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Shaping health systems to include people with disabilities. K4D emerging issues report

DEAN, Laura
et al
November 2018

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People with disabilities are at a heightened risk of communicable and non-communicable diseases and these diseases can cause debility and disability. Health needs of these people often extend beyond requiring continual longterm medical support to addressing broader social inequities. Key areas that are likely to be critical in re-orientating health systems from a biomedical approach towards inclusive health systems that are more responsive to the needs of people with debility and disability in low and middle-income countries (LMICs) are offered in this report and cover the following:

 

  • 1. Nothing about us without us: prioritising person-centred health systems
  • 2. Responding to issues of access in mainstreaming disability within health systems
  • 3. Ensuring the provision of specialised services
  • 4. Community based rehabilitation 
  • 5. Improving the collection and use of disability related data against modified legal and policy frameworks
  • 6. Partnerships are paramount
  • 7. Financing and social protection 

Case studies are provided from Sudan, India, Liberia, Uganda and Nigeria

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

TIWARI, Ajun
et al
January 2018

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The primary objective of this study is to estimate the expenditure in primary (outpatient) care incurred by leprosy patients in two different health system settings in India. The secondary objective is to compare the effect of the health systems on consumer behaviour and practices. 

The study followed a cross-sectional design, where a cohort from the Union Territory of DNH (an administrative division ruled directly by the federal government) was compared with a cohort from Umbergaon block of Valsad district, Gujarat, India. A block is the smallest administrative unit under a district. The cohorts were leprosy cases detected between April 2015 and March, 2016. A sample of 120 participants from each group was selected randomly. In the financial year of 2015–16, DNH reported 425 and Umbergaon reported 287 cases. 

A household survey was conducted between June and October, 2016 by means of a structured questionnaire collecting data on patient demographics, HH socioeconomic status, accessibility of health services, treatment seeking history and OPD expenditure. Respondents were asked to report on the last three OPD visits, either in a public or private facility, in the last 6 months. 

The costs were categorized as direct and indirect expenditure. The direct part included the expenditure on consultation, investigations and medicines & supplies. The indirect part constituted expenditure on transport, food, and days lost during illness of the patient and attendant

PLOS Neglected Tropical Diseases, January 4, 2018

https://doi.org/10.1371/journal.pntd.0006181

Impact of cross-border healthcare on persons with disabilities and chronic conditions

INTERNATIONAL FEDERATION FOR SPINA BIFIDA AND HYDROCEPHALUS
February 2017

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"The International Federation for Spina Bifida and Hydrocephalus (IF) together with the European Disability Forum (EDF) and the European Patients Forum (EPF) conducted a survey among their networks to assess the impact of the Directive 2011/24/EU on the application of patients’ rights in cross border healthcare (crossborder healthcare Directive) on persons with disabilities and chronic conditions in the EU. The findings of the survey showed low awareness and low use of the Directive. A vast majority of 85% has never used crossborder healthcare even though 69% of respondents might have used it had they received information about it. Approximately three quarters (77%) of respondents have never heard about the Directive" 

Improving Ghana’s mental healthcare through task-shifting-psychiatrists and health policy directors perceptions about government’s commitment and the role of community mental health workers

AGYAPONG, Vincent
et al
October 2016

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The aim of this study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs). A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. .

Globalization and Health (2016) 12:57

DOI 10.1186/s12992-016-0199-z

Integration of childhood tuberculosis into maternal and child health, HIV and nutrition services: A case study from Uganda

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Uganda case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The methodology for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and iCCM benchmarks"

Integration of childhood TB into maternal and child health, HIV and nutrition services. A case study from Malawi.

VERKUIJL, Sabine
et al
September 2016

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"Country case studies were conducted in Uganda and Malawi in order to document and analyse experiences and perspectives on childhood TB integration into other programmes at country level and related health system requirements. The aim was to inform the broader thinking about integration of childhood TB services. The Malawi case study identified and described different approaches to integration and unpacked the integration process. The perspective on TB integration of different relevant health actors at national and district level are described. The case study used a health systems approach and focused on the community and primary levels of the health system, paying attention to factors related to children of different ages in a lifecycle approach. The method for the case study included document review, consultations with key health actors at national and district level, a facility visit and a participatory workshop at national level. An analytical framework approach was used to investigate the extent of integration of childhood TB interventions in multiple dimensions. An assessment tool for the case studies was developed, summarising the assessment questions by theme, combining a number of existing tools and frameworks on health care integration in general and childhood TB and benchmarks for integrated community case management (iCCM)"

Global strategy on human resources for health: Workforce 2030. DRAFT for the 69th World Health Assembly

World Health Organisation (WHO)
May 2016

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This report was presented to Member States at the World Health Assembly in May 2016 and is to be read in conjunction with A69/38: Draft global strategy on human resources for health: Workforce 2030. Report by the Secretariat. The vision of this work and report is to "Accelerate progress towards universal health coverage and the UN Sustainable Development Goals by ensuring equitable access to health workers within strengthened health systems". Objectives are "To optimise performance, quality and impact of the health workforce through evidence-informed policies on human resources for health, contributing to healthy lives and well-being, effective universal health coverage, resilience and strengthened health systems at all levels",  "To align investment in human resources for health with the current and future needs of the population and of health systems, taking account of labour market dynamics and education policies; to address shortages and improve distribution of health workers, so as to enable maximum improvements in health outcomes, social welfare, employment creation and economic growth", "To build the capacity of institutions at sub-national, national, regional and global levels for effective public policy stewardship, leadership and governance of actions on human resources for health" and "to strengthen data on human resources for health, for monitoring and ensuring accountability for the implementation of national and regional strategies, and the global strategy".  Global milestones by 2020 and 2030, policy options of Member States, responsibilities of the WHO Secretariat and recommendations to other stakeholders and international partners are discussed for each objective.

 

Strengthening community and primary health systems for tuberculosis. A consultation on childhood TB integration

UNICEF
2016

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An estimated one million children between the age of 0-14 fall ill with tuberculosis (TB) every year, over 67 million children are infected and might develop active disease at any time. In 2013, the WHO with key partners launched the Roadmap for Childhood TB, outlining ten key actions to improve outcomes for children affected by TB, including improved data, development of child-friendly tools for diagnosis and treatment, engagement of key stakeholders at all levels of the system, and the development of integrated family- and community-centred strategies to provide comprehensive and effective services at the community level. A consultation on childhood TB integration took place in New York on June 1 and 2, 2016 to stimulate further the dialogue. The meeting addressed 7 topics: perspectives on childhood TB; country discussions on integration; integrating childhood TB interventions into service delivery; an opportunity for TB risk assessment at the community level: TB/HIV adapted integrated community case management (iCCM); childhood TB integration at the national, district, and community level; and financing childhood TB integration 

Methods for the economic evaluation of health care programmes. 4th edition. Chapter 1 to 3)

DRUMMOND. Michael
et al
September 2015

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The analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly are discussed. A critical appraisal framework is employed, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy.

UNICEF’S STRATEGY FOR HEALTH (2016-2030) (full version)

UNICEF
2015

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For the five year period 2016-2020, UNICEF’s Strategy for Health sets two overarching goals: 1. End preventable maternal, newborn and child deaths 2. Promote the health and development of all children. To achieve these goals, the Strategy considers the health needs of the child at all life stages. It highlights the need for intensified efforts to address growing inequities in health outcomes, including a particular focus on addressing gender-specific needs and barriers that may determine whether boys and girls are able to reach their full potential in health and well-being. Working together with global and local partners, UNICEF will promote three approaches to contribute to these goals: addressing inequities in health outcomes; strengthening health systems including emergency preparedness, response and resilience; and promoting integrated, multisectoral policies and programmes. The three approaches described underpin a "menu of actions” from which country offices can select, based on their situation analysis, country programme focus, and context. 

Study on social and health services of general interest in the European Union : final synthesis report

HUBER, Manfred
MAUCHER, Mathias
SAK, Barbara
June 2008

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This report seeks to improve the knowledge of both operators and the European Commission about the situation of social and health services of general interest in the European Union (EU). It is also designed to examine the impact of the EU rules on the development of social and health services. The purpose is to eventually establish a monitoring and dialogue tool in the form of biennial reports

Connecting for health : global vision, local insight. Report for the World Summit on the Information Society

DZENOWAGIS, Joan
2005

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This report looks at the challenges, policy implications and future potential of e-health. Includes brief regional profiles with essential country statistics. The report stresses that advances in ICT applications to health service delivery requires effort and commitment in six key areas: infrastructure, technology and tools, education and training, policy and standards, evaluation, and leadership

Organization of services for mental health : mental health policy and service guidance package

WORLD HEALTH ORGANIZATION (WHO)
2003

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"This publication aims to: present a description and analysis of mental health services around the world examining different services and their organization and activities; review the current status of service organization around the world; make recommendations for organizing services; discuss crucial issues in the organization of services; discuss barriers to the organization of services and suggest solutions. The publication is intended to be useful to a range of people, including policy-makers and health planners, governmental and non-governmental organisations, and people with mental disorders and their families"

Improving health outcomes of the poor : report of working group 5 of the Commission on Macroeconomics and Health

COMMISSION ON MACROECONOMICS AND HEALTH. Working Group 5
2002

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Analyses health sector issues in the developing world including: avoidable mortality, prioritisation of interventions, overcoming constraints of scaling up, and cost of scaling up interventions. Specific health issues addressed include maternal and perinatal mortality, childhood illness, malnutrition, malaria, TB, smoking, and hiv/aids. Includes statistics and graphs, diagrams and tables to illustrate points

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