universal health coverage (UHC) and ensuring health security. Iran's approach both prior to and during the pandemic is strongly aligned with those regional priorities, which are "primary health care-oriented models; enhancing health workforce; promoting equity; enabling environment for research; improving access to countermeasures; and fostering health system resilience."

Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East

Background: Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. Methods: A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results: We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided. Conclusions: All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.

Geospatial Technology for Health System Strengthening

The authors of this paper understand the term Health System to be the collection of elements (people, institutions, and resources) that contribute toward the health of individuals and communities, arrived at by the marriage of the normative definitions of Health and System. The World Health Organization developed a Health Systems Framework that includes six building blocks: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. Each building block with its corresponding influence on health outcomes, is additionally influenced by contextual factors from the built and natural environments and society. This paper explores the potential for geospatial technology to strengthen health systems using an adaptation and expansion of the WHO Health System Framework. Geospatial technology has been used widely to collect, process, analyze, and visualize location-based data for many industries, including health. Even so, the COVID-19 pandemic inspired rapid increased uptake of this technology in the health care community. The objective of this work was to review new and existing geospatial apps and solutions, developed by the global leader in geospatial technology ESRI, as prospective tools for supporting health system strengthening.

I-COPTIC: Implementation of community pharmacy-based testing for hepatitis C: Delphi consensus protocol.

The World Health Organisation aims to eliminate Hepatitis C (HCV) by 2030. To achieve this, targeted testing needs to be widely available. Studies have demonstrated that community pharmacies can deliver effective targeted testing for HCV and the National Health Service in England has commissioned a national service. However, a recent survey of HCV operational delivery networks has shown limited uptake of this service. The objective of this protocol is to guide the formation of a consensus statement to facilitate the widespread implementation of community pharmacy-based targeted testing for HCV. We will use a modified Delphi method. A purposive selection of panel participants will be identified and recruited from a national survey and via chain-referral sampling. The main inclusion criteria for selection is direct involvement in the implementation of an HCV testing service in pharmacies. We aim for a heterogenous group, encompassing all aspects of the testing service. We will conduct a three round Delphi. The first round will consist of open questions which will be qualitatively analysed using thematic analysis with a framework method based on the WHO Health Systems Framework. This analysis will generate statements, that will be sent to the participants in the second round. A third round will be used where consensus is not reached. The findings from this Delphi consensus study will facilitate the widespread implementation of targeted testing for HCV in community pharmacies.

COVID-19 Testing: A Qualitative Study Exploring Enablers and Barriers in the Greater Accra Region, Ghana.

IntroductionThe COVID-19 pandemic is a global crisis and has reaffirmed that extensive testing along with effective tracing is still crucial to slowing transmission of the COVID-19 virus despite the rolling out of vaccines. This study explored enablers and barriers to COVID-19 testing in the Greater Accra region of Ghana. We envision lessons learned from this study could serve as a road map to strengthen the current response to COVID-19 and preparedness for future outbreaks, particularly in low- and middle-income countries.MethodsA qualitative design was undertaken to explore the phenomenon. Data collection methods included in-depth interviews with key informants with a purposively selected sample of 20 participants. Interviews were conducted using flexible semi-structured interview guides. Depending on the participant's position and involvement in COVID-19 testing, the guides were modified, and key elements were drawn from a tailored version of the WHO Health System Framework, incorporating the Essential Public Health Functions (EPHF). The interview findings were augmented by reviewing published literature.ResultsBetter health governance through political leadership, community participation, multisectoral collaboration, effective resource management, and information systems played a crucial role in catalyzing COVID-19 testing. The primary barriers to testing were mainly COVID-19 infodemic, inadequacy of material resources to meet growing health needs, and a lack of opportunities to have equal and easy access to testing services. Furthermore, although human resources were adequate, they were unevenly distributed across settings.ConclusionDespite rolling out vaccines against COVID-19, testing remains an important measure to control the virus. To effectively be prepared for extensive COVID-19 testing and respond to future outbreaks, the following are recommended: there should be improved political commitments, coordination, and communication with diverse actors to ensure even distribution of all resources across the country; empowerment of community members should be encouraged to develop community-oriented pandemic preparedness and management of COVID-19 infodemic; investment in strengthening capacity of Good Manufacturing Practice (GMP); incorporation of health policy and systems research (HPSR) into the post-COVID-19 pandemic recovery process and future pandemic preparedness.

Quality as an Intermediate Goal of the Dutch Healthcare System: Presentation and Evaluation of the Quality of Cancer Care

Cancer care represents a challenge for the healthcare systems of OECD member states. This also applies to the Netherlands, as cancer is the leading cause of death. High quality of care is essential to effectively tackle the burden of disease caused by cancer. According to the WHO health systems framework, quality is an intermediate goal of health systems, alongside safety, access and coverage. This study aimed to assess the quality of cancer care in the Netherlands, especially in terms of effectiveness. To assess the quality of cancer care in the Netherlands, participation rates in screening and 5-year survival rates for breast, cervical and colorectal cancer were used. The Netherlands is interested in ensuring quality healthcare, and quality is one of the three main objectives of the healthcare system. The 5-year survival rates for breast, cervical and colorectal cancer were above the respective OECD averages in 2014, but some countries are better positioned. Participation in screening for cervical cancer was relatively low in the Netherlands in 2017, below the OECD average. It can be concluded that the Netherlands has high-quality, effective cancer care and is striving to continuously improve it. However, there is room for improvement , especially with regard to participation in cervical cancer screening, transparency about the quality of healthcare and regional differences in the quality of care.

The WHO Prison Health Framework: a framework for assessment of prison health system performance.

BackgroundThe Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison.MethodsThe framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework.ResultsThe framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included.ConclusionsA new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.

Factors influencing COVID-19 testing: a qualitative study in Bhutan

BackgroundThe COVID-19 pandemic has reaffirmed an all-knowing truth—that health is central in the 2030 Sustainable Development Agenda. To fully control the infection in a community, accurate testing of suspected cases along with effective tracing and appropriate treatment (3Ts) is still crucial to slowing transmission of COVID-19 virus This study explored factors that influenced COVID-19 testing in Bhutan. The lessons learned from this study could serve as a roadmap to strengthen the current respond to COVID-19 and for future outbreaks, particularly in low- and middle-income countries.MethodsThe study employed an exploratory qualitative design. Data collection methods included interviews with key informants with a purposively selected sample of 20 participants. The interview findings were augmented by reviewing both published literature and unpublished documents.For the analysis of qualitative interviews, a hybrid approach of inductive and deductive coding and theme development was conducted to analyze findings. A tailored version of the WHO Health System Framework incorporating the Essential Public Health Function was used to guide data interpretation.ResultsPolitical will through the influence and leadership of the King of Bhutan played a crucial role in raising attention to the problem, and provision of adequate financial and technical relief to ensure that all people irrespective of their socioeconomic status do not pay to get tested of COVID-19. A compassionate leadership, Whole of Society approach is backed by the scientific community, functional health systems and community-based approaches, use of information technology for awareness creation and improved surveillance system, and fast-tracked COVID-19 testing service delivery.ConclusionBhutan’s success relied greatly on multi-sectoral and systematic approach during policy design, implementation and monitoring, and active collaborative efforts involving consultation and engagements with a broad range of local (community members), national and global actors for accelerated COVID-19 testing. These efforts were made possible through improved health governance and leadership at all levels of the society.

Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015\u20132020)

BackgroundViolence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings.MethodsWe selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka.ResultsOne-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge.ConclusionSignificant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention.

Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state

Pandemics can result in significantly high rates of morbidity and mortality with higher impact in Lower- and Middle-Income Countries like Nigeria. Health systems have an important role in a multi-sector response to pandemics, as there are already concerns that COVID-19 will significantly divert limited health care resources. This study appraised the readiness and resilience of the Nigerian health system to the COVID-19 pandemic, using Oyo State, southwest Nigeria, as a case study. This study was a cross-sectional qualitative study involving key informant and in-depth interviews. Purposive sampling was used in recruiting participants who were members of the Task Force on COVID-19 in the state and Emergency Operations Centre (EOC) members (physicians, nurses, laboratory scientists, “contact tracers”, logistic managers) and other partners. The state's health system response to COVID 19 was assessed using the WHO health systems framework. Audio recordings of the interviews done in English were transcribed and thematic analysis of these transcripts was carried out using NVIVO software. Results show that the state government responded promptly by putting in place measures to address the COVID-19 pandemic. However, the response was not adequate owing to the fact that the health system has already been weakened by various challenges like poor funding of the health system, shortage of human resources and inadequate infrastructure. These contributed to the health system's sub-optimal response to the pandemic. In order to arm the health system for adequate and appropriate response during major health disasters like pandemics, fundamental pillars of the health system-finance, human resources, information and technology, medical equipment and leadership - need to be addressed in order to have a resilient health system.