scholarly journals Dispensing Antiretrovirals During Covid-19 Lockdown: Pathways to Health System Resilience in Uganda

2021 ◽  
Author(s):  
Henry Zakumumpa ◽  
Christopher Tumwine ◽  
Kiconco Milliam ◽  
Neil Spicer
Keyword(s):  
Health System ◽  
National Level ◽  
Access To Health Services ◽  
District Health ◽  
Home Based ◽  
Related Notion ◽  
Rural Settings ◽  
System Resilience ◽  
The Impact

Abstract INTRODUCTIONAlthough there is an emerging evidence base on the impact of Covid-19 pandemic on access to health services in low-and middle-income countries, the related notion of health system resilience has received little empirical attention. The objective of this study was to explore health system resilience at the sub-national level in Uganda with regard to strategies for dispensing of antiretrovirals during Covid-19 lockdown restrictions.METHODSWe conducted a qualitative case-study of eight districts from Eastern Uganda (Mbale, Sironko, Manafwa, Bulambuli, Bududa) and Western Uganda (Kabarole, Kyegegwa, Kyenjonjo) purposively selected due to having a relatively high HIV burden. Between June and September 2020, we conducted key informant interviews with district health team leaders (n=9), with ART clinic managers (n=36), representatives of PEPFAR implementing organizations (n=6) and six focus group discussions with recipients of HIV/AIDS care (48 participants). Qualitative data were analyzed using thematic approach.RESULTSFive broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based antiretroviral therapy (ART) deliveries,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; an increased reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported benefiting from the Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities.CONCLUSIONAlthough Covid-19 ‘lockdown’ undoubtedly impeded access to facility-based HIV services, it unraveled new possibilities and innovations in the distribution of antiretrovirals in the predominantly rural settings of our case-study districts. Further research is recommended to evaluate the potential of home-based deliveries as an alternative differentiated ART delivery model in Uganda and other countries with a high HIV burden.

scholarly journals Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henry Zakumumpa ◽  
Christopher Tumwine ◽  
Kiconco Milliam ◽  
Neil Spicer
Keyword(s):  
Health System ◽  
National Level ◽  
Hiv Care ◽  
District Health ◽  
Community Based ◽  
Community Based Art ◽  
System Resilience ◽  
Delivery Models ◽  
Art Delivery

Abstract Background The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown. Methods We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach. Results Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities. Conclusion While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

Modernisation of Higher Education – Willful Action or Wishful Thinking? The Case of Bulgaria

2020 ◽  
Vol 8 (3) ◽  
pp. 3-17
Author(s):  
Elena Blagoeva
Keyword(s):  
Higher Education ◽  
Economic Crisis ◽  
Negative Impact ◽  
National Level ◽  
Sustainable Growth ◽  
Research Approach ◽  
Case Study Methodology ◽  
The Impact ◽  
The Eu

The impact of the last global economic crisis (2008) on the European economy put a strain on higher education (HE), yet it also pushed the sector towards intensive reforms and improvements. This paper focuses on the “Strategy for the Development of Higher Education in the Republic of Bulgaria 2014-2020”. With a case study methodology, we explore the strategic endeavours of the Bulgarian government to comply with the European directions and to secure sustainable growth for the HE sector. Our research question is ‘How capable is the Bulgarian HE Strategy to overcome the economic and systemic restraints of Bulgarian higher education?’. Because the development of strategies for HE within the EU is highly contextual, a single qualitative case study was chosen as the research approach. HE institutions are not ivory towers, but subjects to a variety of external and internal forces. Within the EU, this is obviated by the fact that Universities obtain their funds from institutions such as governments, students and their families, donors, as well as EU-level programmes. Therefore, to explore how these pressures interact to affect strategic action on national level, the case method is well suited as it enabled us to study the phenomena thoroughly and deeply. The paper suggests the actions proposed within the Strategy have the potential to overcome the delay, the regional isolation and the negative impact of the economic crisis on the country. Nevertheless, the key elements on which the success or failure of this Strategy hinges are the control mechanisms and the approach to implementation. Shortcomings in these two aspects of strategic actions in HE seem to mark the difference between gaining long-term benefits and merely saving face in front of international institutions.

scholarly journals Integrated home-based screening for people living with disabilities: A case study from rural Malawi

2019 ◽  
Vol 8 ◽  
Author(s):  
Elizabeth M. Petersen ◽  
Emily B. Wroe ◽  
Kondwani Nyangulu ◽  
Chisomo Kanyenda ◽  
Sam Njolomole ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Screening Programme ◽  
Health Workers ◽  
Hiv Care ◽  
Access To Health Services ◽  
Home Based ◽  
Poor Access ◽  
Access To Health ◽  
Integrated Screening

People living with disabilities (PLWDs) have poor access to health services compared to people without disabilities. As a result, PLWDs do not benefit from some of the services provided at health facilities; therefore, new methods need to be developed to deliver these services where PLWDs reside. This case study reports a household-based screening programme targeting PLWDs in a rural district in Malawi. Between March and November 2016, a household-based and integrated screening programme was conducted by community health workers, HIV testing counsellors and a clinic clerk. The programme provided integrated home-based screening for HIV, tuberculosis, hypertension and malnutrition for PLWDs. The programme was designed and implemented for a population of 37 000 people. A total of 449 PLWDs, with a median age of 26 years and about half of them women, were screened. Among the 404 PLWDs eligible for HIV testing, 399 (99%) agreed for HIV testing. Sixty-nine per cent of PLWDs tested for HIV had never previously been tested for HIV. Additionally, 14 patients self-reported to be HIV-positive and all but one were verified to be active in HIV care. A total of 192 of all eligible PLWDs above 18 years old were screened for hypertension, with 9% (n = 17) referred for further follow-up at the nearest facility. In addition, 274 and 371 PLWDs were screened for malnutrition and tuberculosis, respectively, with 6% (n = 18) of PLWDs referred for malnutrition, and 2% (n = 10) of PLWDs referred for tuberculosis testing. We successfully implemented an integrated home-based screening programme in rural Malawi.

The challenges of budgeting in a newly introduced district health system: A case study

2009 ◽  
Vol 5 (1) ◽  
pp. 87-101 ◽  
Author(s):  
G.A. Nnaji ◽  
C. Oguoma ◽  
L.I. Nnaji ◽  
E. Nwobodo
Keyword(s):  
Health System ◽  
District Health ◽  
District Health System ◽  
System A

scholarly journals The impact of family physician supply on district health system performance, clinical processes and clinical outcomes in the Western Cape Province, South Africa (2011–2014)

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Rekai L. Chinhoyi ◽  
Moleen Zunza ◽  
Klaus B. Von Pressentin
Keyword(s):  
South Africa ◽  
Health System ◽  
Family Physician ◽  
System Performance ◽  
Health System Performance ◽  
Western Cape ◽  
Western Cape Province ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: A revised family physician (FP) training programme was introduced in South Africa in 2007. A baseline assessment (2011) of the impact of FP supply on district health system performance was performed within the Western Cape Province, South Africa. The impact of an increased FP supply within this province required re-evaluation.Aim: To assess the impact of FP supply on indicators of district health system performance, clinical processes and clinical outcomes in the Western Cape Province. The objectives were to determine the impact of FPs, nurses, medical officers (MOs) and other specialists.Setting: The study sample included all five rural districts and eight urban subdistricts of the Western Cape Province.Methods: A secondary analysis was performed on routinely collected data from the Western Cape Department of Health from 01 March 2011 until 30 April 2014.Results: The FP supply did not significantly impact the indicators analysed. The supply of nurses and MOs had an impact on some of the indicators analysed.Conclusion: This study did not replicate the positive associations between an increase in FP supply and improved health indicators, as described previously for high-income country settings. The impact of FP supply on clinical processes, health system performance and outcome indicators in the Western Cape Province was not statistically significant. Future re-evaluation is recommended to allow for more time and an increase in FP supply.

scholarly journals Temporal changes in greenspace in a highly urbanized region

2011 ◽  
Vol 7 (5) ◽  
pp. 763-766 ◽  
Author(s):  
Martin Dallimer ◽  
Zhiyao Tang ◽  
Peter R. Bibby ◽  
Paul Brindley ◽  
Kevin J. Gaston ◽  
...  
Keyword(s):  
Land Use ◽  
Urban Areas ◽  
National Level ◽  
Urban Land Use ◽  
Policy Reforms ◽  
Trade Offs ◽  
Dramatic Shift ◽  
Urbanized Region ◽  
The Impact

The majority of the world's population now lives in towns and cities, and urban areas are expanding faster than any other land-use type. In response to this phenomenon, two opposing arguments have emerged: whether cities should ‘sprawl’ into the wider countryside, or ‘densify’ through the development of existing urban greenspace. However, these greenspaces are increasingly recognized as being central to the amelioration of urban living conditions, supporting biodiversity conservation and ecosystem service provision. Taking the highly urbanized region of England as a case study, we use data from a variety of sources to investigate the impact of national-level planning policy on temporal patterns in the extent of greenspace in cities. Between 1991 and 2006, greenspace showed a net increase in all but one of 13 cities. However, the majority of this gain occurred prior to 2001, and greenspace has subsequently declined in nine cities. Such a dramatic shift in land use coincides with policy reforms in 2000, which favoured densification. Here, we illustrate the dynamic and policy-responsive nature of urban land use, thereby highlighting the need for a detailed investigation of the trade-offs associated with different mechanisms of urban densification to optimize and secure the diverse benefits associated with greenspaces.

scholarly journals Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Meyer Swanepoel ◽  
Bob Mash ◽  
Tracey Naledi
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Health System ◽  
System Performance ◽  
Positive Impact ◽  
Family Physicians ◽  
Health System Performance ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

scholarly journals An Exploration of The Key Issues and Challenges in Implementing Public-Private Partnerships: A Case Study of The Central Java Power Plant Project, Indonesia

2021 ◽  
Author(s):  
◽  
Fikriyatul Falashifah
Keyword(s):  
Power Plant ◽  
Social Issues ◽  
Natural Capital ◽  
National Level ◽  
Public Private Partnerships ◽  
Alternative Mechanism ◽  
Sustainable Livelihood ◽  
Central Java ◽  
The Impact

<p>Over the last two decades, Indonesia began to implement Public-Private Partnerships (PPPs) to provide an alternative mechanism for providing public infrastructure. The need to accelerate development, fulfil national demands and address mounting fiscal constraints are the reasons behind choosing PPP approach. One of the infrastructure projects using PPP mechanisms in Indonesia is Central Java Power Plant (CJPP) project, which is claimed to be the largest power plant in Southeast Asia. The project bidding was won by three consortia including ITOCHU Corporation, Adaro Power and J-Power, while the Government of Indonesia provided a guarantee for this project through the Ministry of Finance (MoF) and the Indonesia Infrastructure Guarantee Fund (IIGF). The project is built under Build, Operate, Own, and Transfer (BOOT) PPP model.  In continuing academic research about PPP in general and CJPP in particular, this study was conducted with the aim of exploring critical issues and challenges in implementing PPPs in CJPP project. Three issues were chosen for particular examination, including governance, environment and social issues. This study was conducted by adopting a qualitative approach under a constructivist epistemology to gain meaning and knowledge from certain phenomena or specific circumstances, in this case, by using CJPP as a single case study. Document reviews, semi-structured interviews, and unstructured observation were carried out from July to September 2018 to gain information and perspectives from multilevel stakeholders who are in charge, involved in and were impacted by the implementation of PPP mechanism in CJPP. Stakeholder Analysis and Sustainable Livelihood Approach were taken as the framework for data analysis.  This study found that top-down approach applied to implementing PPP in CJPP project left some governance issues and dynamics about power relations and regulations; conflicting stakeholders’ interests; communication and knowledge gaps; and dualism perspectives for viewing the scheme. The Governments of Central Java and Batang Regency underwent difficulties in structuring and implementing Environmental and Social Impact Assessment (ESIA), or in Bahasa Indonesia known as AMDAL. Meanwhile, coal, the major resource that will be utilised in this project, faces issues surrounding its emissions, stock, and sustainability. Several issues regarding five forms of capital for sustainable livelihood – human capital, social capital, economic capital, natural capital and physical capital – also arose during the project period. These issues included differing perspectives and sentiments among the surrounding societies and economic inequalities, as well as cultural and migration issues.  It is hoped that this research can inform our understanding of PPP implementation, both in policy and in practice. Based on this study, PPP practice at the national level should standardise documents and processes as well as having project assistance. At the regional level, the local government must be more empowered regarding their roles, responsibilities and resource management. Moreover, the impact of PPP on environment and society should be more precisely predicted and managed.</p>

scholarly journals Comparing Impact Evaluation Evidence of EU and Local Development Policies with New Urban Agenda Themes: The Agri Valley Case in Basilicata (Italy)

2021 ◽  
Vol 13 (16) ◽  
pp. 9376
Author(s):  
Piergiuseppe Pontrandolfi ◽  
Priscilla Sofia Dastoli
Keyword(s):  
Impact Evaluation ◽  
Local Development ◽  
Methodological Approach ◽  
National Level ◽  
Open Data ◽  
Use Of Resources ◽  
Italian Regions ◽  
The Impact ◽  
New Urban Agenda

The European Union’s Cohesion Policy is the most important structural policy in terms of financial commitment, geographical size and time frame, aimed at redistributing wealth between regions and countries, to stimulate growth in areas whose development is lagging behind. The reach of the investments prompted the EU Commission to promote an impact evaluation of the European Structural Funds (SF); however, the impact evaluation of EU programs is almost neglected in the Italian regions. This paper is based on the results developed within the RI.P.R.O.VA.RE project and is aimed at defining an impact evaluation of EU SF and other regional funds, based on evidence derived from the analysis of a specific case study in the Agri Valley area (Basilicata, Italy). To develop the impact evaluation process, the euro amounts of all the individual policies organized according to the themes of the New Urban Agenda (NUA), the impact indicators and the trend for the municipalities are considered together, in order to obtain an overall trend for the entire case study area. An important result is achieved above all in the methodological approach to impact evaluation: the municipal territorial scale is taken into account; the maps illustrate the use of resources; regardless of the type of funding source since there is a comparison between the priority axes of the funds with the NUA issues; and indicators are developed with open data available at a national level. This experiment makes it possible to detect that, even in the face of significant investments, some substantial aspects that are part of the policy objectives remain unchanged or even worsen.

scholarly journals Country-Wide Resilience Model for the Health System: A Case Study on Iran, under Coronavirus Outbreak

2021 ◽  
Author(s):  
Nazanin Pilevari ◽  
Mahyar Valeh Shiva
Keyword(s):  
Health System ◽  
Health Systems ◽  
Dynamic Capabilities ◽  
Health Information System ◽  
National Health System ◽  
Building Blocks ◽  
Interpretive Structural Modeling ◽  
System A ◽  
The Impact

Background: The outbreak of the COVID-19 virus has had many destructive impacts on socio-economic and health systems. The health systems of countries could be supportive in crisis management, but they also are affected by the impact of the crisis, consequently, their operational level has declined. This study pursued resilience in an overall national health system under pandemic stress. Methods: Based on WHO building blocks, by interviewing informants of the Ministry of Health and Medical Education, in Tehran-Iran, early 2021 a rich picture of the current situation depicted, the resilience model was extracted via a mixed method of Soft System Methodology (SSM) and total interpretive structural modeling (TISM). Dynamic capabilities were applied for the orchestration of the Iranian health system. Results: Particular functional and structural suggestions applicable for designing a ubiquitous resilience model for the country-wide health system are presented in this study. The variables of crisis sensing, opportunity seizing, and reconfiguration are the cornerstones of health system resilience. Conclusion: Well-suited health technology assessment (HTA) and health information system (HIS) play significant roles in the overall strengthening of the health system. All reforms for resilience will have a lasting result when the capabilities created by the resilience model are learned and reused in a dynamic cycle.

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