IHP news 470: Research

By on May 18, 2018

Global Health Action – Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa

J Doherty, D McIntyre et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2018.1461338

The global focus on promoting UHC has drawn attention to the need to increase public domestic funding for health care in low- and middle-income countries. This article examines whether increased tax revenue in the three territories of Kenya, Lagos State (Nigeria) and South Africa was accompanied by improved resource allocation to their public health sectors, and explores the reasons underlying the observed trends.”

Findings: “…Increased tax revenue led to absolute increases in public health spending in all three territories, but not necessarily in real per capita terms. However, in each of the territories, the percentage of the government budget allocated to health declined for much of the period under review. Factors contributing to this trend include: inter-sectoral competition in priority setting; the extent of fiscal federalism; the Ministry of Finance’s perception of the health sector’s absorptive capacity; weak investment cases made by the Ministry of Health; and weak parliamentary and civil society involvement.”

Global Health Action – Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review

R Mbau & Lucy Gilson; https://www.tandfonline.com/doi/full/10.1080/16549716.2018.1462579

This article aims to identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries.

BMJ Global Health – What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries

M Bouzid et al; http://gh.bmj.com/content/3/3/e000648

Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. … … WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers’ attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients’ socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed.”

Global Public Health – Questioning the current public health approach to countering violent extremism

N K Aggarwal; https://www.tandfonline.com/doi/full/10.1080/17441692.2018.1474936

Since the start of the global War on Terror, governments have used the mental health system for counterintelligence purposes. A recent manifestation of this trend is the call from policymakers and mental health researchers to screen individuals at risk for violent extremism through the public health system. Civil rights organisations have raised alarms that Muslims are being disproportionately referred to law enforcement agencies and that Muslim communities are being selected for surveillance despite government assurances that violent extremism is not exclusive to any ideology. This commentary critically analyzes American policies and calls from mental health professionals to use the public health system for implementing initiatives that counter violent extremism. A close reading of such texts demonstrates a persistent concern with treating communities as vulnerable to extremism, prioritising law enforcement over scientific evidence in crafting policies, and breaking medical confidentiality of patients while not assuring immunity for mental health professionals involved in screening. A genuine engagement with public health provides alternatives that question the assumptions of such policies.”

World Development – What is equitable resilience?

N Matin et al; https://www.sciencedirect.com/science/article/pii/S0305750X18301396

Highlights :

Resilience has attracted criticism for its failure to address social vulnerability and to engage with issues of equity and power. Here, we ask: what is equitable resilience? Our focus is on what resilience does on the ground in relation to development, adaptation and disaster management, and on identifying critical issues for engaging with equity in resilience practice. Using techniques from systematic reviews, with variants of equitable resilience as our key search terms, we carried out an analytical literature review which reveals four interconnected themes: subjectivities, inclusion, cross-scale interactions, and transformation. Drawing on this analysis, we find that ‘equitable resilience’ is increasingly likely when resilience practice takes into account issues of social vulnerability and differential access to power, knowledge, and resources; it requires starting from people’s own perception of their position within their human-environmental system, and it accounts for their realities and for their need for a change of circumstance to avoid imbalances of power into the future. Our approach moves beyond debates that focus on the ontological disconnect between resilience and social theory, to provide a definition that can be used in practice alongside resilience indicators to drive ground level interventions towards equitable outcomes. Defined in this way, equitable resilience is able to support the development of social-ecological systems that are contextually rooted, responsive to change and socially just, and thus relevant to global sustainability challenges.”

World Development – The SDGs in middle-income countries: Setting or serving domestic development agendas? Evidence from Ecuador

P Horn et al; https://www.sciencedirect.com/science/article/pii/S0305750X18301244

Highlights: “Domestic SDG engagement changes with the rise of autonomous middle-income countries. Depart from approaches that treat SDGs as coherent agenda to be translated by states. Ecuador engages selectively with specific SDGs to legitimise domestic policies. In Ecuador decentralisation adds a complex layer to SDG engagement.”

International Journal of Health Services – Embodied Neoliberalism: Epidemiology and the Lived Experience of Consumer Debt

E Sweet et al ; http://journals.sagepub.com/doi/full/10.1177/0020731418776580

A growing set of epidemiological data links personal financial debt to negative mental and physical health outcomes. These findings point to debt as a potentially significant socioeconomic determinant of population health, especially given rising rates of household and consumer debt in industrialized nations. However, the political and economic contexts in which rising consumer debt is embedded and the ways in which it is experienced in everyday life are underexplored in this epidemiological literature. This gap leaves open questions about how best to situate and understand debt as a health determinant with both psychosocial and neo-material attributes. In this article, we discuss findings from a qualitative study of personal debt experience in Boston, Massachusetts. Participants’ debt narratives highlight the powerful feelings of shame, guilt, and personal responsibility that debt engenders. The findings point to the influence of neoliberal ideology in shaping emotional responses to debt and suggest that these responses may be important pathways through which debt affects health. We discuss our findings within the broader landscape of American neoliberal economic policy and its role in shaping trends of consumer debt burden.”

SS&M – HIV as social and ecological experience

B King et al; https://www.sciencedirect.com/science/article/pii/S0277953618301825

“The spread and varied impacts of the HIV/AIDS epidemic demonstrate the complex and reciprocal relationships between the socio-political and biophysical dimensions of human health. Yet even with increasing research and policy attention there remain critical gaps in the literature on how HIV-positive households manage health through their engagement with social and ecological systems. This is particularly urgent given improvements in the global response to the epidemic, whereby expanded access to antiretroviral therapy has extended the possibility for survival for years or decades. Because many HIV-positive families and communities in the Global South remain dependent upon a diverse set of resources to generate income and meet subsistence needs, the impacts of disease must be understood within a mix of social processes, including the maintenance of land and collection of natural resources. Similarly, biophysical systems disrupted by HIV/AIDS vary depending upon resource use and locally-specific dynamics that influence opportunities for agrarian production. This paper reports on the findings from a structured survey completed in three communities in northeast South Africa in 2013 that is integrated with focus group discussions and qualitative interviews conducted from 2012–2016. We concentrate upon the diverse ways that individuals and families experience HIV through livelihood systems that are reliant on economic and natural resources. Because the access and use of these resources are mediated by existing social, cultural, and institutional systems, as well as historical spatial economies, we analyze how this produces differential lived experiences for HIV-positive individuals and households in the age of expanded access to antiretroviral therapy.”

BMJ Global Health – Impact of the US Food and Drug Administration registration of antiretroviral drugs on global access to HIV treatment


Since 2004, the US Food and Drug Administration’s (USFDA) dedicated drug review process in support of President’s Emergency Plan for AIDS Relief (PEPFAR) has made safe, effective and quality antiretrovirals (ARVs) available for millions of patients. Furthermore, the WHO and Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) can add the USFDA-reviewed products to their respective formularies, through a novel process of ‘one-way reliance’. We assessed the number of ARVs made available through WHO and Global Fund based on the USFDA review. We conducted a cross-sectional study of all the USFDA-reviewed PEPFAR drugs between 1 December 2014 and 20 March 2017 to determine 1) the percentage that are included on the WHO and Global Fund formularies; 2) the number of the USFDA ARVs supporting the WHO HIV treatment guidelines, and their uptake by WHO and Global Fund and 3) time between the USFDA review and WHO review of the same ARVs….”

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