Global Health Action最新文献

This commentary is included in the Special Series: Global Financing Facility for Women, Children and Adolescents: Examining National Priorities, Processes and Investments. Studies in the Series provide timely, grounded insights into how the GFF model delivers impact through country ownership, flexible funding, and integrated planning. The Series' findings align with the recent independent evaluation of the GFF, emphasizing the importance of political leadership, implementation support, learning systems, and civil society engagement. The commentary reflects on the lessons emerging from the papers in the Special Series and examines what they mean for strengthening accountability, systems, and equity in the GFF's next strategy.

Background: The WHO recommends the Person-Centred Care approach, based on the biopsychosocial (BPS) model with community participation, to streamline the management of chronic diseases in Primary Health Care (PHC) activities and reduce their growing burden, even in Africa. The Democratic Republic of Congo's (DRC) experience of community participation in implementing the BPS model for chronic diseases has been little explored.

Objective: To describe community ownership of the biopsychosocial model of chronic disease care in PHC facilities in South Kivu province, DRC.

Methods: A basic interpretive qualitative study was conducted in April 2024, in three health areas of the Katana health district, among beneficiaries of chronic disease interventions. Nine in-depth interviews were conducted with care providers and community representatives, followed by two focus groups with community health workers (CHWs) and a document review. An inductive-deductive content analysis was carried out using ATLAS.ti 24 software.

Results: Based on the four main themes identified in the study, community ownership of the model depends on various factors (relational, organizational, and motivational/supportive). As perceptions, respondents recognized the model's application through partner support, meetings with community representatives and patient decision-making. Community involvement in the model was observed through participatory meetings, reinforced home visits, psycho-education, and club solidarity. Significant challenges included the lack of training for providers and CHWs, CHW's financial demotivation, poor dissemination of model, and patient poverty. Proposed strategies included a participatory stakeholder audit, capacity-building on the model, psychologist availability, and income-generating activities to motivate CHWs.

Conclusions: Community ownership of the BPS model is a vital pillar to support effective and resilient chronic disease management, rationalizing it in PHC for better health outcomes. Healthcare systems should consider these identified factors in the policy definition and rationalization process for these diseases by establishing effective coordination mechanisms.

Background: Digital innovations incorporating clinical digital support can improve the delivery of perinatal and postnatal care, yet few interventions exist in primary care settings.

Objectives: We aimed to adapt a digital quality improvement system (Neotree) from tertiary facilities to lower-level facilities providing Level 1 newborn care.

Methods: We conducted a mixed method stepwise study using the ADAPT framework. We conducted a needs and technology assessment of eight facilities in Lilongwe district, Malawi. We next adopted a user-centred approach to modify the clinical decision support and data capture functionalities to fit the new context. We completed 'think aloud' usability testing with six prospective users to refine the system, alongside qualitative research informed by behavioural science frameworks with 10 healthcare professionals to identify potential barriers and facilitators to implementation. Finally, we carried out a stakeholder assessment to identify a potential pathway to scale.

Results: The adapted application was highly usable achieving a mean System Usability Scale (SUS) score of 92.5 among prospective users during the final round of testing. Our qualitative findings indicated Neotree was anticipated to be acceptable among healthcare professionals. We found high levels of motivation to implement Neotree, but key perceived implementation barriers included psychological and physical capability (such as skills and knowledge in neonatal care), as well as physical opportunity (e.g. human resources, equipment and adequate space for newborn care).

Conclusion: Using a stepwise user-centred approach, we successfully adapted a digital quality improvement intervention (Neotree) ready for real-world piloting in community hospital and primary health centres in Malawi.

Background: There are substantial issues with the quality of care (QoC) received by persons living with chronic conditions, particularly in low- and middle-income countries (LMICs). One possible channel to improve QoC is through financing, specifically purchasing arrangements for health services. This has been actively explored in high-income country settings, generating a growing body of scientific knowledge.

Objective: To understand the potential and the constraints of using purchasing arrangements as a way to improve QoC for chronic conditions in resource-constrained settings.

Methods: A Delphi survey was conducted with 49 international participants with content expertise in chronic care management, health financing, or both, and context expertise in resource-constrained settings including in Small Island Developing States or Fragile and Conflict-Affected States, to assess the possible contribution of purchasing arrangements to QoC for chronic conditions with respect to specific types of care providers (e.g. patients and relatives, community health workers, public health centres), decentralized coordination bodies and purchasing agencies in such settings.

Results: There was a high level of consensus among the Delphi panel in favour of considering purchasing arrangements as one of the levers to improve QoC for people living with chronic conditions. Specific directions for action were identified along with their caveats.

Conclusions: The challenge of improving the quality of chronic care in resource-constrained settings is extensive and requires immediate attention. Leveraging purchasing arrangements is one promising channel to strengthen quality chronic care in such settings.

Background: In 2014, the Zambian government introduced the Comprehensive Sexuality Education (CSE) framework, decentralising its implementation from the national to the provincial administration. The provincial structures of the Ministries of Health and Education play an important role in providing technical, policy direction and coordination support. However, little research has focused on the role of CSE collaboration at the provincial level.

Objectives: This study sought to explore multisectoral collaboration dynamics influencing the implementation of the CSE framework at the provincial level in Zambia.

Methods: This qualitative study involved 29 interviews with diverse stakeholders at the provincial level such as government departments (health, education, etc.), private sector, religious and traditional leaders involved in CSE implementation. We used reflexive thematic analysis, guided by an integrative collaborative governance framework.

Results: The findings were grouped under collaboration dynamics domains: principled engagement, shared motivation, and capacity for joint action. Barriers to principled engagement included provincial structures and their mandate, exclusion or sidelining of certain actors, inadequate financial transparency, and weak formal relations. Shared motivation included collective understanding of the purpose, a supportive policy environment and consensus in adapting the CSE framework. Capacity for joint action efforts included collaborative training of teachers, joint monitoring, and collaborative to address SRHR challenges.

Conclusion: This study highlights challenges limiting meaningful engagement, exclusion of some actors, financial constraints, and weak coordination, which hinder collaboration. There is need for enhancing provincial leadership capacity to effectively coordinate stakeholders through enforcement of transparent resource management, collective planning, implementation and monitoring for effective CSE delivery.

Background: Stunting remains a major public health issue in Indonesia, and the limitations of anthropometric measures highlight the need for alternative tools such as the Child Development Card (KKA).

Objectives: This study aimed to determine the validity and reliability of the KKA as a tool to measure the growth and development of stunted and normal children through direct observation.

Methods: The revised KKA was administered to 262 children aged 13-60 months, including 174 normal and 88 stunted children, from three stunting-locus regencies in West Java Province, Indonesia. The data were analysed using content validity, the Guttman coefficient of reproducibility, and Cronbach alpha to develop a revised KKA observation guideline.

Results: A total of 15 conceptually inappropriate items were revised, and an observation guideline was developed as a guide for the direct observation of children. In each aspect of growth and development, age range, and sample category, the reproducibility and scalability coefficients showed values of >0.9 and >0.6, respectively. Meanwhile, Cronbach alpha values for each age range and sample category were >0.7.

Conclusion: The revised KKA demonstrated both validity and reliability as a tool for the detection, monitoring, and early intervention of growth and developmental delays in children with stunted as well as those with normal development.

The rise of social media has transformed communication, allowing social media influencers to shape opinions and behaviors with unprecedented reach and engagement. In Africa, where traditional health campaigns often struggle to gain traction, social media influencers have the potential to provide a complementary platform and a unique avenue to engage young and targeted audiences, further enhancing the reach and impact of health information. This paper explores the role of influencers in health communication, highlighting their ability to drive trust, engagement, and behavioral change. Drawing on global and African case studies, it highlights the successes of influencer-led health campaigns, such as those promoting vaccinations and mental health awareness. While influencer-driven messaging has great potential, challenges such as misinformation, commercialization, and credibility concerns must be addressed. By strategically utilizing social media influencers, public health initiatives can enhance health literacy, overcome accessibility barriers, and drive positive health outcomes in Africa.

Background: Type 2 diabetes mellitus (T2DM) is increasingly prevalent in low- and middle-income countries. Metabolic control reflects not only clinical care and individual behaviors but also intersecting social determinants such as sex, education, and insurance status.

Objective: To identify sociodemographic factors associated with poor metabolic control among patients with T2DM at a public outpatient clinic in Quito, Ecuador.

Methods: We conducted a cross-sectional study of adults with T2DM (ICD-10 E10-E14) attending the clinic in the first semester of 2018. Clinical variables included body mass index (BMI), blood pressure, and laboratory results (HbA1c, total cholesterol, HDL-C, LDL-C, triglycerides). Sociodemographic variables were age, sex, education, marital status, and insurance type. Associations with uncontrolled metabolic indicators were examined using bivariate tests and multivariable logistic regression.

Results: A total of 644 patients were included, 53.6% women. Women had significantly higher odds of poor HDL-C control (aOR 1.73; 95% CI 1.26-2.38) and overweight/obesity (aOR 1.96; 95% CI 1.40-2.74) compared with men. No significant sex differences were observed for HbA1c, blood pressure, or LDL-C. Lower education and younger age were also associated with poorer metabolic outcomes.

Conclusions: Metabolic control in this population is shaped by intersecting sociodemographic determinants. These findings highlight the relevance of sex, age, education, and insurance in shaping diabetes outcomes and underscore the value of an intersectional approach for understanding inequities. Equity-oriented strategies that incorporate intersectionality may improve diabetes care in Ecuador. Given the cross-sectional design, findings indicate associations rather than causality.

Background: Community engagement has been recognized as a key tool for supporting national health agendas, and experiences from the COVID-19 pandemic can offer important lessons for tackling future global health challenges such as antimicrobial resistance. This paper provides much-needed evaluation knowledge on relational community engagement initiatives and their impact on COVID-19-related attitudes and practices.

Methods: A two-round mixed-method evaluative study to examine outcome indicators related to COVID-19-prevention and health-seeking behavior was implemented from October 2022 to December 2023 among 14 diverse case study communities in four Lao provinces. Data involved 50 semi-structured interviews with villagers, 50 key informant interviews, and two rounds of complete census surveys (3,161 survey observations incl. matched panel data from 618 individuals) to discern outcomes among villagers with different levels of activity participation in a difference-in-difference analysis.

Results: Relative to non-participating villagers, villagers participating in the activities had higher COVID-19 vaccine uptake (+0.13 doses), higher public healthcare utilization for presentations consistent with COVID-19 (e.g. fever and neurological and/or respiratory symptoms; +69.4% points), and less antibiotic use per illness episode (-0.2 antibiotic use episodes). However, the activity raised worries to disclose a COVID-19-positive status and was often interpreted as a health education campaign.

Conclusions: Relational community engagement offers a respectful way of addressing persistent healthcare challenges and supporting vulnerable populations - and thus holds key for ongoing global health priorities such as emerging infectious disease responses and antimicrobial resistance. We recommend that community engagement initiatives become a standard component of national health policy portfolios beyond the scope of COVID-19.

The role of institutional partnerships is increasingly recognized as a means of advancing our collective efficacy in improving public health. Shared challenges related to infectious and chronic diseases, as well as social determinants of health including environmental stressors, have led to a growth in academic global health collaborations. Triggered by the 2004 tsunami, the University of Ruhuna, Sri Lanka, and Duke University, USA, established an educational and research collaboration that has been sustained and broadened over two decades. The initiation and development of the collaboration, as well as its educational and research components, are described in this manuscript. We discuss lessons learned that may be of interest to other emerging partnerships: the keys to the collaboration's success, challenges and barriers faced, as well as plans to sustain and further grow an equitable, academically rigorous, and impactful global health partnership.