Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

Archive for the ‘Health Systems’ Category

New Spreadsheet on Under Five Mortality Rates (with some thoughts on disease advocacy)

Posted by ryanlindsay on June 17, 2008

Here is an excellent spreadsheet made available through some listserve discussions through the CORE group. The spreadsheet is being used by the Child Health Epidemiology Reference Group (CHERG), Partnership for Maternal, Neonatal, and Child Health (PMNCH), and the Countdown to 2015 Group. Its modeling methods are explained in the 2003 Child Survival Lancet series (another excellent resource). The 2003 version was updated recently and this is the latest version (2007).

This data is objective and comes as a great resource in the midst of a heated discussion with regards to disease advocacy and funding wars currently raging in the global health realm. The battle really was set off after Roger England questioned HIV/AIDS funding. For example, this mortality data shows HIV/AIDS as the number cause of mortality in one country, South Africa. Some diseases (especially HIV/AIDS) get more social arousal than the very unflattering diarrhea. Should funding ever be disease-specific?

Posted in Child Survival, Global Health Topics, Health Systems, HIV/AIDS, Uncategorized | Tagged: , , | 3 Comments »

Health Systems Links

Posted by chads on May 19, 2008

I’ve found the following links useful and/or interesting with regards to Health Systems Development:

Health Systems Action Network

NGO Code of Conduct for Health Systems Strengthening

Health Systems Database

Consortium for Research on Equitable Health Systems (CREHS)

Posted in Health Systems, Links | Leave a Comment »

“Eldis”

Posted by chads on August 18, 2007

I stumbled across this website this morning. Eldis is part of the Institute of Development Studies in Sussex, England, and “aims to share the best in development, policy, practice and research.” There are over 18,000 documents free to download from it’s website, and they are organized into over 20 subjects. (I will be visiting health systems often.)

“The aim of Eldis is to:

* support the documentation, exchange and use of evidence-based development knowledge
* communicate this knowledge effectively through a range of appropriately designed services, using the Internet (web and email) as the main communication medium for delivery
* reach audiences of researchers, development practitioners and policy formers at national and international levels
* play a role in the processes of evidence-based policy formation
* provide this information and services free of charge at point of use”

Looks like a great resource!

Posted in Evidence-based Global Health, Health Systems, Links | 2 Comments »

“Global Health Issues and Challenges”

Posted by chads on August 18, 2007

I spent this morning (while cleaning the bathroom!?!) listening to “Global Health Issues and Challenges,” a panel discussion put on by WBGH. I recommend it because it addresses many of the important global health issues: urgency, feasibility, health systems development (simple management and leadership needs as opposed to high-tech problems). The discussants were involved in a PBS documentary, Rx for Survival, which I also highly recommend.

Posted in Health Systems, Links | Leave a Comment »

Health Systems Development: An Introduction

Posted by chads on July 14, 2007

I am convinced that, ultimately, health systems will need to be strengthened before global health disparities are decreased long-term. Defining “health system” is a challenge. It is (relatively!) easy, on the other hand, to define, communicate, implement, and measure, for example, the treatment of AIDS, or the distribution of mosquito nets, or the eradication of polo through mass immunization campaigns. Those focused interventions in and of themselves, however, may not improve health. Indeed, it is possible that the opposite may happen. While mortality from specific diseases may decrease, the intervention may have unintended consequences. For example:

-Sudden increased funding in response to a particular disease (AIDS) can lead to health workers leaving established programs (child health) for the new programs.

-If eradication of specific diseases (small pox, polio) don’t lead to the improvement of local capacity to respond to new diseases (AIDS, SARS, Avian Influenza), then health will not likely improve long-term.

-Short-term funding for programs meant to further only political ambitions or humanitarian means are not likely to include evaluation and monitoring mechanisms that will allow local public health practitioners to learn to make necessary adjustments in programs.

In order for the health of people in developing countries to improve, I am convinced that the health system must be strengthened. What, then, is a health system?

It is the capacity of locals to respond effectively to their own health problems.

In the words of the WHO, a health system

 

is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.

A CDC paper published in 1999 outlined four components of health systems:

  • health policy, regulatory and strategic planning functions; — definition and development of institutions/organizational arrangements;
  • mobilization and allocation of financial resources;
  • mobilization and allocation of human resources; and
  • management and delivery of health services.

What does all of this mean? That’s a complicated question that I hope to tease out in future posts and reading. For funders, it might mean providing long enough time, as well as provisions in the proposals to allow human capacity development. For researchers and universities, it might mean evaluating how interventions affect health systems. For humanitarian organizations and NGOs, it might mean always considering the impact that their interventions have on the health system – on the local workers, on the often fragile existing state-sponsored health programs, and on the ability to respond to future global health challenges. In short, I believe that everyone involved in global health should ask themselves the following question:

Does my involvement add to or take away from the current health programs, and what affect will my involvement have on their ability to respond to future health challenges?

Posted in Health Systems | Leave a Comment »

RESULTS, XDR-TB, and emergencies

Posted by chads on March 11, 2007

We had our monthly RESULTS meeting and teleconference on March 10. The thrust of the discussion was on obtaining funding for “extremely drug resistant tuberculosis”, or XDR-TB. The WHO explains:

MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs – isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The folks at RESULTS urge us to push our elected officials for additional funding for XDR-TB in the “Emergency Defense Supplemental”:

Please continue to urge Congress to support an emergency infusion of resources to help address the XDR-TB (extremely drug resistant TB) emergency. (The continuing resolution did not contain bilateral TB funding in it.) XDR-TB has a very high mortality rate, is especially deadly for those with HIV/AIDS, and threatens to undermine AIDS and TB treatment in southern Africa. The U.S. is also quickly facing the dangers of XDR-TB. When the president sent his Emergency Defense Supplemental request to Congress it contained monies for Avian Flu, which is a theoretical emergency. XDR TB is a REAL emergency.

I wholeheartedly agree with this plea for fundingwith a passion. Well, sorta. The need for a comprehensive response to tuberculosis is, in my mind, indisputable. And the public health crisis that barely treatable (and sometimes untreatable) XDR TB presents is unacceptable.

I have mixed feelings, however, about calling this an emergency. You see, public health officials and clinicians have known for many, many years that TB was becoming resistant to many drugs, and that it had the potential to become a public health emergency. XDR TB exists because of our failure to respond properly to TB; a failure to strengthen the health system. The WHO continues:

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

Screaming “emergency” is an effective fund-raising tool, though it more often that not comes in unpredictable spurts. It seems to me that such sporadic responses lead in the long term to corruption, dependence, and lack of preparedness for the next “emergency.” Those suffering from diseases like tuberculosis desperately need a health system that is strong, flexible, and promotes evidence-based health interventions.

So, I’ll support this Emergency Defense Supplemental funding for XDR-TB. Because something has to be done. But there has to be more of a focus on health systems strengthening.

Posted in Health Systems, RESULTS, Tuberculosis | Leave a Comment »