The experiences of frontline healthcare professionals are essential in identifying strategies to mitigate the disruption to healthcare services caused by the COVID-19 pandemic.
We conducted a ...cross-sectional study of TB and HIV professionals in low and middle-income countries (LMIC). Between May 12 and August 6, 2020, we collected qualitative and quantitative data using an online survey in 11 languages. We used descriptive statistics and thematic analysis to analyse responses.
669 respondents from 64 countries completed the survey. Over 40% stated that it was either impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. The most common barriers reported to affect patients were: fear of getting infected with SARS-CoV-2, transport disruptions and movement restrictions. 37% and 28% of responses about TB and HIV stated that healthcare provider access to facilities was also severely impacted. Strategies to address reduced transport needs and costs-including proactive coordination between the health and transport sector and cards that facilitate lower cost or easier travel-were presented in qualitative responses. Access to non-medical support for patients, such as food supplementation or counselling, was severely disrupted according to 36% and 31% of HIV and TB respondents respectively; qualitative data suggested that the need for such services was exacerbated.
Patients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and non-medical support for patients was particularly impacted. Synthesising recommendations of frontline professionals should be prioritised for informing policymakers and healthcare service delivery organisations.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although concerns have historically been raised about the influence of external donors on health policy process in recipient countries, remarkably few studies have investigated perspectives and ...experiences of domestic policymakers and advisers. This study examines donor influence at different stages of the health policy process (priority setting, policy formulation, policy implementation and monitoring and evaluation) in two aid-dependent LMICs, Cambodia and Pakistan. It identifies mechanisms through which asymmetries in influence between donors and domestic policy actors emerge. We conducted 24 key informant interviews—14 in Pakistan and 10 in Cambodia—with high-level decision-makers who inform or authorize health priority setting, allocate resources and/ or are responsible for policy implementation, identifying three routes of influence: financial resources, technical expertise and indirect financial and political incentives. We used both inductive and deductive approaches to analyse the data. Our findings indicate that different routes of influence emerged depending on the stage of the policy process. Control of financial resources was the most commonly identified route by which donors influenced priority setting and policy implementation. Greater (perceived) technical expertise played an important role in donor influence at the policy formulation stage. Donors’ power in influencing decisions, particularly during the final (monitoring and evaluation) stage of the policy process, was mediated by their ability to control indirect financial and political incentives as well as direct control of financial resources. This study thus helps unpack the nuances of donor influence over health policymaking in these settings, and can potentially indicate areas that require attention to increase the ownership of domestic actors of their countries’health policy processes.
Bien que par le passé, on se soit préoccupé de l’influence des donateurs externes sur le processus de la politique sanitaire nationale des pays bénéficiaires, il est remarquable de constater que peu d’études se soient intéressées aux attentes et expériences des décideurs et des conseillers nationaux. La présente étude examine l’influence des bailleurs de fonds à différents stades du processus de la politique sanitaire (établissement des priorités, formulation des politiques, mise en œuvre, suivi et évaluation des politiques) dans deux PRFI dépendants de l’aide; le Cambodge et le Pakistan. Elle identifie les mécanismes par lesquels émergent les asymétries d’influence entre les donateurs et les acteurs politiques nationaux. Nous avons réalisé 24 entretiens avec des témoins privilégiés - 14 au Pakistan et 10 au Cambodge -, ainsi qu’avec des décideurs de haut niveau qui orientent ou autorisent l’établissement de priorités sanitaires, affectent des ressources et/ou sont responsables de la mise en œuvre des politiques; ces entretiens ont permis d’identifier trois voies d’influence: les ressources financières, l’expertise technique et les incitations financières et politiques indirectes. Nous avons utilisé en même temps les approches inductive et déductive pour analyser les données. Nos résultats indiquent que différentes voies d’influence ont émergé en fonction du stade du processus politique. Le contrôle des ressources financières était la voie la plus fréquemment identifiée par laquelle les donateurs influencent l’établissement des priorités et la mise en œuvre des politiques. La plus grande expertise technique (telle que perçue) des donateurs joue un important rôle dans leur influence au stade de la formulation des politiques. Le pouvoir des donateurs d’influencer les décisions, en particulier pendant la phase finale (suivi et évaluation) du processus politique, est tributaire de leur capacité à contrôler les incitations financières et politiques indirectes ainsi que du contrôle direct qu’ils exercent sur les ressources financières. La présente étude permet ainsi de dégager les nuances de l’influence des bailleurs de fonds sur l’élaboration des politiques sanitaires dans ces milieux et peut potentiellement indiquer les domaines nécessitant une attention particulière pour renforcer l’appropriation des processus des politiques de santé par les acteurs nationaux.
虽然国外捐助者影响受捐国卫生政策构成的担忧早已有之, 但 稍有研究探讨国内决策者和建议者的观点和经验。本研究在 两个依赖援助的中低收入国家, 柬埔寨和巴基斯坦, 调查捐助 者对卫生政策过程不同阶段的影响（确定优先事项、制定政 策、实施政策以及监督和评价）。研究意在发现产生捐助者 和国内政策行动者不平衡的机制。我们进行了24次关键知情 人访谈（巴基斯坦14次、柬埔寨10次）, 受访者为高级别决策 者, 他们指导或批准卫生政策优先事项和资源配置, 或者负责 政策实施。访谈发现三种影响政策的途径：经济资源、专业 技术、间接经济和政治奖励。我们采用归纳和演绎法分析数 据。研究发现显示, 不同影响途径的出现取决于政策的阶段。 控制经济资源是捐助者在确定优先事项和政策实施阶段最常 用的途径。在政策制定阶段, 捐助者的影响主要通过更先进的 专业技术。捐助者对决策的影响, 尤其是在最终阶段（监督和 评估）的影响, 主要通过直接控制经济资源, 以及控制间接经 济和政治激励措施。因此, 本研究有助于剖析捐助者对卫生决 策的影响, 同时提示在哪些方面可加强国内行动者对本国卫生 政策过程的自主性。
Aunque históricamente se han expresado preocupaciones acerca de la influencia de los donantes externos en el proceso de políticas de salud en los países beneficiarios, muy pocos estudios han investigado las perspectivas y experiencias de los responsables de la formulación de políticas y asesores nacionales. Este estudio examina la influencia de los donantes en las diferentes etapas del proceso de políticas de salud (establecimiento de prioridades, formulación de políticas, implementación de políticas y monitoreo y evaluación) en dos países de ingresos bajos y medios dependientes de la ayuda, Camboya y Pakistán. Este artículo identifica los mecanismos a través de los cuales surgen las asimetrías de influencia entre los donantes y los actores domésticos de política. Llevamos a cabo 24 entrevistas con informantes claves -14 en Pakistán y 10 en Camboya- con tomadores de decisiones de alto nivel quienes informan o autorizan el establecimiento de prioridades de salud, asignan los recursos y/o son responsables de la implementación de políticas, identificando tres rutas de influencia: recursos financieros, experiencia técnica e incentivos indirectos financieros y políticos. Usamos enfoques tanto inductivos como deductivos para analizar los datos. Nuestros hallazgos indican que las diferentes rutas de influencia surgieron dependiendo de la etapa del proceso de política. El control de los recursos financieros fue la ruta más comúnmente identificada por la cual los donantes influyeron en el establecimiento de prioridades y la implementación de políticas. Una mayor experiencia técnica (percibida) jugó un papel importante en la influencia de los donantes en la etapa de formulación de políticas. El poder de los donantes para influir en las decisiones, particularmente durante la etapa final (monitoreo y evaluación) del proceso de políticas, estuvo mediado por su capacidad para controlar los incentivos indirectos financieros y políticos, así como el control directo de los recursos financieros. Este estudio ayuda a analizar los matices de la influencia de los donantes sobre la formulación de políticas de salud en estos entornos, y puede potencialmente indicar las áreas que requieren atención para aumentar el sentido de propiedad de los actores nacionales sobre los procesos de políticas de salud de sus países.
...the silence of individuals and institutions working in global public health, humanitarian assistance, and health care, despite the values key to their work—such as alleviating suffering, ...preserving life, and upholding dignity for all—is disappointing. The silencing of health-care professionals and academics has been driven by funders, such as several European countries who froze funding to non-governmental organisations highlighting human rights violations in Palestine,5 by institutional leadership penalising individuals who make statements echoing those of the UN,6 and by aggressive backlash from colleagues in their field.7 Academics and health-care professionals have always been crucial advocates for justice, including during the COVID-19 pandemic, when they played valuable roles in scrutinising governments' actions. In the global public health sphere, the failure to strongly condemn human rights violations in Gaza is raising questions about organisations' true purpose and values, especially as the global health field has already been called out for its “implicit function of legitimising and reproducing the existing power structure”.9 For many, institutions' silence and their role in silencing in the face of a raging, manufactured public health crisis in Gaza reveals their level of commitment to challenging racial stereotyping and dehumanisation better than statements they have made.
Anybody working in humanitarian settings will testify that moral boundaries are routinely blurred, and evidence of sexual exploitation by humanitarian workers, including UN peacekeepers, has been ...well documented for decades.3 Surprising is the colossal failure of internal and external authorities with responsibility for preventing such incidents to fulfil their mandates....it relied on information based on Oxfam's own investigation indicating that there was no cause for concern.4 Therefore, I would argue that the issue here is not only about sexual exploitation or weeding out individuals unfit for international development work.Without effective structures for monitoring, evaluation, and accountability, in addition to sexual misconduct, corruption and unintended consequences of programmes implemented can also be concealed.5 Here the positioning of international development agencies as holders of superior knowledge and values with respect to development often results in their authority being difficult to challenge.6 But questions must now be asked about all organisations-charities, funding bodies, and research institutes-that claim to be supporting better governance and human rights in LMICs.
•In 2020, COVID-19 dislodged TB as the top infectious disease cause of mortality globally.•Globally, an estimated 10.0 million people developed active TB disease in 2019, with 1.4 million TB ...deaths.•The WHO regions of South-East Asia, Africa, and the Western Pacific had the most cases of TB.•Progress in achieving the United Nations (UN) General Assembly End TB targets remains slow.•TB services need to be ramped up, and underlying drivers of TB need be addressed.
The October 2020 Global TB report reviews TB control strategies and United Nations (UN) targets set in the political declaration at the September 2018 UN General Assembly high-level meeting on TB held in New York. Progress in TB care and prevention has been very slow. In 2019, TB remained the most common cause of death from a single infectious pathogen. Globally, an estimated 10.0 million people developed TB disease in 2019, and there were an estimated 1.2 million TB deaths among HIV-negative people and an additional 208, 000 deaths among people living with HIV. Adults accounted for 88% and children for 12% of people with TB. The WHO regions of South-East Asia (44%), Africa (25%), and the Western Pacific (18%) had the most people with TB. Eight countries accounted for two thirds of the global total: India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6.0%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%). Only 30% of the 3.5 million five-year target for children treated for TB was met. Major advances have been development of new all oral regimens for MDRTB and new regimens for preventive therapy. In 2020, the COVID-19 pandemic dislodged TB from the top infectious disease cause of mortality globally. Notably, global TB control efforts were not on track even before the advent of the COVID-19 pandemic. Many challenges remain to improve sub-optimal TB treatment and prevention services. Tuberculosis screening and diagnostic test services need to be ramped up. The major drivers of TB remain undernutrition, poverty, diabetes, tobacco smoking, and household air pollution and these need be addressed to achieve the WHO 2035 TB care and prevention targets. National programs need to include interventions for post-tuberculosis holistic wellbeing. From first detection of COVID-19 global coordination and political will with huge financial investments have led to the development of effective vaccines against SARS-CoV2 infection. The world now needs to similarly focus on development of new vaccines for TB utilizing new technological methods.
As a novel concept of responding to disease epidemics, Fangcang shelter hospitals were deployed to expand the health system's capacity and provide medical services for non-severe COVID-19 patients ...during the outbreak in Wuhan. To give insights on patient management within Fangcang hospitals, we conducted a retrospective analysis to: 1) describe the characteristics of the patients admitted to Fangcang hospitals and 2) explore risk factors for longer length of stay (LOS). We enrolled 136 confirmed COVID-19 patients, including asymptomatic patients and those with mild symptoms, who were hospitalized in the Wuti Fangcang Hospital. 58 patients completed the treatment and discharged before 1 March 2020. After describing patients' demographic and clinical characteristics, exposure history, treatment received and time course of the disease, we conducted linear regression analysis to identify factors influencing LOS. We found that patients having fever before admission were hospitalized 3.5 days (95%CI 1.39 to 5.63, p = 0.002) longer than those without fever and that patients having bilateral pneumonia were hospitalized 3.4 days (95%CI 0.49 to 6.25, p = 0.023) longer than those with normal CT scan results. We also found weak evidence suggesting that patients with diabetes were hospitalized 3.2 days longer than those without diabetes (95%CI -0.2 to 6.56, p = 0.065). However, we observed no significant differences in LOS between symptomatic and asymptomatic patients and between patients who received treatment and those without treatment. Longer duration of hospitalization among non-severe COVID-19 patients is associated with having fever, bilateral pneumonia on CT scan and diabetes. However, being asymptomatic and using supportive medications at the early stage of infection do not have significant influences on LOS. Our study is a single-centered study with relatively small sample size. The findings provide evidence for predicting hospital bed demand in a novel response scenario and may help decision-makers in preparing for ramping up the health system capacity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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