Global Health Research and Policy最新文献

Background: Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95% with a high number of zero-dose children. Declining immunization rates led to outbreaks of vaccine-preventable diseases such as measles, polio, and pertussis. This study aimed to identify the factors affecting childhood vaccine uptake by exploring the perspectives of community members, program managers, and coordinators.

Methods: Three regions with low vaccine coverage in the Philippines were selected as study sites. We conducted focus groups with adult caregivers of vaccinated and unvaccinated children aged 0-11 years recruited by barangay (community) health workers. Key informant interviews were also conducted with immunization program managers and coordinators from different administrative levels. Focus group and interview guides were informed by the World Health Organization's Behavioural and Social Drivers (BeSD) of Vaccination framework. Transcripts were analysed by themes and deductive axial coding was used to categorize themes into BeSD domains and socioecological levels.

Results: Twelve focus groups (n = 143) and 57 key informant interviews were done. Various behavioural and social drivers of vaccination present at different levels of the socioecological model affect vaccine decisions both positively and negatively. Under the 'Thinking and feeling' domain of the BeSD, at the intrapersonal level, the perception of benefits and negative side effects of routine vaccines were clear drivers of vaccination. In the 'Social processes' domain, factors at multiple socioecological levels such as the influence of family, barangay health workers, and community leaders were identified. Practical issues such as the availability of vaccines and accessibility of vaccination sites remain a barrier to vaccination.

Conclusions: Availability of routine vaccines and accessibility to vaccination sites are major challenges in the Philippines. Acceptability of routine vaccines continue to be affected by previous controversies around the Dengue vaccine and the recent COVID-19 pandemic. Findings suggest that enhancing advocacy for immunization through continuing communication training for health care workers on health promotion and education regarding vaccination may contribute to increased vaccine uptake. Integration of immunization with other population-based health programs could be explored.

Background: International organisations and development agencies have important roles to play in addressing noncommunicable diseases (NCDs) and their risk factors at the nexus of health, socioeconomic, and environmental development challenges. Much of this work occurs through direct engagement with the private sector. We aimed to assess the types of private sector engagement (PSE) approaches and the degree of alignment across ten major international organisations whose work is critical to achieving global NCD and mental health goals.

Methods: We examined the publicly available PSE strategy documents for a purposive sample of ten major international development partners. We obtained copies of each organisation's publicly available PSE policy documents and extracted data on the stated purpose, processes, and types of engagement. We used thematic analysis and triangulation to identify areas of agreement, dissonance and silence across the policy approaches.

Results: Whilst all PSE documents emphasised the importance of conducting due diligence, they varied widely in their approach to the risk of engagement and the sophistication of potential conflict of interest management strategies. Many documents were silent on prohibited industries, managing reputational risks, and guidance to Member States. The proactive engagement stance in USAID and World Bank policy documents contrasted starkly with more conservative approaches advanced by UNDP, FAO, and WHO.

Conclusions: The core practices of conducting due diligence and risk mitigation are common to all of the major international organizations we assessed, however, the framing, content, and PSE processes vary widely. The potential impact of these findings is that WHO and other partners can focus on adopting common approaches wherever possible for greater coherence and smoother coordination across the wider development system.

There is growing recognition of the need for global health and associated research to decolonise. Yet discourse so far has overlooked the role that research paradigms play within this. Left unaddressed, this omission could further engender hierarchical approaches in global health research. The transformative paradigm articulates the relationships between evidence, power and oppression. With this acknowledgement, we can strive for positive social change through research. In this commentary, we argue the importance of considering the transformative paradigm in efforts to decolonise global health research. We provide an initial overview of key terms in this debate, before exploring what is meant by a research paradigm in more detail and then arguing that a transformative paradigm offers unique and powerful opportunities to address enduring colonial inequities in global health research; we then illustrate how this was applied in a recent mixed methods study which explored experiences and barriers to accessing cancer treatment in Ghana. We show how researcher sensitivity to historical injustices and community-based values were vital to our study design and also in specific methods like a participatory creative task and qualitative interviews. This commentary is important as part of the wider debate about decolonising global health and provides a unique critical insight into how research and how particularly research paradigms are of importance in this task, offering suggestions based on a transformative paradigm.

Background: Effective public health emergency management (PHEM) is crucial for safeguarding population health and societal resilience in the face of escalating global threats. However, standardized tools for comprehensively assessing emergency readiness across diverse contexts are lacking, particularly in resource-constrained settings like Ethiopia. Existing assessment approaches have demonstrated limitations, including narrow scope focused on specific hazards or sectors, over-emphasis on implementation processes rather than programmatic outcomes, and lack of empirical grounding in tool development and validation. This study aimed to develop and validate a standardized tool to assess PHEM programs.

Methods: This study employed a sequential exploratory mixed methods design. Relevant assessment domains were identified through a literature review, stakeholder consultations, and expert consultations conducted at a workshop. This study utilizes Donabedian's structure-process-outcome framework to guide the assessment of public health emergency management. A questionnaire containing 60 items was then generated and underwent translation, face validation, and content validity assessment. Construct validity was evaluated using exploratory factor analysis with responses from 260 professionals. Internal consistency reliability was assessed utilizing Cronbach's alpha.

Results: A 45-item tool for assessing PHEM programs in diverse contexts in Ethiopia was developed and validated. The tool demonstrated high content validity (CVIs > 0.83), good construct validity (15-factor structure explaining 74.8% variance), and excellent reliability (overall α = 0.863, subscales > 0.70). The final tool covers domains such as multi-sectoral coordination, resource allocation, transparency/accountability, workforce capacity, and provision of essential supplies.

Conclusions: This study developed a comprehensive tool to assess emergency management programs across diverse contexts. The validation revealed critical preparedness factors like multi-sector coordination, funding transparency and workforce strength. The mixed-methods approach proved effective for crafting contextually appropriate evaluation methods in low-resource settings with infrastructure barriers. By standardizing measurement of capacities and gaps, this validated tool can guide strategic policy planning to bolster resilience nationwide. Ongoing monitoring of progress using this model can help prioritize investments and direct coordinated responses to future crises.

The World Health Organization (WHO) recognizes myopia as a significant public health concern, as its prevalence has been rising at an alarming rate worldwide. In the WHO's Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2014-2019, myopia has already been identified as a major target for action. However, the attention paid and measures taken to treat this target is significantly diverse across the globe. This report presents the summary of the Global Myopia Public Health Summit jointly organized by the International Agency for the Prevention of Blindness (IAPB), the Asia Optometric Congress (AOC), and Aier Eye Hospital Group in September 2024. The summit centered on the public health, clinical challenges, and practical barriers faced in different regions of the world, along with strategic recommendations for myopia prevention and control. The summit has concluded: (1) although myopia prevalence is rising globally, population-based data remain limited in many regions; (2) common challenges such as limited awareness of myopia, the high cost of interventions, and the lack of continuing education for practitioners should be addressed; (3) while effective interventions are crucial for controlling myopia, their cost-effectiveness needs to be evaluated both at the individual and societal levels; (4) countries like China, where government-led initiatives have integrated school vision screening, reduction of education burden, compulsory increase of outdoor activities, and advocacy for eye health awareness, offer valuable experience and lessons for other countries or regions facing similar myopia epidemics.

The COVID-19 pandemic highlighted the essential role of disease modeling in shaping public health responses. However, models designed in high-resource settings often fail to capture disease dynamics accurately in lower-resource contexts like Ghana, where socio-ecological factors, infrastructure constraints, and data fragmentation complicate accurate predictions. In this Commentary, we examine the challenges of adapting global modeling approaches to Ghana's context and propose strategies to improve their accuracy, relevance, and policy utility. These challenges were further compounded during the pandemic recovery period, when Ghana simultaneously faced outbreaks of Marburg virus and Mpox. These additional pressures-against a backdrop of rapid urbanization, increased human-wildlife interaction, shifting transmission dynamics, and environmental degradation-underscore the limitations of current modeling approaches. A key limitation lies in the difficulty of collecting raw, disaggregated data, accounting for sociocultural determinants, and capturing the complex interplay between disease dynamics and adaptive behaviors. Addressing these challenges requires valid, timely, and disaggregated data on social and epidemiological dynamics for model parameterization and validation. To examine the challenges faced in adapting global models for local use, we focus on Ghana's unique context and argue for a rethinking of modeling approaches in this commentary. To mitigate potential harm, it is imperative to emphasize context-specific data, interdisciplinary input, and integration of social and economic factors, as foundational principles for future frameworks that can better support pandemic preparedness in Ghana and similar settings.

Background: To improve the utilization of maternal and child health (MCH) services, the Democratic Republic of the Congo initiated a performance-based financing (PBF) program in 2017. An impact evaluation of the PBF program was conducted in 2023 using a cluster randomized controlled trial research design. This study aimed to assess the cost-effectiveness of the PBF program in comparison with the direct facility financing (DFF) program.

Methods: A decision-tree model incorporating key MCH services was developed to estimate cost-effectiveness. Data on costs of maternal health services, epidemiological consequences, and utilities of various health statuses were obtained from the literature. The impact evaluation results on the coverage of key MCH services were included as key inputs to simulate the effectiveness measured as quality-adjusted life years (QALYs). Sensitivity analyses were conducted on the inclusion of the PBF's impact on the quality of care and the uncertainty regarding the costs and the impact of PBF on MCH services.

Results: A total of US$205.9 million in 2021 dollar was spent on the PBF arm over the five years (2017-2021), with 70.60% allocated as incentive payments to health facilities and 19.41% as financial transfers to provincial purchasing agencies for contracting PBF facilities and managing the PBF program. On average, the annual cost per capita was estimated at US$2.05 and US$1.71 for implementing the PBF and DFF program, respectively. Without the quality adjustment, the improvement in MCH services resulted in 1,372 lives (192,036 QALYs) saved over 2017-2021. The incremental cost-effectiveness ratio (ICER) of the PBF program reached US$ 1,374 per QALY with substantial variation. After adjusting for quality, the ICER of PBF became smaller.

Conclusions: Using three times the gross domestic product per capita in 2021 (US$1,732) as the threshold, the PBF program is a cost-effective strategy, though with substantial variation. It is crucial to take action to maintain gains from the improved MCH coverage resulting from the PBF program.

The binary nature of a Public Health Emergency of International Concern (PHEIC) alert was brought to attention during COVID-19, with the COVID-19 IHR Emergency Committee and some States Parties advocating for an intermediate or regional tier of warning. However, the recent amendments to the International Health Regulations (2005) yielded an unexpected outcome: no proposed lower tier was added to the binary alert framework; instead, 'pandemic emergency' was introduced as a tier of alert within the PHEIC framework. This paper argues that the influence of introducing a 'pandemic emergency' tier within the World Health Organization's alert framework, as outlined in the amendments to the International Health Regulations (2005), has been underestimated. While a proposed intermediate alert received some support, it is unlikely to function effectively in raising awareness or mobilizing resources. In contrast, a 'pandemic emergency' alert-previously framed as a descriptive, non-binding concept -has been perceived as a more effective tool for alerting against communicable disease threats. The formalization of a de facto determination of pandemic emergency results in a de jure expansion of the World Health Organization's emergency powers, demonstrating what is often termed as a 'ratchet effect'. Moreover, the amended International Health Regulations (2005) grant the World Health Organization enhanced legal competences, notably in a binding way. The adoption of the World Health Organization Pandemic Agreement could further extend the legal implications of the World Health Organization's power to determine a pandemic emergency.