Designing and implementing equity-based pandemic preparedness and response learning modules: lessons from a multi-country short-course.

BACKGROUND: The COVID-19 pandemic has had disproportionate impacts across race, social class, and geography. Insufficient attention has been paid to addressing the massive inequities worsened by COVID-19. In July 2020, Partners In Health (PIH) and the University of Global Health Equity (UGHE) delivered a four-module short course, 'An Equity Approach to Pandemic Preparedness and Response: Emerging Insights from COVID-19 Global Response Leaders.' OBJECTIVE: We describe the design and use of a case-based, short-course education model to transfer knowledge and skills in equity approaches to pandemic preparedness and response. METHODS: This course used case studies of Massachusetts and Navajo Nation in the US, and Rwanda to highlight examples of equity-centered pandemic response. Course participants completed a post-session assessment survey after each of the four modules. A mixed-method analysis was conducted to elucidate knowledge acquisition on key topics and assess participants' experience and satisfaction with the course. RESULTS: Forty-four percent of participants identified, 'Immediate need for skills and information to address COVID-19' as their primary reason for attending the course. Participants reported that they are very likely (4.75 out of 5) to use the information, tools, or skills from the course in their work. The average score for content-related questions answered correctly was 82-88% for each session. Participants (~70-90%) said their understanding was Excellent or Very Good for each session. Participants expressed a deepened understanding of the importance of prioritizing vulnerable communities and built global solidarity. CONCLUSION: The training contributed to a new level of understanding of the social determinants of health and equity issues surrounding pandemic preparedness and response. This course elucidated the intersection of racism and wealth inequality; the role of the social determinants of health in pandemic preparedness and response; and the impacts of neocolonialism on pandemic response in low- and middle-income countries.

Equitable and Effective Distribution of the COVID-19 Vaccines - A Scientific and Moral Obligation.

The rapid development of coronavirus disease 2019 (COVID-19) vaccines has not been met with the assurance of an effective and equitable global distribution mechanism. Low-income countries are especially at-risk, with the price of the vaccines and supply shortages limiting their ability to procure and distribute the vaccines. While the COVAX initiative is one of the solutions to these challenges, vaccine nationalism has resulted in the hoarding of vaccines and the signing of parallel bilateral deals, undermining this formerly promising initiative. Moreover, inequity in local distribution also remains a problem, with clear discrimination of minorities and lack of logistical preparation in some countries. As we continue to distribute the COVID-19 vaccines, pharmaceutical companies should share their technology to increase supply and reduce prices, governments should prioritize equitable distribution to the most at-risk in all nations and low-income countries should bolster their logistical capacity in preparation for mass vaccination campaigns.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide.

CONTEXT: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Time for the ethical management of COVID-19 vaccines.

The ethical distribution of life-saving medical and public health interventions to vulnerable groups has often been overlooked. Valuation of life linked to an individual's country of origin, the pharmaceutical industry's prioritisation of profit, the exploitation of vulnerable groups in clinical trials, and the resulting hesitancy towards drugs and vaccines have, among other factors, made the human right to health unattainable for many people. The COVID-19 pandemic presents itself as an opportunity to reverse this long-standing trajectory of unethical practices in global health. By ensuring the ethical inclusion of vulnerable groups in the vaccine development process and making a safe, effective vaccine accessible to all, pharmaceutical companies, governments, and international organisations can usher in a new era of global health that relies solely on ethical decision making.

Addressing power dynamics in community-engaged research partnerships.

BACKGROUND: Successful community-engaged research depends on the quality of the collaborative partnerships between community -members and academic researchers and may take several forms depending on the purpose which dictates the degree to which power dynamics are handled within the collaborative arrangement. METHODS: To understand the power dynamics and related concepts within community-engaged research arrangements, a secondary analysis of an existing qualitative data set was undertaken. Two models of community-engaged research, a review of literature, and the applied experiences of researchers familiar with community engagement practices confirmed the power dynamics concepts used to carry out the analysis of the qualitative data set according to the principles of directed content analysis. This analysis yielded quotes on power dynamics and related issues. Tools to address the power dynamics exposed by the quotes were selected using the literature and lived experience of the researchers. Finally, to ensure trustworthiness, the selected quotes on power dynamics and the recommended tools were subjected to naturalistic treatment using peer debriefings and triangulation. RESULTS: Analysis of existing qualitative data made clear that community-engaged research between health practitioners and communities may take several forms depending on the purpose and dictate how power dynamics, including inequities, biases, discrimination, racism, rank and privilege, are handled within the collaborative arrangement. Three tools including implicit bias training, positionality, and structural competency may be used to address power dynamics and related concepts. CONCLUSION: Analysis of the qualitative data set highlighted the power dynamics within different community-engaged research models and the tools that may be used to address inequitable power dynamics including implicit bias training, positionality, and structural competency.

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice.

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.

Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone.

An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.

Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage.

Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described.

Three perspectives on partnering to close the care gap.

Given their frontline relationship with patients, community pharmacists fill a vital role in our healthcare system. This article offers three perspectives on how a team-based approach, which integrates the community pharmacist, can enhance patient care and reduce system costs. It is the success of these partnership models which have helped drive system-level change. It offers reflections by Dr. Ross T. Tsuyuki, among Canada's leading researchers on the subject, and presents some findings over his 20-year partnership with Merck in Canada. Dr. Tsuyuki's peer-reviewed studies have been largely centred in Alberta, one province in which the scope of practice for pharmacists has been expanded.

Prendre le virage des partenariats.

Deux projets démontrent que la mise en œuvre de données colligées sur le terrain peut contribuer à régler des problèmes dans le milieu de la santé pour favoriser de meilleurs résultats et de plus grandes efficiences. Dans le premier exemple, une vaste coalition de partenaires publics et privés de l'Alberta recourt aux techniques de mesures améliorées et à la méthodologie du Triple objectif pour améliorer les résultats cliniques de populations de cas complexes et lourds du quartier Eastwood d'Edmonton. On espère que les conclusions novatrices qui en sont tirées seront adaptées à d'autres régions de la province. Dans le deuxième exemple, la Childhood Obesity Foundation s'associe à Merck au Canada et à Ayogo (une société de thérapies numériques située à Vancouver) et utilise le concept novateur de la « ludification ¼ pour mobiliser les jeunes de plus en plus sédentaires du Canada et modifier leurs comportements.