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The BMJ has made all of its articles referring to the Ebola outbreak free to access.
The conten
...
t includes latest guidance for healthcare workers, which 'will continue to update healthcare workers, outside of west Africa, with the latest guidance from the UK's Health Protection Agency and the US Center for Disease Control'
more
Free information about the Ebola virus and how best to treat it, is available from BMJ Best Practice [https://bestpractice.bmj.com/topics/en-gb/121
...
0], the clinical support tool from BMJ, for clinicians working on the frontline in affected rural and urban regions of DR Congo. The information has been reviewed and aligned with WHO guidance.
more
The BMJ's collection on "The World Bank and financing global health" is a series of articles providing an overview of
...
the bank’s evolving role in international health.
Accessed 22nd of May 2019.
more
Karen Grépin examines the pledges made to the Ebola crisis, how much has actually reached affected countries, and the lessons to be learnt
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income c
...
ountries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
more
BMJ Global Health Vol.4 (2019 no.4
The Drug Resistance Index (DRI) is proposed as measure of antibiotic effectiveness in a given country, by combining, in a single metric
...
the use of various antibiotic groups and the resistance proportions of several pathogens.It is a complicated measure that gives results that cannot be understood by common knowledge and logic. The DRI conveys a wrong message.
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The COVID-19 pandemic demonstrated that
the world was not well prepared to respond
to an infectious disease threat of this magnitude. Countries across all socioeconomic and development categories
...
have struggled
to implement effective national responses. Substantial amounts of additional investment are required to support the development of country capacities to prevent, detect and respond to both existing and emerging
infectious disease threats. Prior research efforts have estimated that between US$96 and $204billion is required, globally, to
advance country-level health security capacities, with US$63–131billion needed over a 3-year period. Given the substantial costs
of ongoing COVID-19 response, estimated to
be over US$12.5trillion through 2024, and an estimated 12.1–22.7million excess deaths, globally, due to COVID-19 as of January 2022,
the importance and potential return on investment of such upfront investments in capacity building are more evident than ever before.
more
Rising levels of inflation, debt and macrofiscal tightening are putting expenditures on the social sectors including health under immense scrutiny. Already, there are worrying signs of reductions in social sector investments. However, even before
...
the pandemic, evidence showed the significant returns on investments in health equity and its social determinants. Emerging data and trends show that these potential returns have increased during the COVID-19 pandemic - investments in social determinants can mitigate widespread reductions in human capital and the increasing likelihood of costly syndemics, while promoting access to healthcare innovations that have thus far been inequitably distributed. Therefore, we argue that, despite immediate fiscal pressures, this is exactly the time to invest in health equity and its broader social determinants, as the returns on such investments have never been greater.
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BMJ 2020;368:m1052 doi: 10.1136/bmj.m1052 (Published 13 March 2020)
The article "Time to Align: Development Cooperation for the Prevention and Control of Non-Communicable Diseases" argues for greater international cooperation and investment in addressing non-communi
...
cable diseases (NCDs), especially in low- and middle-income countries. Traditionally, global health funding has focused on infectious diseases, but the growing burden of NCDs—such as cardiovascular diseases, cancer, and diabetes—necessitates new approaches to development assistance.
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COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health s
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ystems. Drawing from practitioner expertise across four WHO regions, this article outlines the targeted actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.
BMJ Global Health2020;5:e002550. doi:10.1136/bmjgh-2020-002550
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Since the Alma Ata Declaration in 1978, community health volunteers (CHVs) have been at the forefront, providing health services, especially to underserved communities, in low-income countries. Howe
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ver, consolidation of CHVs position within formal health systems has proved to be complex and continues to challenge countries, as they devise strategies to strengthen primary healthcare. Malawi’s community health strategy, launched in 2017, is a novel attempt to harmonise the multiple health
service structures at the community level and strengthen service delivery through a team-based approach. The core community health team (CHT) consists of health surveillance assistants (HSAs), clinicians, environmental health officers and CHVs. This paper reviews Malawi’s strategy, with particular focus on the interface between HSAs, volunteers in community-based programmes and
the community health team. Our analysis identified key challenges that may impede the strategy’s implementation:
(1) inadequate training, imbalance of skill sets within CHTs and unclear job descriptions for CHVs; (2) proposed community-level interventions require expansion of pre-existing roles for most CHT members; and (3) district authorities may face challenges meeting financial obligations and filling community-level positions. For effective implementation, attention and further deliberation is needed on the appropriate forms of CHV support, CHT composition with possibilities of co-opting trained CHVs
from existing volunteer programmes into CHTs, review of CHT competencies and workload, strengthening coordination and communication across all community actors, and financing mechanisms. Policy support through the development of an addendum to the strategy, outlining opportunities for task-shifting between CHT members, CHVs’ expected duties and interactions with paid CHT personnel is recommended.
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of
...
asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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The UK could regain its leadershipin the provision of development assistance for healthunder the next government. But this doesn’t seem likely if
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the party manifestos are any guide.
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INTRODUCTION: Health service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020,
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the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lock-down measures in the Gombe health zone.
METHODS: Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (i.e, Gombe vs other health zones).
RESULTS: Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lock-down was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.
CONCLUSION: The COVID-19 pandemic resulted in important reductions in health service utilizsation in Kinshasa, particularly Gombe. Lifting of lock-down led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.
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BMJ Global Health, Vol. 4 (2019) no.2
Antibiotic resistance is threatening global health, development and food security; however, measures for assessing and communicating the threat of resistance
...
are lacking. The Drug Resistance Index (DRI) allows for global assessment of the relative efficacy of countries’ antibiotic therapy.
more
The COVID-19 pandemic has impacted regular cardiovascular healthcare access and delivery. Service utilisation has declined, and excess cardiovascular mortality has been reported in several countries. We aim to estimate excess cardiovascular deaths i
...
n Chile during 2020.
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BMJ Glob Health 2017;2:e000345. doi:10.1136/bmjgh-2017-000345. WHO's 2020 milestones for Chagas disease include having all endemic Latin American countries certified with no intradomiciliary Trypanosoma cruzi transmission, and infected patients unde
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r care. Evaluating the variation in historical exposure to infection is crucial for assessing progress and for understanding the priorities to achieve these milestones.
more
Introduction
In 2017, development assistance for health (DAH) comprised 5.3% of total health spending in lowincome countries. Despite the key role DAH plays in global health-spending, little is known about
...
the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.
Methods
We extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.
Results
Factors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).
Conclusion
Substantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.
more
