Strengthening Health Systems Using Innovative Digital Health Technologies in Africa.

While effective health systems are needed to advance Universal Health Coverage and actualize the health Sustainable Development Goals, information system verticalization remains a challenge among African health systems. Most investments are vertical, partner-driven and program-specific with limited system-wide impacts. Poor linkages exist amongst different solutions as they are not designed to capture robust data across multiple programmatic areas. To address these challenges, the World Health Organization Africa Regional Office has proposed the adoption of a Digital Health Platform (DHP) to streamline different solutions to a cohesive whole. The DHP presents a pragmatic approach of bringing multiple platforms together using recognized standards to create a national infostructure, which bridges information solutions toward healthy and sustainable outcomes. It has capacities to curate accurate, high fidelity and timely data feedback loops needed to strengthen and continuously improve program delivery, monitoring, management, and informed decision-making at every level of the health system regardless of location. This paper contributes to the ongoing regional conversations on the need to harness innovative digital solutions to improve healthcare delivery in Africa.

Monkeypox vaccination in the global south: Fighting a war without a weapon.

Background: The Mpox outbreak awakened countries worldwide to renew efforts in epidemiological surveillance and vaccination of susceptible populations. In terms of Mpox vaccination, various challenges exist in the global south, which impede adequate vaccine coverage, especially in Africa. This paper reviewed the situation of Mpox vaccination in the global south and potential ameliorative approaches. Methods: A review of online literature from PubMed and Google Scholar concerning Mpox vaccination in countries belonging to the 'global south' category was done between August and September, 2022. The major focus areas included inequity in global vaccine distribution, challenges impeding vaccine coverage in the global south, and potential strategies for bridging the gap in vaccine equity. The papers that met the inclusion criteria were collated and narratively discussed. Results: Our analysis revealed that, while the high-income countries secured large supplies of the Mpox vaccines, the low- and middle-income countries were unable to independently access substantial quantities of the vaccine and had to rely on vaccine donations from high-income countries, as was the case during the COVID-19 pandemic. The challenges in the global south particularly revolved around inadequate vaccine production capacity due to lack of qualified personnel and specialized infrastructure for full vaccine development and manufacturing, limited cold chain equipment for vaccine distribution, and consistent vaccine hesitancy. Conclusion: To tackle the trend of vaccine inequity in the global south, African governments and international stakeholders must invest properly in adequate production and dissemination of Mpox vaccines in low- and middle-income countries.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia.

BACKGROUND: Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS: Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS: At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION: This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.

Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE).

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country's adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Social distancing in urban contexts in the COVID-19 pandemic: challenges for the field of mental health / Distanciamento social em contextos urbanos na pandemia de Covid-19: desafios para o campo da saúde mental

Resumo Neste artigo, analisamos o distanciamento social, principal ação preventiva na pandemia de Covid-19, como fenômeno que ultrapassa sua demarcação como medida sanitária, revelando-se como experiência humana desdobrada em sofrimentos psíquicos diversos, desafiando sob muitas formas o campo da saúde mental. Situamos essa problemática no cenário brasileiro, periférico no capitalismo globalizado, contextualizado na hipermodernidade, no qual sobressai o modo de vida urbano, marcado por desigualdades e produtor de vulnerabilidades que se evidenciam no combate à pandemia, expressandose em sofrimentos e transtornos que desafiam o campo da saúde mental coletiva. Apontamos reflexões e subsídios para a ampliação desse campo, sob uma perspectiva crítica e complexa, concernentes à produção de conhecimentos e do cuidado, focalizando a urbanidade como dimensão analítica central na compreensão do distanciamento. Ilustramos com alguns desafios e também possibilidades de reinvenção em saúde mental, no contexto da pandemia de Covid-19, focalizando tanto ações voltadas à esfera coletiva, em escala macro, na rede pública de saúde, como nos encontros constitutivos do processo de cuidado, buscando subsidiar uma clínica ampliada nesse contexto.

Abstract In this article, we examine social distancing, the main preventive action in the Covid-19 pandemic, as a phenomenon that goes beyond its demarcation as a health measure, revealing itself as a human experience unfolded in various psychological sufferings, challenging the field of Mental Health in many ways. The analysis places this subject in the Brazilian scenario, peripheral in globalized capitalism, contextualized in hypermodernity, in which the urban way of life, stands out, marked by inequalities and vulnerabilities that are evident in the fight against the pandemic, expressing itself in suffering and disorders that challenge the field collective mental health. We point out reflections and subsidies for the expansion of this field, from a critical and complex perspective, concerning the production of knowledge and care practices, focusing on urbanity as a central analytical dimension in the understanding of social distancing. We illustrate with some challenges and possibilities of reinventing mental health, in the context of the Covid-19 pandemic, focusing both on actions aimed at the collective sphere, on a macro scale, in the public health network, as well as in the constitutive meetings of the care process, seeking subsidize an expanded clinic in this context.

Aging and the COVID-19 pandemic: The inter-related roles of biology, physical wellbeing, social norms and global health systems.

The coronavirus disease 2019 (COVID-19) pandemic has had a devastating and disproportionate impact on the elderly population. As the virus has swept through the world, already vulnerable elderly populations worldwide have faced a far greater burden of deaths and severe disease, crippling isolation, widespread societal stigma, and wide-ranging practical difficulties in maintaining access to basic health care and social services - all of which have had significant detrimental effects on their mental and physical wellbeing. In this paper, we present an overview of aging and COVID-19 from the interrelated perspectives of underlying biological mechanisms, physical manifestations, societal aspects, and health services related to the excess risk observed among the elderly population. We conclude that to tackle future pandemics in an efficient manner, it is essential to reform national health systems and response strategies from an age perspective. As the global population continues to age, elderly-focused health services should be integrated into the global health systems and global strategies, especially in low- and middle-income countries with historically underfunded public health infrastructure and insufficient gerontological care.

Integrating health systems for children and young people in out of home care: Challenging the nature of siloed service delivery in rural Australia.

OBJECTIVE: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co-located between child protection practitioners and community health services clinicians. SETTING: Rural Northwest Victoria. PARTICIPANTS: Sunraysia Community Health Services and the Department of Health and Human Services. DESIGN: The qualitative design of the project evaluation involved semi-structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID-19. RESULTS: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector-wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area-based stakeholders, but did not translate to increased access to health plans for children. CONCLUSION: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID-19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area-based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10-year project.

Using generalized structured additive regression models to determine factors associated with and clusters for COVID-19 hospital deaths in South Africa.

BACKGROUND: The first case of COVID-19 in South Africa was reported in March 2020 and the country has since recorded over 3.6 million laboratory-confirmed cases and 100 000 deaths as of March 2022. Transmission and infection of SARS-CoV-2 virus and deaths in general due to COVID-19 have been shown to be spatially associated but spatial patterns in in-hospital deaths have not fully been investigated in South Africa. This study uses national COVID-19 hospitalization data to investigate the spatial effects on hospital deaths after adjusting for known mortality risk factors. METHODS: COVID-19 hospitalization data and deaths were obtained from the National Institute for Communicable Diseases (NICD). Generalized structured additive logistic regression model was used to assess spatial effects on COVID-19 in-hospital deaths adjusting for demographic and clinical covariates. Continuous covariates were modelled by assuming second-order random walk priors, while spatial autocorrelation was specified with Markov random field prior and fixed effects with vague priors respectively. The inference was fully Bayesian. RESULTS: The risk of COVID-19 in-hospital mortality increased with patient age, with admission to intensive care unit (ICU) (aOR = 4.16; 95% Credible Interval: 4.05-4.27), being on oxygen (aOR = 1.49; 95% Credible Interval: 1.46-1.51) and on invasive mechanical ventilation (aOR = 3.74; 95% Credible Interval: 3.61-3.87). Being admitted in a public hospital (aOR = 3.16; 95% Credible Interval: 3.10-3.21) was also significantly associated with mortality. Risk of in-hospital deaths increased in months following a surge in infections and dropped after months of successive low infections highlighting crest and troughs lagging the epidemic curve. After controlling for these factors, districts such as Vhembe, Capricorn and Mopani in Limpopo province, and Buffalo City, O.R. Tambo, Joe Gqabi and Chris Hani in Eastern Cape province remained with significantly higher odds of COVID-19 hospital deaths suggesting possible health systems challenges in those districts. CONCLUSION: The results show substantial COVID-19 in-hospital mortality variation across the 52 districts. Our analysis provides information that can be important for strengthening health policies and the public health system for the benefit of the whole South African population. Understanding differences in in-hospital COVID-19 mortality across space could guide interventions to achieve better health outcomes in affected districts.

Healthcare Financing in Nigeria: A Policy Review.

A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

[Contributions of the new framework for essential public health functions to addressing the COVID-19 pandemicContribuições da nova estrutura para funções essenciais de saúde pública na resposta à pandemia de COVID-19]. / Aportes del nuevo marco para las funciones esenciales de salud pública a la lucha contra la pandemia de COVID-19.

This article uses a health stewardship perspective to interpret the strengths of and challenges to national health authorities' capacities to respond to the COVID-19 pandemic through the renewed essential public health functions (EPHF) framework. Based on a literature review, this article argues that the institutional capacities required by countries to respond to the COVID-19 pandemic in the Americas included all four stages of the new EPHF policy cycle: assessment, policy development, allocation of resources and access. While health authorities provided these key functions (e.g. data analysis, intersectoral policy dialogues, allocation of additional funds), the interventions implemented depended on each 'country's own institutional structures. Health authorities faced significant challenges including fragmentation and the lack of institutional and personnel capacities, thus compromising the delivery of an effective and equitable response. In addition, the response to the pandemic has been uneven due to weaknesses in central leadership and coordination capacity, the politicization of the response and differences in the capacity to respond at subnational levels. Such challenges reflect structural weaknesses that existed prior to the onset of the pandemic, as well as the low prioritization of public health in agendas for health systems strengthening. A future agenda should prioritize improving structural elements while strengthening the stewardship capacities of health authorities and developing institutional structures that guarantee access to and universal coverage of health care.

Este artigo utiliza uma perspectiva de gestão de saúde para interpretar os pontos fortes e os desafios das capacidades das autoridades nacionais de saúde na resposta à pandemia de COVID-19, por meio da estrutura renovada das funções essenciais de saúde pública (FESP). Com base em uma revisão da literatura, este artigo argumenta que as capacidades institucionais requeridas pelos países para responder à pandemia de COVID-19 nas Américas incluíram todas as quatro etapas do novo ciclo de políticas das FESP: avaliação, formulação de políticas, alocação de recursos e acesso. Embora as autoridades de saúde tenham fornecido essas funções essenciais (por exemplo, análise de dados, diálogos intersetoriais de política, alocação de fundos adicionais), as intervenções implementadas dependiam das próprias estruturas institucionais de cada país. As autoridades de saúde enfrentaram desafios significativos, incluindo a fragmentação e a falta de capacidades institucionais e de pessoal, comprometendo, assim, uma resposta eficaz e equitativa. Além disso, a resposta à pandemia tem sido desigual em decorrência de pontos fracos na liderança central e na capacidade de coordenação, da politização da resposta e de diferenças na capacidade de resposta nos níveis subnacionais. Tais desafios refletem as fragilidades estruturais que existiam antes do início da pandemia, bem como a baixa priorização da saúde pública nas agendas para o fortalecimento dos sistemas de saúde. Uma agenda futura deve priorizar a melhoria dos elementos estruturais, ao mesmo tempo em que fortalece as capacidades de gestão das autoridades de saúde e desenvolve estruturas institucionais que garantam o acesso à saúde e a cobertura universal de saúde.

[Organization of healthcare systems to confront COVID-19: a scoping reviewOrganización de los sistemas de salud para hacer frente a la COVID-19: revisión del alcance]. / Organização dos sistemas de saúde no enfrentamento à covid-19: uma revisão de escopo.

Objective: To identify evidence in the literature on the response of managers regarding the organization of global healthcare systems to face the COVID-19 pandemic. Method: For this scoping review, searches were performed in 11 databases accessible through the Virtual Health Library. Eleven studies, published in 2019 and 2020, were selected based on the following guiding question: "How did managers act to organize healthcare systems to face the coronavirus pandemic?". The results were organized in terms of the categories outlined in the Pan-American Health Organization's Framework for the response of Integrated Health Service Delivery Networks to COVID-19: governance; model of care; organizational and management; financial allocations. Results: Managers in countries that invested and articulated actions in the categories of the Reference Framework, with coordination of care at the primary healthcare level, achieved better outcomes in coping with the COVID-19 pandemic. Conclusions: Situating the coordination of healthcare systems at the primary care level, preparing managers and ensuring the continued allocation of financial resources to healthcare are important factors to secure a satisfactory response to crises such as the covid-19 pandemic.

Objetivo: Hacer una búsqueda bibliográfica de la evidencia de la respuesta de los gestores en lo referente a la organización de los sistemas mundiales de salud para hacer frente a la pandemia por el nuevo coronavirus. Método: Se trata de una revisión del alcance, con búsquedas realizadas en 11 bases de datos disponibles en la Biblioteca Virtual de Salud. A partir de la pregunta orientadora sobre "¿cómo actuaron los gestores en la organización de los sistemas de salud para enfrentar la pandemia relacionada con el coronavirus?", se seleccionaron 11 estudios publicados en el período 2019­2020. Los resultados se organizaron a partir de las categorías del Marco de referencia de la red integrada de servicios de salud para la respuesta a la pandemia de COVID-19 de la Organización Panamericana de la Salud, a saber, gobernanza de la red, modelo de atención, organización y gestión, y financiamiento o recursos. Resultados: Se observó que los gestores de los países que invirtieron recursos y organizaron acciones en las categorías del marco de referencia, con la coordinación de los cuidados por medio del sistema de atención primaria de salud, obtuvieron mejores resultados en el abordaje de la pandemia. Conclusiones: La coordinación de los sistemas de salud en el nivel de atención primaria, la preparación de los gestores y el mantenimiento de la asignación continua de recursos financieros al sector de la salud son factores importantes para garantizar una respuesta satisfactoria a crisis como la causada por la pandemia de COVID-19.