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Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
C_WHO
Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care syst
...
ems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
more
Strengthening resource tracking and monitorig health expanditure
The Core Set of Indicators and respective Indicator Data Sheets aim to pave the way towards a common understanding, greater consistency and comparability across countries
...
and alignment of results chains of German Development Cooperation in the field of health and social health protection with the internationally recognized health systems framework of WHO and International Health Partnership (IHP+).
more
The role of an essential health benefit in health systems in east and southern Africa: Learning from regional research
R. Loewenson, M. Mamdani and others
Regional Network for Equity in Health in east and southern Africa (EQUINET)
(2018)
C1
Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 113
This report synthesises the learning across the full programme of work. It presents the method ... s used, the context and policy motivations for developing EHBs; how they are being defined, costed, disseminated and used in health systems, including for service provision and quality, resourcing and purchasing services and monitoring and accountability on service delivery and performance, and for learning, useful practice and challenges faced. more
This report synthesises the learning across the full programme of work. It presents the method ... s used, the context and policy motivations for developing EHBs; how they are being defined, costed, disseminated and used in health systems, including for service provision and quality, resourcing and purchasing services and monitoring and accountability on service delivery and performance, and for learning, useful practice and challenges faced. more
This document contains guidance for strengthening the disability inclusiveness of MHPSS responses and programmes in emergency settings. It is intended to supplement the IASC Guidelines on Mental Health
...
and Psychosocial Support in Emergency Settings (2007).
Overall Objective
To consider and address the mental health and psychosocial support (MHPSS) requirements of persons living in emergency settings with all types of disabilities on an equal basis to the MHPSS requirements of all persons, using a human rights-based approach and implementing social-ecological frameworks.
more
This guidance note is intended primarily for health actors working in emergency and disaster risk management (hereafter 'emergency risk management') at the local, national or internati
...
onal level, and in governmental or nongovernmental agencies. People with disabilities, those working in the disability sector and those working in other sectors that contribute to improved health outcomes related to emergency risk management, may also find this guidance note useful.
more
Developing health centres and hospital s indices for Syria, based on HeRAMS dataset 2014
World Health Organization
(2017)
C_WHO
This research paper uses the Health Resources and services Availability Mapping System (HeRAMS) database to develop two composite indices – one for
...
health centres and one for hospitals – in order to analyse and assess the health facilities’ performance across time and to evaluate the disparities among regions in the Syrian Arab Republic. The indices will provide an evidence-based tool for the main actors in the health sector to identify gaps, to intervene accordingly and to assess the impact of their interventions on the health system. The process of constructing the indices includes description and selection of variables, application of normalization techniques and weighting methods, and sensitivity analysis.
A literature review, analysis of the scope of the HeRAMS database, analysis of the crisis situation, data limitation and expert consultations were the main aspects of the construction process of the indices.
more
This report presents further analysis of the 2015 Nepal Health Facility Survey. Data analysis is based on the Donabedian framework for assessing quality of care in health services, which divides the
...
indicators into three groups: structure, process, and outcome. The World Health Organization Service Availability and Readiness Assessment (SARA) indicator guideline was used to assess facility service readiness, service quality and client satisfaction with maternal health services. The study performed both bivariate and multivariate regression analysis to examine the association of maternal health service readiness and quality indicators with client satisfaction.
more
WHO Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities
recommended
The aim of this guidance is to enhance the capacity of health care facilities to protect and improve the health of their target communities in an u
...
nstable and changing climate; and to empower health care facilities to be environmentally sustainable, by optimizing the use of resources and minimizing the release of waste into the environment. Climate resilient and environmentally sustainable health care facilities contribute to high quality of care and accessibility of services, and by helping reduce facility costs also ensure better affordability. They are, therefore, an important component of universal health coverage (UHC).
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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors
...
in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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It is often observed that educated women have lower birth rates than do the less educated, inviting a causal interpretation. However, educated women also differ from those who have never attended school in a
variety of other ways: the two factors are multiply related. This article analyzes the rela
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tionship between schooling and fertility in contemporary Cameroon as both a statistical and a social phenomenon, using data from the 1998 Cameroon DHS alongside ethnographic field data collected by
the author. T
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Gender-based violence and child protection among Syrian refugees in Jordan, with a focus on early marriage
UNWomen
(2013)
Findings from this report reveal that, rates of early marriage are high, a significant percentage of children contribute to the household’s income or are its main source of income, and restrictions on the mobility of women
...
and girls constrain their participation in social and economic activities and their access to basic services. As the overwhelming majority of refugees do not have paid employment and rely mainly on aid and dwindling family resources, the more the situation of displacement is prolonged the greater the likelihood of higher rates of child labour for boys and early marriage for girls.
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