Towards an understanding of resilience Hanefeld, Johanna; Mayhew, Susannah; Legido-Quigley, Helena ...
Health policy and planning,
04/2018, Letnik:
33, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that ...health systems need not only to be stronger but also more ‘resilient’. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013–16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify ‘3 plus 2’ critical dimensions of particular relevance to health systems’ ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: ‘health information systems’ (having the information and the knowledge to make a decision on what needs to be done); ‘funding/financing mechanisms’ (investing or mobilising resources to fund a response); and ‘health workforce’ (who should plan and implement it and how). These intersect with two cross-cutting aspects: ‘governance’, as a fundamental function affecting all other system dimensions; and predominant ‘values’ shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the ‘3 plus 2’ dimensions can inform pragmatic policies seeking to increase health systems resilience.
La récente épidémie de la maladie à virus Ebola (MVE) en Afrique de l’Ouest a attiré l’attention sur le rôle et la réactivité des systèmes de santé face au choc. Elle a mis en évidence l’idée que les systèmes de santé doivent non seulement être plus forts, mais aussi plus «résilients». Dans le présent article, nous soutenons que la réponse aux chocs est un aspect important de la résilience, en examinant le comportement du système de santé face à quatre types de chocs contemporains: la crise financière en Europe à partir de 2008; les catastrophes liées au changement climatique; l’épidémie de MVE en Afrique de l’Ouest de 2013 à 2016; et la récente crise des réfugiés et des migrations en Europe. Sur la base de cette analyse, nous identifions les dimensions critiques «3 plus 2» particulièrement pertinentes pour la capacité des systèmes de santé à s’adapter et à réagir aux chocs; les actions dans tous ces domaines vont déterminer le niveau de réussite d’une riposte. Il s’agit-l à de trois dimensions fondamentales correspondant à trois fonctions des systèmes de santé: les «systèmes d’information sur la santé» (disposer des informations et des connaissances nécessaires afin de prendre une décision sur ce qui doit être fait); les «mécanismes de financement/financement» (investir ou mobiliser des ressources pour financer une riposte); et le «personnel de santé» (qui devrait planifier, mettre en œuvre et la manière de le faire). Celles-ci recoupent deux aspects transversaux: la «gouvernance», en tant que fonction fondamentale affectant toutes les autres dimensions du système; et les «valeurs» prédominantes façonnant la riposte, et comment elle est vécue aux niveaux individuel et communautaire. De plus, dans toutes les crises examinées ici, l’intégration au sein du système de santé a contribué à la résilience, tout comme la connexion avec les communautés locales; à preuve, les ripostes communautaires réussies face à Ebola et les mouvements sociaux répondant à la crise financière. Dans toutes les crises, les inégalités ont augmenté, mais nos données montrent également que l’impact des chocs se prête à l’action du gouvernement. Tous ces facteurs sont façonnés par le contexte. Nous soutenons que les dimensions «3 plus 2» peuvent éclairer des politiques pragmatiques visant à renforcer la résilience des systèmes de santé.
西非的埃博拉病毒 （EVD） 暴发引发人们关注卫生体系在冲 击中的作用以及应对冲击的能力。核心的想法是卫生体系不 仅需要更强, 而且要更有韧性。我们认为应对冲击是韧性的重 要方面, 在本文中将剖析面对当代四种冲击时的卫生体系行 为：自2008年起的欧洲金融危机；气候变化灾害；2013至 2016年西非EVD疫情；以及近期欧洲难民和移民危机。依据 这一分析, 我们发现了卫生体系应对冲击时至关重要 的”3+2”维度；在这些维度采取行动可决定应对是否成功。 其中包括3个核心维度, 对应卫生体系的3个功能：”卫生信息 系统”（具备决策所需的信息和知识）；”资金/筹资机 制”（投入或调度应对所需的资源）；”卫生人力”（规划和实 施人员以及工作方案）。以上维度又与两个方面交叉：”治 理”, 是影响所有体系维度的基本功能；主导”价值观”, 指导 应对措施, 决定其对个人和社区的影响。此外, 在本文探讨的 所有危机中, 卫生体系内部整合有助于提高韧性, 埃博拉疫情 中的成功社区应对机制和应对金融危机的社会动员还证明, 与 地方社区联合同样有助于提高卫生体系韧性。所有危机都带 来了不平等现象, 但我们的证据也显示, 冲击的影响与政府行 动相关。所有因素都随环境而改变。我们认为”3+2”维度可 以指导制定提高卫生体系韧性的务实政策。
El reciente brote de la Enfermedad del Virus del Ébola (EVE) en África Occidental ha llamado la atención sobre el papel y la capacidad de respuesta de los sistemas de salud frente al choque. La EVE resaltó la idea de que los sistemas de salud necesitan no solo ser más fuertes sino también más “flexibles”. En este artículo, argumentamos que la respuesta a los choques es un aspecto importante de la capacidad de recuperación, examinando el comportamiento del sistema de salud frente a cuatro tipos de choques contemporáneos: la crisis financiera en Europa a partir de 2008; desastres del cambio climático; el brote de EVE en África Occidental 2013-2016; y la reciente crisis de refugiados y migración en Europa. Con base en este análisis, identificamos las dimensiones críticas ‘3 más 2’ de relevancia particular para la capacidad de los sistemas de salud para adaptarse y responder a los choques; las acciones en todos estos determinarán el grado de éxito de una respuesta. Estas son tres dimensiones básicas que corresponden a tres funciones de los sistemas de salud: ‘sistemas de información de salud’ (tener la información y el conocimiento para tomar una decisión sobre lo que se debe hacer); ‘mecanismos de fondos/financiación’ (inversión o movilización de recursos para financiar una respuesta); y ‘personal ’de la salud’ (quién debería planearlo e implementarlo y cómo). Estas dimensiones se cruzan con dos aspectos transversales: ‘gobernanza’, como una función fundamental que afecta a todas las demás dimensiones del sistema; y ‘valores’ predominantes que dan forma a la respuesta, y cómo ésta se experimenta a niveles individual y comunitario. Además, a través de las crisis examinadas aquí, la integración dentro del sistema de salud contribuyó a la capacidad de recuperación, al igual que la conexión con las comunidades locales, evidenciado por las respuestas comunitarias exitosas al Ébola y los movimientos sociales que respondieron a la crisis financiera. En todas las crisis, las desigualdades crecieron, pero nuestra evidencia también resalta que el impacto de los choques es susceptible a la acción gubernamental. Todos estos factores están formados por el contexto. Argumentamos que las dimensiones ‘3 más 2’ pueden informar las políticas pragmáticas que buscan aumentar la capacidad de recuperación de los sistemas de salud.
SDG3 - Good Health and Wellbeing: Re-Calibrating the SDG Agendawill explore topics surrounding the contemporary discussions concerning the implementation of the goal. It will cover concepts and ...concerns, and include practical case studies of how SDG3 has been implemented in different regions of the world.
Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between ...health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities. Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities. Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.
Kangaroo Mother Care (KMC) est une intervention axée sur des bases factuelles qui réduit la morbidité et la mortalité néonatales. Cependant, son adoption varie au sein des systèmes de santé. Il est essentiel de comprendre l’interaction entre les fonctions du système de santé - leadership, financement, agents de santé (AS), technologies, information et recherche, et prestation de services - et la méthode KMC pour comprendre l’adoption de ladite méthode. Nous présentons un examen systématique des obstacles et des facilitateurs de la mise en oeuvre de la méthode KMC du point de vue des systèmes de santé, en mettant l’accent sur les agents de santé et les formations sanitaires. En utilisant les termes de recherche «kangaroo mother care», «skin to skin (STS) care» et «kangaroo care», nous avons effectué des recherches dans Embase, Scopus, Web of Science, Pubmed et dans les bases de données régionales de l’Organisation mondiale de la santé. On a également inclus des rapports et des recherches manuelles de publications. Le filtrage et l’abstraction des données ont été effectués par deux examinateurs indépendants utilisant des formulaires normalisés. On a élaboré un modèle conceptuel permettant d’évaluer les thèmes d’adoption de la méthode KMC grâce au logiciel NVivo. Notre stratégie de recherche a produit 2875 études. Nous avons inclus 86 études contenant des données qualitatives sur la mise en oeuvre de la méthode KMC du point de vue des agents de santé et/ou des formations sanitaires. Six thèmes ont émergé sur les obstacles et les facilitateurs relatifs à l’adoption de la méthode KMC: acceptation et liens affectifs; soutien social; temps; préoccupations médicales; formation et normes culturelles. L’analyse des interactions entre les agents de santé et les formations sanitaires a révélé d’autres obstacles et facilitateurs dans les domaines de la formation, de la communication et du soutien. Les agents de santé et les formations sanitaires sont deux facteurs importants dans l’adoption de la méthode Kangaroo Mother Care dans un système de santé. Les composantes complexes de la KMC sont à l’origine d’obstacles et de facilitateurs multiformes à l’intégration, qui font connaître les recommandations des formations sanitaires, des régions et des pays pour une intensification de l’adoption. Il est nécessaire de poursuivre les recherches sur les méthodes permettant de promouvoir l’adoption d’une KMC spécifique au contexte des systèmes de santé.
袋鼠妈妈护理法 （KMC） 是一项降低新生儿疾病和死亡率的 循证干预。但是, 不同卫生体系对该方法的采用有所差异。为 了了解KMC 的采用, 必须理解卫生体系功能（领导、筹资、 医疗工作者 （HCWs）、技术、信息与研究、服务提供）和 KMC 之间的相互作用。我们对从卫生体系角度探讨KMC实 施的阻碍和促进因素的文献进行了系统综述, 重点关注HCWs 和卫生机构。使用“袋鼠妈妈护理 （kangaroo mother care） ”, “肌肤接触护理 （skin to skin care） ” 和“袋鼠护理 （kangaroo care） ” 为检索词, 检索Embase 、Scopus 、 Web of Science、Pubmed 和世界卫生组织的区域数据库。 包含项目报告和文献的手动检索结果。由两名研究人员采用 标准化表格进行文献筛选和数据提取。使用NVivo 软件建立 评估KMC 采纳的概念模型。检索策略检索到 2875 项研究。 纳入的 86 项研究提供了 HCWs 和/或卫生机构角度的KMC 实施定性数据。分析显示了 KMC 阻碍和促进因素的 6 个相 关主题：认同和亲子关系；社会支持；时间；医疗因素；培 训；文化规范。关于 HCWs 与卫生机构相互作用的分析显示, 在培训、沟通和支持方面还存在更多阻碍和促进因素。 HCWs 和卫生机构是卫生体系中采用袋鼠妈妈护理的重要实 行者。KMC 的复杂构成导致了多方面的阻碍和促进因素, 在 机构、区域和国家层面推进 KMC 时都要考虑这些因素。需 要进一步研究如何促进在卫生体系层面根据具体环境采用 KMC 。
La Atención de la Madre Canguro (AMC) es una intervención basada en evidencia que reduce la morbilidad y la mortalidad neonatal. Sin embargo, la adopción entre los sistemas de salud ha variado. Comprender la interacción entre las funciones del sistema de salud -liderazgo, financiación, trabajadores de la atención de la salud (TASs), tecnologías, información e investigación y prestación de servicios- y la AMC es esencial para comprender la adopción de la AMC. Presentamos una revisión sistemática de las barreras y los facilitadores para la implementación de la AMC desde la perspectiva de los sistemas de salud, con un enfoque en los TASs y las instalaciones de salud. Usando los términos de búsqueda ‘atención de la madre canguro’, ‘cuidado de piel a piel (PAP)’ y ‘cuidado de canguro’, llevamos a cabo búsquedas en Embase, Scopus, Web of Science, Pubmed y en las Bases de Datos Regionales de la Organización Mundial de la Salud. También se incluyeron informes y referencias de búsqueda manual de las publicaciones. La revisión y la extracción de datos fueron realizadas por dos revisores independientes usando formularios estandarizados. Se desarrolló un modelo conceptual para evaluar los temas de adopción de la AMC usando el software NVivo. Nuestra estrategia de búsqueda arrojó 2875 estudios. Incluimos 86 estudios con datos cualitativos sobre la implementación de la AMC desde la perspectiva de los TASs y/o de las instalaciones. Seis temas surgieron sobre las barreras y los facilitadores para la adopción de la AMC: aceptación y vinculación; apoyo social; tiempo; preocupaciones médicas; entrenamiento; y normas culturales. El análisis de las interacciones entre los TASs y las instalaciones arrojó nuevas barreras y facilitadores en las áreas de entrenamiento, comunicación y apoyo. Los TASs y las instalaciones de salud sirven como dos importantes adoptadores de la Atención de la Madres Canguro dentro de un sistema de salud. Los complejos componentes de la AMC conducen a barreras y facilitadores multifacéticos de la integración, los cuales informan las recomendaciones para aumentar la adopción a nivel de instalación, regional y nacional. Se necesita más investigación de métodos para promover la adopción de la AMC en contextos específicos a nivel de sistemas de salud.
The 2014-2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further ...exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency.
We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization's Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations.
We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings.
An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
Purpose To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data. Methods Approximately 45,000 individuals valued their current health ...status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents' answers on a self-rated health (SRH) question was assessed. Results Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly. Conclusions A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals' overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies.
Objectives. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential ...country‐level drivers of health system responsiveness.
Data Source. Data on responsiveness are taken from the World Health Survey. Information on country‐level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP).
Study Design. A two‐step procedure. First, using survey data we derive a country‐level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross‐sectional country‐level regressions of responsiveness on potential drivers.
Principal Findings. Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively).
Conclusions. From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study.
Little is known about the quality, quantity and disease areas analysed by health economic research that inform healthcare decision-making in Central America. This study aimed to review the existing ...health economic evaluations (HEEs) and budget impact analyses (BIAs) evidence in Central America based on scope and reporting quality.
HEEs and BIAs published from 2000 to April 2021 were searched in five electronic databases: PubMed, Embase, LILACS (Latin American and Caribbean Health Science Literature), EconLIT and OVID Global Health. Two reviewers assessed titles, abstracts and full texts of studies for eligibility. The quality appraisal for the reporting was based on La Torre and colleagues' version of the Drummond checklist and the ISPOR good practices for BIA. For each country, we correlated the number of studies by disease area with their respective burden of disease to identify under-researched health areas.
102 publications were eligible for this review. Ninety-four publications reported a HEE, six publications reported a BIA, and two studies reported both a HEE and a BIA. Costa Rica had the highest number of publications (n = 28, 27.5%), followed by Guatemala (n = 25, 24.5%). Cancer and respiratory infections were the most common types of disease studied. Diabetes mellitus, chronic kidney diseases, and mental disorders were under-researched relative to their disease burden in most of the countries. The overall mean quality reporting score for HEE and BIA studies were 71/119 points (60%) and 7/10 points (70%), respectively; however, these assessments were made on different scales.
In Central America, health economic research is sparse and is considered as suboptimal quality for reporting. The findings reported information useful to other low- and middle-income countries with similar advances in the application of economics to promote health policy decision-making.
Background
The public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and ‘free at the point of delivery’, is coming under increasing strain due to escalating ...expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term.
Objectives
This study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system.
Methods
A total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences.
Results
The evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme.
Conclusions
Quality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences.
This paper focuses on the effects of a 2005 health insurance reform in Vietnam. Through this reform, public health insurance was newly offered to nonpoor children under 6 years old, but it required ...the use of community health facilities. This requirement potentially limited the value of the insurance. Employing difference‐in‐discontinuities and triple‐difference methods and using data from 2002, 2004, and 2006, I show that, despite health coverage among nonpoor children increasing by nearly three times, there is little or no evidence that the reform significantly increased health care utilization, changed care locations from private to public sites, lowered out‐of‐pocket costs, or improved health status for nonpoor young children. My results suggest a “bypassing” phenomenon whereby nonpoor families skipped free health care at low‐quality facilities.
The project reported here aimed to describe the effects that alternative health care payment models have on physicians and physician practices in the United States. Project findings should help guide ...efforts to improve current and future alternative payment programs and help physician practices succeed in these new payment models. The report provides both findings and recommendations.
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