Suchergebnisse

The impact of urbanization on the health of citizens in developing countries has received increasing attention recently. This book addresses the problems in an integrated way, looking in detail at both the problems themselves and the action and research necessary to alleviate them. It includes contributions from leading practitioners and advisors to many of the main international agencies and presents the latest thinking of those institutions. It also presents recent information on research findings, the management and financing of urban health services and trends in urban health policy. Case

Im Zentrum des Beitrags stehen hemmende Faktoren im öffentlichen Gesundheitswesen auf Distrikt- und Regionalebene und zwar aus der Sicht der dort in leitender Funktion Tätigen. Grundlage bildet eine breit angelegte Evaluation von Gesundheitseinrichtungen im primären Bereich in der Morogoro-Region, die 1989-91 durchgeführt wurde. Den größeren, theoretischen Rahmen bildet die Diskussion um Zentralisation bzw. Dezentralisation. Die zahlreichen Varianten von Dezentralisation werden aufgezeigt; der Distrikt wird herausgestellt, als besonders wichtige Organsations- und Verwaltungsebene, und es werden die Hauptprobleme und Schwachstellen im Gesundheitswesen bei der Dezentralisierung behandelt. Empfehlungen, wie künftig vorgegangen und wie die Reformen fortgesetzt werden sollen, schließen den Beitrag ab. (APAF-Glz)

AbstractAn evaluation of primary‐level healthcare undertaken in Tanzania 1989‐91 found that district health managers felt powerless to address health care performance weaknesses, although the district is the unit to which government management functions have been decentralized. In order to understand the managers views, this article analyses the pattern of decentralization within the health system from their perspective. It reviews the hislorical development of government structures and the theory and practice of decentralization within Tanzania. The matrix of accountability for health care has become very confusing, with multiple and cross‐cutting flows of authority within and between levels of the system. District health managers have limited authority to take management action, such as managing resources, in ways that would begin to address problems of inefficiency and poor quality of care within primary care. District health management also suffers from weak resource allocation and financial management piocedures. The main obstacles preventing more effective management are: resource constraints; conflicts between the demands for central control and local discretion; limited institutional capacity; and political and cultural influences over the implementation of decentralization. Evaluation of past experience suggests that future policy influencing the organizational structure of government health services must be developed cautiously, recognizing the critical importance of complementary action to develop both institutional capacity and political and economic support for the health system.

The availability of highly effective SARS-CoV-2 vaccines brought about renewed hope worldwide to overcome the pandemic, becoming an integral part of public health measures. However, vaccine hesitance, defined as the reluctance of people to receive the recommended vaccines, threatens to stand in the way. Understanding why people are not taking up the recommended vaccines can assist in strategy development, which is critical for increasing vaccine uptake. Unfortunately, during the pandemic, social media has often been involved in misinformation and misinterpretation of the scarce research data. This has widened the existing chasms in the society, causing strong polarisation of vaccine-uptaking vs vaccine-hesitant people. Confrontation and stigmatisation can turn hesitance into defiance, and this will have additional detrimental effect. Researchers and medical workers must lead the forefront of honest and respectful communication, acknowledging the concerns that vaccine hesitant people have. This is particularly important as most vaccine hesitant people neither have a political agenda nor are they committed to an anti-scientific cause. Although it may sound trivial, public health needs to revert to its roots of teaching medicine to the people.

Background. Myanmar is a premalaria elimination country with artemisinin-resistant malaria. A strategy for transmission control is focused on vulnerable groups such as mobile and migrant populations (MMPs), and includes improving access to insecticidetreated bed nets in the Myanmar artemisinin resistance containment (MARC) zones using multisectoral approaches (MSA). Methods. This narrative systematic review addressed MSAs targeted to MMPs in Myanmar for malaria prevention. We searched relevant studies in electronic databases and present the narrative findings in 4 domains: stakeholder groups, net coverage and utilization, social determinates, and facilitators/barriers. Results. Nine studies were included. The review identified stakeholders involved in intersectoral collaboration. Net ownership was higher than utilization rates in the MARC zones and rates remained below the WHO recommended target of 100%. There was inadequate description of roles and responsibilities for implementation and on channels of communication within the partnerships and with the Government. Conclusions. Findings show that interventions to distribute treated bed nets were supported by the multiple stakeholders. Due to the design of the primary studies, analysis of the added value of intersectoral collaboration was limited. More attention must be paid to designing studies to document and evaluate the contributions and outcomes of intersectoral collaboration. Keywords. malaria; prevention; bed nets; multisectoral approach; artemisinin resistance containment zones; Myanmar.

Background: Community engagement and participation has played a critical role in successful disease control and elimination campaigns in many countries. Despite this, its benefits for malaria control and elimination are yet to be fully realized. This may be due to a limited understanding of the influences on participation in developing countries as well as inadequate investment in infrastructure and resources to support sustainable community participation. This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. Methods: Evidence derived from quantitative research was considered both independently and collectively with qualitative research papers and case reports. All papers included in the review were systematically coded using a pre-determined qualitative coding matrix that identified influences on community participation at the individual, household, community and government/civil society levels. Colour coding was also carried out to reflect the key primary health care period in which community participation programmes originated. These processes allowed exhaustive content analysis and synthesis of data in an attempt to realize conceptual development beyond that able to be achieved by individual empirical studies or case reports. Results: Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. Due to inherent differences in their design, interventions and outcome measures, results could not be compared. However, these studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources are common and important elements ...

Technological innovation has a significant role in improving health systems (HSs) and achieving universal health coverage (UHC). The World Health Organization (WHO) has declared resolutions on Health Technology Assessment (HTA) and other global organizations emphasized on HTA systems to achieve the Sustainable Development Goals (SDGs). HTA is a modern multidisciplinary decision-making framework linking knowledge and policymaking by assessing the medical, social, economic, organizational, and ethical effects, and/or impacts within health and social systems. The research significance lies in the growing need for HTA at these moments than ever as it is seen as an essential development approach to tackle the current global challenges and pandemics, particularly in developing countries. The research aims to comprehensively evaluate and understand HTA systems concerning the level of knowledge about HTA, current HTA structure, practices, application, capacity, gaps, and solutions. The project starts in January 2021 and ends in January 2022 and will be carried out in seven countries: Canada, Switzerland, Brazil, Lebanon, Jordan, Palestine, and Tanzania. A mixed-methods, quantitative and qualitative, along with a literature review will be applied. In each country, ten HTA-associated institutions will complete an adapted electronic survey, developed by the WHO, and ten key-informants selected purposively from the government, academia, NGOs, and private sectors to participate in ten individual in-depth interviews. One government representative from each country will participate in one expanded inter-country workshop. Excel, IBM Statistical Package for the Social Sciences (SPSS), and MAXQDA software programs will be used for data management and analysis. The research will form cutting-edge evidence not only for the seven countries, but also for the global, regional, and national endeavors with regards to opening a room for HTA best application and optimization. It will reveal lessons learned, determine gaps, and build a ...

Objectives: Over the last 2 decades, the World Health Organization (WHO) has proposed a global strategy and initiatives to establish a Health Research System (HRS) focusing on Health Research Quality and Standardization (HRQS), Health Research Knowledge Transfer and Dissemination (HRKTD), and Health Research Translation and Utilization into Health Care Decisions and Policies (HRTUDP). Despite the increase in health research productivity over the past several decades, HRS Capacity (HRSC) in Palestine and in the Middle East and North Africa (MENA) region has rarely been objectively evaluated. This study aims at eliciting the perceptions of HRS performers in Palestine in order to understand the status of HRSC, identify gaps, and generate policies and solutions capable of strengthening HRSC in Palestine. Methods: Key informants from three sectors, namely government, academia, and local and international organizations, were selected purposively based on different sampling methods: criterion, critical case, snowball, and homogeneous sampling. Fifty-two in-depth interviews with key informants and a total of fifty-two individuals, participating in six focus groups, were conducted by the principal investigator in Palestine. Data were analyzed by using MAXQDA 12. Results: The overall pattern of the Palestinian HRSC is relatively weak. The key findings revealed that while HR productivity in Palestine is improving, HRQS is at an average level and quality guidelines are not followed due to paucity of understanding, policies, and resources. HRKTD is a central challenge with both a dearth of conceptualization of translational science and inadequate implementation. The factors related to inadequate HRKTD include lack of awareness on the part of the researchers, inadequate regulatory frameworks and mechanisms for both communication and collaboration between and among researchers and policy-makers and clinicians, and lack of availability of, and credibility in, systematized and reliable HR data. Despite the limited knowledge ...