The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital.

BACKGROUND: The COVID-19 pandemic and its containment measures have drastically impacted end-of-life and grief experiences globally, including those related to medical assistance in dying (MAiD). No known qualitative studies to date have examined the MAiD experience during the pandemic. This qualitative study aimed to understand how the pandemic impacted the MAiD experience in hospital of persons requesting MAiD (patients) and their loved ones (caregivers) in Canada. METHODS: Semi-structured interviews were conducted with patients who requested MAiD and their caregivers between April 2020 and May 2021. Participants were recruited during the first year of the pandemic from the University Health Network and Sunnybrook Health Sciences Centre in Toronto, Canada. Patients and caregivers were interviewed about their experience following the MAiD request. Six months following patient death, bereaved caregivers were interviewed to explore their bereavement experience. Interviews were audio-recorded, transcribed verbatim, and de-identified. Transcripts were analyzed using reflexive thematic analysis. RESULTS: Interviews were conducted with 7 patients (mean [SD] age, 73 [12] years; 5 [63%] women) and 23 caregivers (mean [SD] age, 59 [11] years; 14 [61%] women). Fourteen caregivers were interviewed at the time of MAiD request and 13 bereaved caregivers were interviewed post-MAiD. Four themes were generated with respect to the impact of COVID-19 and its containment measures on the MAiD experience in hospital: (1) accelerating the MAiD decision; (2) compromising family understanding and coping; (3) disrupting MAiD delivery; and (4) appreciating rule flexibility. CONCLUSIONS: Findings highlight the tension between respecting pandemic restrictions and prioritizing control over the dying circumstances central to MAiD, and the resulting impact on patient and family suffering. There is a need for healthcare institutions to recognize the relational dimensions of the MAiD experience, particularly in the isolating context of the pandemic. Findings may inform strategies to better support those requesting MAiD and their families during the pandemic and beyond.

Rapid Expansion and Adaptability of California Medical Disaster Teams.

The California Medical Assistance Team (CAL-MAT) program is coordinated by the California Emergency Medical Services Authority (EMSA). The program was developed to deploy and support medical personnel for disaster medical response. During the coronavirus disease (COVID-19) pandemic, the program and missions grew rapidly in response to medical surge, programs for testing and vaccination, and other concurrent disasters. CAL-MAT enrollment increased 10-fold from approximately 200 members at the beginning of 2020, to an estimated 2200 members by June 2021. This article describes the flexible use of a state-managed disaster medical response program within California and some of the challenges associated with rapid expansion and varied demands during the COVID-19 surges of March 2020-March 2022. CAL-MAT may serve as a model for development of similar state-sponsored or other disaster medical response teams.

Post-COVID-19 pandemic public health: Issues and challenges in India.

COVID-19 was an unexpected public health emergency. The key positive features of the Indian health system were demonstrated during the pandemic. Postpandemic is the time to introspect. Various issues and challenges facing the Indian Public Health System require due attention.

Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making.

A private-academic partnership built the Vaccine Equity Planner (VEP) to help decision-makers improve geographic access to COVID-19 vaccinations across the United States by identifying vaccine deserts and facilities that could fill those deserts. The VEP presented complex, updated data in an intuitive form during a rapidly changing pandemic situation. The persistence of vaccine deserts in every state as COVID-19 booster recommendations develop suggests that vaccine delivery can be improved. Underresourced public health systems benefit from tools providing real-time, accurate, actionable data. (Am J Public Health. 2023;113(4):363-367. https://doi.org/10.2105/AJPH.2022.307198).

What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs.

BACKGROUND: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. METHODS: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. RESULTS: The following four key 'foundations of resilience' were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: 'realigned relationships,' 'foresight,' 'motivation,' and 'emergency preparedness.' The attribute to 'integrate' was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. CONCLUSIONS: Health system resilience is a collective endeavour and a result of many stakeholders' consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. The experiences and perspectives of Swiss NGOs in this article highlight the vital role NGOs may play in building resilient health systems in their partner countries. Specifically, strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and bear the responsibility to support governments to prioritise investing in the key 'foundations of resilience' in order to activate greater attributes of resilience. Resilience building will not only prepare countries for future shocks but bridge the disparate health and development agenda in order to better address the nexus between humanitarian aid and development cooperation.

How can we strengthen partnership and coordination for health system emergency preparedness and response? Findings from a synthesis of experience across countries facing shocks.

BACKGROUND: Discussions of health system resilience and emergency management often highlight the importance of coordination and partnership across government and with other stakeholders. However, both coordination and partnership have been identified as areas requiring further research. This paper identifies characteristics and enablers of effective coordination for emergency preparedness and response, drawing on experience from different countries with a range of shocks, including floods, drought, and COVID-19. METHODS: The paper synthesises evidence from a set of reports related to research, evaluation and technical assistance projects, bringing together evidence from 11 countries in sub-Saharan Africa and South Asia. Methods for the original reports included primary data collection through interviews, focus groups and workshop discussions, analysis of secondary data, and document review. Reports were synthesised using a coding framework, and quality of evidence was considered for reliability of the findings. RESULTS: The reports highlighted the role played by coordination and partnership in preparedness and response, and identified four key areas that characterise and enable effective coordination. First, coordination needs to be inclusive, bringing together different government sectors and levels, and stakeholders such as development agencies, universities, the private sector, local leaders and civil society, with equitable gender representation. Second, structural aspects of coordination bodies are important, including availability of coordination structures and regular meeting fora; clear roles, mandates and sufficient authority; the value of building on existing coordination mechanisms; and ongoing functioning of coordination bodies, before and after crises. Third, organisations responsible for coordination require sufficient capacity, including staff, funding, communication infrastructure and other resources, and learning from previous emergencies. Fourth, effective coordination is supported by high-level political leadership and incentives for collaboration. Country experience also highlighted interactions between these components, and with the wider health system and governance architecture, pointing to the need to consider coordination as part of a complex adaptive system. CONCLUSION: COVID-19 and other shocks have highlighted the importance of effective coordination and partnership across government and with other stakeholders. Using country experience, the paper identifies a set of recommendations to strengthen coordination for health system resilience and emergency management.

The contribution of social norms and religious practices towards low death registration in 3 HDSS sites of Uganda.

BACKGROUND: Uganda has low levels of death registration, estimated at two per cent by the National Identification and Registration Authority (NIRA). There are 56 tribes and over 5 religious denominations with so many social norms and religious practices that could have contributed to low death registration in Uganda. Previous studies on the factors affecting death registration have not assessed the contribution of social norms and religious practices toward low death registration in developing countries. METHODS: A qualitative study design was adopted to examine the contribution of social norms and religious practices toward low death registration in the 3 Health and Demographic Surveillance systems (HDSS) sites of Uganda. The methods of data collection included: focus group discussions, key informant interviews, and a document review of the death registration booklet. 6 FGDs, 2 from each HDSS site were conducted comprising 1 female FGD of 10 participants and 1 male FGD of 10 participants. In addition, 26 key informant interviews were conducted with the district leaders, local council leaders, health care workers, cultural leaders, elderly, HDSS scouts and religious leaders in the 3 HDSS sites. RESULTS: In the 4 sub-counties and 1 town council where the study was conducted, only 32 deaths were registered with NIRA, the Civil Registration authority in Uganda for the entire year from 1st January to 31st December 2020. The study shows that social norms and religious practices have contributed to the low death registration in the 3 HDSS sites in Uganda. Social norms and religious practices either hinder or discourage death registration initiatives by the government of Uganda. It was found out that burials that take place on the same day of death discourage death registration. Cultural taboo to announcing the death of infants, neonates, twins and suicides in the community hinder death registration. The burying of a woman at her parent's house after bride price payment default by the family of a husband discourages death registration. The religious institutions have their own set of rules, practices, and norms, which in most cases discourage death registration. For example, religious leaders refuse to lead funeral prayers for non-active members in religious activities. Results also showed that mixed religions in families bring about conflicts that undermine death registration. Lastly, results showed that traditionalists do not seek medical treatment in hospitals and this hinders death registration at the health facilities. CONCLUSION: The study shows that death registration is very low in the 3 HDSS sites in Uganda and that social norms and religious practices contribute greatly to the low death registration. To overcome the negative effects of social norms and religious practices, a social behaviour campaign is proposed. In addition, community dialogue should be conducted to identify all negative social norms and religious practices, how they are perpetuated, their effects, and how they can be renegotiated or eliminated to bring about high death registration in the 3 HDSS sites of Uganda. Lastly, there is a need for partnerships with cultural and religious leaders to sensitize community members on the effect of social norms and religious practices on low death registration in the 3 HDSS sites in Uganda.

Factors influencing international collaboration on the prevention of COVID-19.

OBJECTIVES: COVID-19 has spread rapidly throughout the world, which has highlighted the importance of collaboration between countries to prevent further transmission of the virus. This review aims to identify the factors that influence international collaboration between policymakers for COVID-19 prevention and consider strategies to manage pandemics in the future. STUDY DESIGN: A scoping review was conducted using the Arksey and O'Malley framework for scoping reviews. METHODS: A literature search was performed across PubMed, Google Scholar, Scopus and Embase databases using relevant keywords. The initial search identified 1010 articles; after selection criteria were applied, 28 studies were included in the review. RESULTS: Most of the selected articles were literature reviews, and China had the greatest contribution of articles to this study. The following seven key categories influencing international collaboration were identified: political, structure, infrastructure, leadership and governance, knowledge and information sharing, community engagement, and process/action. CONCLUSION: Leadership and governance was the most important factor identified in international collaboration between countries. In addition, knowledge and information sharing were seen to help avoid repetition of negative situations experienced in other countries. Moreover, controlling COVID-19 on a global scale is more likely to be achieved when there are sufficient structures and resources and when appropriate communication between countries, health systems and communities is used. This collaboration can also greatly benefit low- and middle-income countries where resources and expertise are often limited.

Universality of universal health coverage: A scoping review.

BACKGROUND: The progress of Universal health coverage (UHC) is measured using tracer indicators of key interventions, which have been implemented in healthcare system. UHC is about population, comprehensive health services and financial coverage for equitable quality services and health outcome. There is dearth of evidence about the extent of the universality of UHC in terms of types of health services, its integrated definition (dimensions) and tracer indicators utilized in the measurement of UHC. Therefore, we mapped the existing literature to assess universality of UHC and summarize the challenges towards UHC. METHODS: The checklist Preferred Reporting Items for Systematic reviews and Meta-analysis extension for Scoping Reviews was used. A systematic search was carried out in the Web of Science and PubMed databases. Hand searches were also conducted to find articles from Google Scholar, the World Bank Library, the World Health Organization Library, the United Nations Digital Library Collections, and Google. Article search date was between 20 October 2021 and 12 November 2021 and the most recent update was done on 03 March 2022. Articles on UHC coverage, financial risk protection, quality of care, and inequity were included. The Population, Concept, and Context framework was used to determine the eligibility of research questions. A stepwise approach was used to identify and select relevant studies, conduct data charting, collation and summarization, as well as report results. Simple descriptive statistics and narrative synthesis were used to present the findings. RESULTS: Forty-seven papers were included in the final review. One-fourth of the articles (25.5%) were from the African region and 29.8% were from lower-middle-income countries. More than half of the articles (54.1%) followed a quantitative research approach. Of included articles, coverage was assessed by 53.2% of articles; financial risk protection by 27.7%, inequity by 25.5% and quality by 6.4% of the articles as the main research objectives or mentioned in result section. Most (42.5%) of articles investigated health promotion and 2.1% palliation and rehabilitation services. Policy and healthcare level and cross-cutting barriers of UHC were identified. Financing, leadership/governance, inequity, weak regulation and supervision mechanism, and poverty were most repeated policy level barriers. Poor quality health services and inadequate health workforce were the common barriers from health sector challenges. Lack of common understanding on UHC was frequently mentioned as a cross-cutting barrier. CONCLUSIONS: The review showed that majority of the articles were from the African region. Methodologically, quantitative research design was more frequently used to investigate UHC. Palliation and rehabilitation health care services need attention in the monitoring and evaluation of UHC progress. It is also noteworthy to focus on quality and inequity of health services. The study implies that urgent action on the identified policy, health system and cross-cutting barriers is required to achieve UHC.

Liquidity constraints, cash transfers and the demand for health care in the Covid-19 pandemic.

This paper proposes the hypothesis that liquidity constraints may delay or even prevent sick individuals from seeking medical help. If this is the case, a cash transfer can directly increase the demand for medical care. We evaluated this hypothesis empirically in the context of the implementation of Emergency Aid (EA), a large-scale cash transfer program in Brazil, during the Covid-19 pandemic. We used the program's implementation calendar along with a Regression Discontinuity in Time to assess the causal effects of EA on the search for the health system. Consistent with our hypothesis, we estimate that the transfer immediately decreased the time to search for the health system by 14% and increased COVID-19 hospitalizations by 0.015%.

The impact of coronavirus disease 2019 on medical assistance in dying.

PURPOSE OF REVIEW: The COVID-19 pandemic and measures to contain its impact are drastically altering end-of-life and grief experiences around the world, including the practice and experience of medical assistance in dying (MAiD). RECENT FINDINGS: Recent published literature on the impact of COVID-19 on MAiD can be described under the following categories: studies investigating the impact of COVID-19 on MAiD from the healthcare providers' perspective; studies investigating the impact of COVID-19 on MAiD from the patient/family perspective; and opinion papers that review the impact of COVID-19 on MAiD from a legal-ethical perspective. Most of these studies were either conducted in Canada or included mostly Canadian participants. SUMMARY: Recent published research on the impact of COVID-19 on MAiD highlights the tensions between COVID-19 restrictions and individual control over the circumstances of dying, and the resulting impact on patient and family suffering and on moral injury for their MAiD providers. These reports may help inform risk mitigation strategies for the current pandemic and future similar public health crises that acknowledge the value of humane, family-centered care at the end of life.

COVID-19 Home Monitoring After Diagnosis and Health Care Utilization in an Integrated Health System.

This cohort study examines health care utilization patterns for patients with COVID-19 who were enrolled vs not enrolled in a home monitoring program.

The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages.

BACKGROUND: Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. METHODS/ RESULTS: To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as 'state security' not 'human security' or population health. CONCLUSION: Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.

European Countries Step-up Humanitarian and Medical Assistance to Ukraine as the Conflict Continues.

On the 24th of February 2022, the Russian Federation began an unprovoked invasion of Ukraine, marking the biggest military attack in Europe since the second world war. Over 4 million people have fled their homeland within the first month of the war and have triggered a large refugee crisis with impacts far beyond the Ukrainian border. People in the neighboring countries have shown tremendous support by stepping forward to donate food, clothes, medications, money, and other essential supplies. The governments and other regional stakeholders have also been supportive in accommodating and easing regulations for the incoming refugees. Herein, we summarize the humanitarian measures and medical donations that have been made by European countries as they stepped up their efforts to provide refugees with all necessary basic services. We further highlight potential oncoming challenges in Ukraine and the host countries along with relevant solutions to these challenges. The current scenario highlights the need for multi-party and multi-level collaborations (both public and private) to tackle the emerging situation.