Impact of health systems reform on COVID-19 control in Sierra Leone: a case study.

BACKGROUND: There are various impacts of COVID-19 on health systems of the world. The health systems of low- and middle-income countries are less developed. Therefore, they have greater tendencies to experience challenges and vulnerabilities in COVID-19 control compared to high-income countries. It is important to contain the spread of the virus, and likewise strengthen the capacity of health systems in order for the response to be effective and swift. The experience from 2014 to 2016 Ebola outbreak in Sierra Leone served as preparation for COVID-19 outbreak. The aim of this study is to determine how control of COVID-19 outbreak in Sierra Leone was enhanced by the lessons learned from 2014 to 2016 Ebola outbreak, and health systems reform. METHODS: We used data from a qualitative case study conducted in four districts in Sierra Leone through key informant interviews, focus group discussions, document, and archive record reviews. A total of 32 key informant interviews and 14 focus group discussions were conducted. A thematic analysis was used to analyze the data, and all transcripts were coded and analyzed with the aid of ATLAS.ti 9 software program. RESULTS: The six themes obtained were composed of categories that connect with each other and with codes to form networks. The analysis of the responses demonstrated that "Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners", and "Awareness in the Community" were among the key interventions used during the control of 2014-2016 Ebola virus disease outbreak, which were applied in the control of COVID-19. An infectious disease outbreak control model was proposed based on the results obtained from the analysis of the lessons learned during the Ebola virus disease outbreak, and health systems reform. CONCLUSIONS: "Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners" and "Awareness in the Community" are key strategies that enhanced the control of the COVID-19 outbreak in Sierra Leone. It is recommended that they are implemented in controlling COVID-19 pandemic or any other infectious disease outbreak. The proposed model can be used in controlling infectious disease outbreaks, especially in low- and middle-income countries. Further research is needed to validate the usefulness of these interventions in overcoming an infectious disease outbreak.

Reforming Our School Systems Around a Humanizing Curriculum: Schooling During and After COVID-19

Highlights • The COVID-19 pandemic provides an opportunity to create new school systems that are centered around a humanizing curriculum. • A humanizing curriculum values self, social, and cultural knowledge in addition to academic knowledge, celebrating students as whole human beings who are learning about and creating their place in society. • This curriculum is co-created and co-implemented with students and families. • Through this co-creation and co-implementation process, we shift school systems to support a humanizing curriculum.

Who's to blame for Greece?: Life after bankruptcy: Between optimism and substandard growth

This expanded and enlarged third edition of Theodore Pelagidis and Michael Mitsopoulos' popular Who's to Blame for Greece? covers almost a decade of Greece's economic crisis from 2009 to 2019, as well as recent developments in the first months of 2020. It provides an overview of recent developments in the Greek economy and outlines the most important obstacles to a return to robust and sustainable growth rates. It considers the new optimism being developed in Greece after the crisis, but also the policy challenges facing Greece emanating from a deeply hurt economy in the aftermath of the crisis and the structural problems that persist. The book covers the most recent issues that affect the Greek economy including, the migration crisis at the borders with Turkey as well as a faltering global economy hit by the Covid-19 pandemic. This book will appeal to researchers, practitioners and policy makers interested in the EU and the political economy of Greece and offers valuable updates on the second edition. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021.

Exploring austerity and planning reforms: insight from UK stakeholders

This paper explores the extent to which UK planning system reforms introduced during austerity affected the expectations, purposes and outcomes for and of planning. The perspectives of UK-wide planning system stakeholders were sought and collected through an extensive questionnaire. The findings indicate that though most reforms were welcomed in principle, the anticipated benefits had not been delivered. Instead, a loss of experienced staff and capacity, and the favouring of a neoliberal ideology that inadvertently constrained the purposes and delivery of the reforms, affecting in turn, planning's evolving raison d'être, occurred. With frequent mentioning of austerity as a needed tool for financial management, given the current national economic conditions e.g., in the UK (living cost crisis, post covid need for economic growth, public funding of facilities), the relevance of this paper is in warning about the risks towards planning reforms, that must now be more precautionary, and more evidence driven, during austerity. © 2023 ICE Publishing: All rights reserved.

Comparison of hospitalization expenses for identical diseases between traditional Chinese medicine and Western medicine hospitals based on interrupted time-series analysis.

Objective In light of the comprehensively implemented reform of medical insurance payments, this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine (TCM) and Western medicine hospitals, to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load. Methods From January 2014 to December 2020, we gathered data including 9 900 individual medical records of woman-related malignant tumors (WMT) from all 23 public hospitals in a district of Shanghai. We developed an interrupted time-series analysis model based on the above two interventions, to compare the inpatient average per-time expenses between different hospitals and different groups. Results The average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention, and increased again during the pandemic. In TCM hospitals, the expenses continued to increase and fluctuated after the pandemic. Conclusion The policy intervention has achieved a good effect on controlling the cost of Western hospitals, rather than the significant increase in TCM hospitals. Meanwhile, the COVID-19 pandemic has had a significant impact on hospitalization expenses. It's urgent to develop a payment model that fits the development and characteristics of TCM, to control the unreasonable growth of expenses. Moreover, the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.Copyright © 2023 West China University of Medical Science. All rights reserved.

Comparison of hospitalization expenses for identical diseases between traditional Chinese medicine and Western medicine hospitals based on interrupted time-series analysis.

Objective In light of the comprehensively implemented reform of medical insurance payments, this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine (TCM) and Western medicine hospitals, to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load. Methods From January 2014 to December 2020, we gathered data including 9 900 individual medical records of woman-related malignant tumors (WMT) from all 23 public hospitals in a district of Shanghai. We developed an interrupted time-series analysis model based on the above two interventions, to compare the inpatient average per-time expenses between different hospitals and different groups. Results The average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention, and increased again during the pandemic. In TCM hospitals, the expenses continued to increase and fluctuated after the pandemic. Conclusion The policy intervention has achieved a good effect on controlling the cost of Western hospitals, rather than the significant increase in TCM hospitals. Meanwhile, the COVID-19 pandemic has had a significant impact on hospitalization expenses. It's urgent to develop a payment model that fits the development and characteristics of TCM, to control the unreasonable growth of expenses. Moreover, the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.Copyright © 2023 West China University of Medical Science. All rights reserved.

How to not revert to type: Complexity-informed learnings from the pandemic response for health system reform and universal access to integrated care.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Background: COVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities. Aims and objectives: This study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation. Methods: The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context. Findings: A range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.

COVID, Crime & Criminal Justice: Affirming the Call for System Reform Research.

Early into the COVID-19 pandemic, Miller & Blumstein (2020) outlined a theoretical research program (TRP) oriented around themes of contagion control and containment, legal amnesty, system leniency, nonenforcement, and tele-justice. Here, two and a half years later, these lingering themes are revisited to advocate for empirical research informing criminal justice system reform. The pandemic created rare natural experiment research conditions that enable unique and potentially valuable insights on necessitated innovations that may indicate future justice practices and policies. Given the sweeping effects of the shutdown, examples are numerous ranging from staffing analyses to estimate agencies' personnel needs to ensure that basic public safety functions can be met after early retirements and resignations from virus risk and anti-police sentiment, the use of virtual communication in various legal proceedings at arrest, incarceration, and release junctures, and, especially, the risks versus benefits of early release. In addition to better identifying who should be jailed pre-trial, prioritization of calls for service, triaging of court cases, and hygiene and sanitation issues within facilities are other important examples central to a COVID and crime TRP. Attending research could demonstrate the utility of normative operations and identify shortfalls to be addressed during anomic conditions prior to another shutdown or similar event and present, through comparison of innovative and traditional derived outcomes, system reform and improvement opportunities. By seizing upon rare data made possible by natural experimental COVID generated conditions, researchers can meaningfully investigate the ongoing applicability of justice system adaptations mandated by the pandemic in terms of effectiveness and efficiency toward the interrelated goals of evidence-based practice discovery and justice reform.

Development Status and Trend Analysis of Internet of Medical Things Industry in China

This article analyzes the development status, development trend and prospects of China's Internet of Medical Things (IoMT) industry from a macro perspective. Our survey mainly includes: analyzing the necessity and urgency of China's medical system reform from the various dilemmas faced by China's medical system, and analyzing the development of the IoMT industry based on the current basic conditions of development of the Internet of Things (IoT), information technology and background of COVID-19 epidemic. Opportunities and the evolution of China's IoMT policy were also analyzed. Moreover, from the five aspects of medical industry informatization, Internet hospitals, smart wearable devices, medical AI industry and medical industry digitization, the development status and trends of China's IoMT industry are analyzed. Finally, it looks forward to the development prospects and directions of IoMT industry for health care in China. © 2022 The authors and IOS Press.

Challenges and Countermeasures for the Sustainable Development of Local Finance under the Impact of COVID-19

In recent years, the risks and challenges at home and abroad have increased significantly, and the downward pressure on the economy has increased, especially the implementation of larger-scale tax and fee cuts under the proactive fiscal policy, while the rigidity of local fiscal expenditure has not been reduced, and the sustainable development of local finance is facing greater challenges. In particular, the COVID-19 pandemic has had a serious impact on the already stressed local finance, which has led to the intensified contradiction between local fiscal revenue and expenditure. This paper analyzes the challenges to the sustainable development of local finance under the impact of COVID-19 from four angles: the greater economic downward pressure combined with larger-scale tax and fee cuts, the fiscal relationship between the central and local governments, land finance, and transfer payment, then puts forward the corresponding policy recommendations. © 2021 Published by De Gruyter on behalf of the National Academy of Economic Strategy, Chinese Academy of Social Sciences.

Implementing High-Quality Primary Care Through a Health Equity Lens.

The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report's framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion, and health equity that have been long overdue. The time to transition those conversations to actionable items to improve the health of patients, families, and communities is now.Appeared as Annals "Online First" article.

Suggestions and thoughts on the reform of China’s public health system during COVID-19

This paper analyzed many problems in the construction of China′s public health system exposed in the process of prevention and control of novel coronavirus′s epidemic situation. Conscientiously studying the spirit of the two sessions, combined with the national conditions of our country, this paper put forward several specific reform suggestions on the legal system construction of the public health system, the improvement of the institutional system, the training direction of public health personnel, the public health service system, the information construction and the construction of the health emergency system, to made a preliminary exploration on the further improvement of the emergency response mechanism of major epidemic situations. © 2021, Publication Centre of Anhui Medical University. All rights reserved.

Building health system resilience through policy development in response to COVID-19 in Ireland: From shock to reform.

Health systems worldwide are experiencing profound shocks resulting from the COVID-19 pandemic, with increased attention to health system resilience and researching ways to endure shocks. Pre-COVID-19, Ireland had begun a ten-year programme of reform, Sláintecare, aiming to deliver universal, timely access to integrated care. This study examines whether and how the Irish government's pandemic response contributed to health system reform and increased resilience including delivering universal healthcare. Documentary analysis identified and critiqued relevant government, health system and budgetary documents, published March 2020 - May 2021. Thirteen national policy documents were found, showing increased policy rhetoric and intent to implement reform, demonstrated by increased policy alignment with and budgetary allocation to Sláintecare, alongside implementation of key innovations. Ireland's health system response to COVID-19 offers a unique opportunity to advance understanding of government efforts to reform amidst a global pandemic. It indicated policy intent and funding to manage the Irish COVID-19 crisis, but to also build health system resilience through implementing Sláintecare. This case study has international significance, enabling policy development with potential for long-term health system transformation.

Pandemic momentum for health systems financialisation: Under the cloaks of Universal Health Coverage.

Although a highly ambiguous and contested idea, Universal Health Coverage (UHC) is the hegemonic concept in international debates on health system reforms. States' difficulties to provide adequate and comprehensive response to people's health needs arising from the COVID-19 pandemic strengthened the impetus for UHC implementation. But while featured as the way to achieve justice in health, analyses of UHC-kind reform experiences since the 1990s show that it may be comprehended rather as a new facet of neoliberalism in the health policies' arena. Its insurance arrangements are aimed to finance packages of health goods and services for the poor, while states play mainly a role of public funds administrators, buying from public and private providers competing in the market. UHC contributes to health system fragmentation and segmentation, weakens public structures and opens new markets for corporations to capture public funds. COVID-19 pandemic subjected health systems to unforeseen stress, underscoring the crucial role that a well-funded public health system plays in people's lives. Assessing pandemic's challenges may be an opportunity to build more egalitarian health systems, based on dignity and not people's money. However, the unreflecting adoption of technocratic health paradigms and solutions may, instead, ultimately pave the way for further health financialisation and injustice.

Sláintecare implementation status in 2020: Limited progress with entitlement expansion.

The Sláintecare report developed by political consensus sets out a ten year plan for achieving Universal Health Care (UHC) in Ireland. This paper evaluates the design and progress of the report to mid 2020, but with some reflection on the new COVID 19 era, particularly as it relates to the expansion of entitlements to achieve UHC. The authors explore how close Sláintecare is to the UHC ideal. They also review the phased strategy of implementation in Sláintecare that utilises a systems-thinking approach with interlinkages between entitlements, funding, capacity and implementation. Finally the authors review the Sláintecare milestones against the reality of implementation since the publication of the report in 2017, cognisant of government policy and practice. Some of the initial assumptions around the context of Sláintecare were not realised and there has been limited progress made toward expanding entitlements, and certainly short of the original plan. Nevertheless there have been positive developments in that there is evidence that Government's Implementation Strategy and Action Plans are focussing on reforming a complex adaptive system rather than implementing a blueprint with such initiatives as integrated care pilots and citizen engagement. The authors find that this may help the system change but it risks losing some of the essential elements of entitlement expansion in favour of organisational change.

The 2019 crisis in Chile: fundamental change needed, not just technical fixes to the health system.

Chile has been viewed as an exemplar of social and economic progress in Latin America, with its health system attracting considerable attention. Eruption of widespread civil disorder marred this image in 2019. We trace the evolution of Chilean health policy and place it in context with developments in other sectors, pensions and education. We argue that much has been achieved, but further progress will necessitate politicians tackling the enduring power of elites that has prevented reform of a two-tier system enshrined in policies of the dictatorship.

The social underpinnings of mental distress in the time of COVID-19 - time for urgent action.

We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.  Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services.  However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations.  Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care.  Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

National Response to COVID-19 in the Republic of Korea and Lessons Learned for Other Countries.

In the first two months of the COVID-19 pandemic, the Republic of Korea (South Korea) had the second highest number of cases globally yet was able to dramatically lower the incidence of new cases and sustain a low mortality rate, making it a promising example of strong national response. We describe the main strategies undertaken and selected facilitators and challenges in order to identify transferable lessons for other countries working to control the spread and impact of COVID-19. Identified strategies included early recognition of the threat and rapid activation of national response protocols led by national leadership; rapid establishment of diagnostic capacity; scale-up of measures for preventing community transmission; and redesigning the triage and treatment systems, mobilizing the necessary resources for clinical care. Facilitators included existing hospital capacity, the epidemiology of the COVID-19 outbreak, and strong national leadership despite political changes and population sensitization due to the 2015 Middle East respiratory syndrome-related coronavirus (MERS-CoV) epidemic. Challenges included sustaining adequate human resources and supplies in high-caseload areas. Key recommendations include (1) recognize the problem, (2) establish diagnostic capacity, (3) implement aggressive measures to prevent community transmission, (4) redesign and reallocate clinical resources for the new environment, and (5) work to limit economic impact through and while prioritizing controlling the spread and impact of COVID-19. South Korea's strategies to prevent, detect, and respond to the pandemic represent applicable knowledge that can be adopted by other countries and the global community facing the enormous COVID-19 challenges ahead.