Institutional capacity for health systems research in East and Central African Schools of Public Health: strengthening human and financial resources

Science.gov (United States)

2014-01-01

Background Despite its importance in providing evidence for health-related policy and decision-making, an insufficient amount of health systems research (HSR) is conducted in low-income countries (LICs). Schools of public health (SPHs) are key stakeholders in HSR. This paper, one in a series of four, examines human and financial resources capacities, policies and organizational support for HSR in seven Africa Hub SPHs in East and Central Africa. Methods Capacity assessment done included document analysis to establish staff numbers, qualifications and publications; self-assessment using a tool developed to capture individual perceptions on the capacity for HSR and institutional dialogues. Key informant interviews (KIIs) were held with Deans from each SPH and Ministry of Health and non-governmental officials, focusing on perceptions on capacity of SPHs to engage in HSR, access to funding, and organizational support for HSR. Results A total of 123 people participated in the self-assessment and 73 KIIs were conducted. Except for the National University of Rwanda and the University of Nairobi SPH, most respondents expressed confidence in the adequacy of staffing levels and HSR-related skills at their SPH. However, most of the researchers operate at individual level with low outputs. The average number of HSR-related publications was only capacity. This study underscores the need to form effective multidisciplinary teams to enhance research of immediate and local relevance. Capacity strengthening in the SPH needs to focus on knowledge translation and communication of findings to relevant audiences. Advocacy is needed to influence respective governments to allocate adequate funding for HSR to avoid donor dependency that distorts local research agenda. PMID:24888371

Building Public Health Capacity through Online Global Learning

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Madhok, Rajan; Frank, Erica; Heller, Richard Frederick

2018-01-01

Rising disease burden and health inequalities remain global concerns, highlighting the need for health systems strengthening with a sufficient and appropriately trained workforce. The current models for developing such a workforce are inadequate and newer approaches are needed. In this paper we describe a model for public health capacity building…

Strengthening global health security capacity--Vietnam demonstration project, 2013.

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Tran, Phu Dac; Vu, Long Ngoc; Nguyen, Hien Tran; Phan, Lan Trong; Lowe, Wayne; McConnell, Michelle S; Iademarco, Michael F; Partridge, Jeffrey M; Kile, James C; Do, Trang; Nadol, Patrick J; Bui, Hien; Vu, Diep; Bond, Kyle; Nelson, David B; Anderson, Lauren; Hunt, Kenneth V; Smith, Nicole; Giannone, Paul; Klena, John; Beauvais, Denise; Becknell, Kristi; Tappero, Jordan W; Dowell, Scott F; Rzeszotarski, Peter; Chu, May; Kinkade, Carl

2014-01-31

Over the past decade, Vietnam has successfully responded to global health security (GHS) challenges, including domestic elimination of severe acute respiratory syndrome (SARS) and rapid public health responses to human infections with influenza A(H5N1) virus. However, new threats such as Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza A(H7N9) present continued challenges, reinforcing the need to improve the global capacity to prevent, detect, and respond to public health threats. In June 2012, Vietnam, along with many other nations, obtained a 2-year extension for meeting core surveillance and response requirements of the 2005 International Health Regulations (IHR). During March-September 2013, CDC and the Vietnamese Ministry of Health (MoH) collaborated on a GHS demonstration project to improve public health emergency detection and response capacity. The project aimed to demonstrate, in a short period, that enhancements to Vietnam's health system in surveillance and early detection of and response to diseases and outbreaks could contribute to meeting the IHR core capacities, consistent with the Asia Pacific Strategy for Emerging Diseases. Work focused on enhancements to three interrelated priority areas and included achievements in 1) establishing an emergency operations center (EOC) at the General Department of Preventive Medicine with training of personnel for public health emergency management; 2) improving the nationwide laboratory system, including enhanced testing capability for several priority pathogens (i.e., those in Vietnam most likely to contribute to public health emergencies of international concern); and 3) creating an emergency response information systems platform, including a demonstration of real-time reporting capability. Lessons learned included awareness that integrated functions within the health system for GHS require careful planning, stakeholder buy-in, and intradepartmental and interdepartmental coordination and

Developing capacity-building activities for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners, and researchers.

Science.gov (United States)

Semrau, M; Alem, A; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Kigozi, F; Lempp, H; Lund, C; Petersen, I; Shidhaye, R; Thornicroft, G; Hanlon, C

2018-02-01

There is increasing international recognition of the need to build capacity to strengthen mental health systems. This is a fundamental goal of the 'Emerging mental health systems in low- and middle-income countries' (Emerald) programme, which is being implemented in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). This paper discusses Emerald's capacity-building approaches and outputs for three target groups in mental health system strengthening: (1) mental health service users and caregivers, (2) service planners and policy-makers, and (3) mental health researchers. When planning the capacity-building activities, the approach taken included a capabilities/skills matrix, needs assessments, a situational analysis, systematic reviews, qualitative interviews and stakeholder meetings, as well as the application of previous theory, evidence and experience. Each of the Emerald LMIC partners was found to have strengths in aspects of mental health system strengthening, which were complementary across the consortium. Furthermore, despite similarities across the countries, capacity-building interventions needed to be tailored to suit the specific needs of individual countries. The capacity-building outputs include three publicly and freely available short courses/workshops in mental health system strengthening for each of the target groups, 27 Masters-level modules (also open access), nine Emerald-linked PhD students, two MSc studentships, mentoring of post-doctoral/mid-level researchers, and ongoing collaboration and dialogue with the three groups. The approach taken by Emerald can provide a potential model for the development of capacity-building activities across the three target groups in LMICs.

Assessment of capacity for Health Policy and Systems Research and Analysis in seven African universities: results from the CHEPSAA project

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Mirzoev, Tolib; Lê, Gillian; Green, Andrew; Orgill, Marsha; Komba, Adalgot; Esena, Reuben K; Nyapada, Linet; Uzochukwu, Benjamin; Amde, Woldekidan K; Nxumalo, Nonhlanhla; Gilson, Lucy

2014-01-01

The importance of health policy and systems research and analysis (HPSR+A) is widely recognized. Universities are central to strengthening and sustaining the HPSR+A capacity as they teach the next generation of decision-makers and health professionals. However, little is known about the capacity of universities, specifically, to develop the field. In this article, we report results of capacity self- assessments by seven universities within five African countries, conducted through the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA). The capacity assessments focused on both capacity ‘assets’ and ‘needs’, and covered the wider context, as well as organizational and individual capacity levels. Six thematic areas of capacity were examined: leadership and governance, organizations’ resources, scope of HPSR+A teaching and research, communication, networking and getting research into policy and practice (GRIPP), demand for HPRS+A and resource environment. The self-assessments by each university used combinations of document reviews, semi-structured interviews and staff surveys, followed by comparative analysis. A framework approach, guided by the six thematic areas, was used to analyse data. We found that HPSR+A is an international priority, and an existing activity in Africa, though still neglected field with challenges including its reliance on unpredictable international funding. All universities have capacity assets, such as ongoing HPSR+A teaching and research. There are, however, varying levels of assets (such as differences in staff numbers, group sizes and amount of HPSR+A teaching and research), which, combined with different capacity needs at all three levels (such as individual training, improvement in systems for quality assurance and fostering demand for HPSR+A work), can shape a future agenda for HPSR+A capacity strengthening. Capacity assets and needs at different levels appear related. Possible integrated strategies for

Improving African health research capacity

DEFF Research Database (Denmark)

Lazarus, Jeff; Wallace, Samantha A; Liljestrand, Jerker

2010-01-01

The issue of strengthening local research capacity in Africa is again high on the health and development agenda. The latest initiative comes from the Wellcome Trust. But when it comes to capacity development, one of the chief obstacles that health sectors in the region must confront is the migrat......The issue of strengthening local research capacity in Africa is again high on the health and development agenda. The latest initiative comes from the Wellcome Trust. But when it comes to capacity development, one of the chief obstacles that health sectors in the region must confront...... is the migration of health professionals to countries that offer more lucrative opportunities, like those in western Europe. To combat this ''brain drain'', already back in 1984, the Swedish International Development Cooperation Agency (Sida) created a training programme in which healthcare professionals from...... Africa conducted the bulk of their research in their own countries. However, the model was only partly successful. Several years ago, we assessed the preconditions for the renewal of Sida support for research and research training activities in the region. Based on our work to develop a critical mass...

Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review

Directory of Open Access Journals (Sweden)

Roxanne Keynejad

2016-10-01

Full Text Available Abstract Background Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs. We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed

Institutional capacity for health systems research in East and Central African schools of public health: knowledge translation and effective communication.

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Ayah, Richard; Jessani, Nasreen; Mafuta, Eric M

2014-06-02

Local health systems research (HSR) provides policymakers and practitioners with contextual, evidence-based solutions to health problems. However, producers and users of HSR rarely understand the complexities of the context within which each operates, leading to the "know-do" gap. Universities are well placed to conduct knowledge translation (KT) integrating research production with uptake. The HEALTH Alliance Africa Hub, a consortium of seven schools of public health (SPHs) in East and Central Africa, was formed to build capacity in HSR. This paper presents information on the capacity of the various SPHs to conduct KT activities. In 2011, each member of the Africa Hub undertook an institutional HSR capacity assessment using a context-adapted and modified self-assessment tool. KT capacity was measured by several indicators including the presence of a KT strategy, an organizational structure to support KT activities, KT skills, and institutional links with stakeholders and media. Respondents rated their opinions on the various indicators using a 5-point Likert scale. Averages across all respondents for each school were calculated. Thereafter, each school held a results validation workshop. A total of 123 respondents from all seven SPHs participated. Only one school had a clear KT strategy; more commonly, research was disseminated at scientific conferences and workshops. While most respondents perceived their SPH as having strong institutional ties with organizations interested in HSR as well as strong institutional leadership, the organizational structures required to support KT activities were absent. Furthermore, individual researchers indicated that they had little time or skills to conduct KT. Additionally, institutional and individual links with policymakers and media were reported as weak. Few SPHs in Africa have a clear KT strategy. Strengthening the weak KT capacity of the SPHs requires working with institutional leadership to develop KT strategies designed

Strengthening Health Systems Research Capacity in Mozambique ...

International Development Research Centre (IDRC) Digital Library (Canada)

Mozambique's health sector is dealing with system-wide challenges. ... the Ministry's work on national health accounts, resource allocation, and national health ... a combined INS-FIOCRUS program, and the master's in public health and field ...

Building policy-making capacity in the Ministry of Health: the Kazakhstan experience.

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Chanturidze, Tata; Adams, Orvill; Tokezhanov, Bolat; Naylor, Mike; Richardson, Erica

2015-01-20

Recent economic growth in Kazakhstan has been accompanied by slower improvements in population health and this has renewed impetus for health system reform. Strengthening strategic planning and policy-making capacity in the Ministry of Health has been identified as an important priority, particularly as the Ministry of Health is leading the health system reform process. The intervention was informed by the United Nations Development Programme (UNDP) framework for capacity building which views capacity building as an ongoing process embedded in local institutions and practices. In response to local needs extra elements were included in the framework to tailor the capacity building programme according to the existing policy and budget cycles and respective competence requirements, and link it with transparent career development structures of the Ministry of Health. This aspect of the programme was informed by the institutional capability assessment model used by the United Kingdom National Health Service (NHS) which was adapted to examine the specific organizational and individual competences of the Ministry of Health in Kazakhstan. There were clear successes in building capacity for policy making and strategic planning within the Ministry of Health in Kazakhstan, including better planned, more timely and in-depth responses to policy assignments. Embedding career development as a part of this process was more challenging. This case study highlights the importance of strong political will and high level support for capacity building in ensuring the sustainability of programmes. It also shows that capacity-building programmes need to ensure full engagement with all local stakeholders, or where this is not possible, programmes need to be targeted narrowly to those stakeholders who will benefit most, for the greatest impact to be achieved. In sum, high quality tailor-made capacity development programmes should be based on thorough needs assessment of individual and

Quasi-experimental study designs series-paper 12: strengthening global capacity for evidence synthesis of quasi-experimental health systems research.

Science.gov (United States)

Rockers, Peter C; Tugwell, Peter; Grimshaw, Jeremy; Oliver, Sandy; Atun, Rifat; Røttingen, John-Arne; Fretheim, Atle; Ranson, M Kent; Daniels, Karen; Luiza, Vera Lucia; Bärnighausen, Till

2017-09-01

Evidence from quasi-experimental studies is often excluded from systematic reviews of health systems research despite the fact that such studies can provide strong causal evidence when well conducted. This article discusses global coordination of efforts to institutionalize the inclusion of causal evidence from quasi-experiments in systematic reviews of health systems research. In particular, we are concerned with identifying opportunities for strengthening capacity at the global and local level for implementing protocols necessary to ensure that reviews that include quasi-experiments are consistently of the highest quality. We first describe the current state of the global infrastructure that facilitates the production of systematic reviews of health systems research. We identify five important types of actors operating within this infrastructure: review authors; synthesis collaborations that facilitate the review process; synthesis interest groups that supplement the work of the larger collaborations; review funders; and end users, including policymakers. Then, we examine opportunities for intervening to build the capacity of each type of actors to support the inclusion of quasi-experiments in reviews. Finally, we suggest practical next steps for proceeding with capacity building efforts. Because of the complexity and relative nascence of the field, we recommend a carefully planned and executed approach to strengthening global capacity for the inclusion of quasi-experimental studies in systematic reviews. Copyright © 2017 Elsevier Inc. All rights reserved.

Policy Capacity Meets Politics: Comment on "Health Reform Requires Policy Capacity".

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Fafard, Patrick

2015-07-22

It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise. © 2015 by Kerman University of Medical Sciences.

Country ownership and capacity building: the next buzzwords in health systems strengthening or a truly new approach to development?

Directory of Open Access Journals (Sweden)

Goldberg Jessica

2012-07-01

Full Text Available Abstract Background During the last decade, donor governments and international agencies have increasingly emphasized the importance of building the capacity of indigenous health care organizations as part of strengthening health systems and ensuring sustainability. In 2009, the U.S. Global Health Initiative made country ownership and capacity building keystones of U.S. health development assistance, and yet there is still a lack of consensus on how to define either of these terms, or how to implement “country owned capacity building”. Discussion Concepts around capacity building have been well developed in the for-profit business sector, but remain less well defined in the non-profit and social sectors in low and middle-income countries. Historically, capacity building in developing countries has been externally driven, related to project implementation, and often resulted in disempowerment of local organizations rather than local ownership. Despite the expenditure of millions of dollars, there is no consensus on how to conduct capacity building, nor have there been rigorous evaluations of capacity building efforts. To shift to a new paradigm of country owned capacity building, donor assistance needs to be inclusive in the planning process and create true partnerships to conduct organizational assessments, analyze challenges to organizational success, prioritize addressing challenges, and implement appropriate activities to build new capacity in overcoming challenges. Before further investments are made, a solid evidence base should be established concerning what works and what doesn’t work to build capacity. Summary Country-owned capacity building is a relatively new concept that requires further theoretical exploration. Documents such as The Paris Declaration on Aid Effectiveness detail the principles of country ownership to which partner and donor countries should commit, but do not identify the specific mechanisms to carry out these

Capacity Building in Open Medical Record System (OpenMRS) in ...

International Development Research Centre (IDRC) Digital Library (Canada)

Capacity Building in Open Medical Record System (OpenMRS) in Rwanda ... Partners in Health (PIH), an international nongovernmental organization, has demonstrated the usefulness of ... Journal articles ... will fund social science, population and public health, and health systems research relevant to the emerging crisis.

Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India.

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Prashanth, Nuggehalli Srinivas; Marchal, Bruno; Devadasan, Narayanan; Kegels, Guy; Criel, Bart

2014-08-26

Health systems interventions, such as capacity-building of health workers, are implemented across districts in order to improve performance of healthcare organisations. However, such interventions often work in some settings and not in others. Local health systems could be visualised as complex adaptive systems that respond variously to inputs of capacity building interventions, depending on their local conditions and several individual, institutional, and environmental factors. We aim at demonstrating how the realist evaluation approach advances complex systems thinking in healthcare evaluation by applying the approach to understand organisational change within local health systems in the Tumkur district of southern India. We collected data on several input, process, and outcome measures of performance of the talukas (administrative sub-units of the district) and explore the interplay between the individual, institutional, and contextual factors in contributing to the outcomes using qualitative data (interview transcripts and observation notes) and quantitative measures of commitment, self-efficacy, and supervision style. The talukas of Tumkur district responded differently to the intervention. Their responses can be explained by the interactions between several individual, institutional, and environmental factors. In a taluka with committed staff and a positive intention to make changes, the intervention worked through aligning with existing opportunities from the decentralisation process to improve performance. However, commitment towards the organisation was neither crucial nor sufficient. Committed staff in two other talukas were unable to actualise their intentions to improve organisational performance. In yet another taluka, the leadership was able to compensate for the lack of commitment. Capacity building of local health systems could work through aligning or countering existing relationships between internal (individual and organisational) and external

CDMA systems capacity engineering

CERN Document Server

Kim, Kiseon

2004-01-01

This new hands-on resource tackles capacity planning and engineering issues that are crucial to optimizing wireless communication systems performance. Going beyond the system physical level and investigating CDMA system capacity at the service level, this volume is the single-source for engineering and analyzing systems capacity and resources.

Public health capacity in the provision of health care services.

Science.gov (United States)

Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick

2015-12-01

In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

Investment, managerial capacity, and bias in public health preparedness.

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Langabeer, James R; DelliFraine, Jami L; Tyson, Sandra; Emert, Jamie M; Herbold, John

2009-01-01

Nearly $7 billion has been invested through national cooperative funding since 2002 to strengthen state and local response capacity. Yet, very little outcome evidence exists to analyze funding effectiveness. The objective of this research is to analyze the relationship between investment (funding) and capacity (readiness) for public health preparedness (PHP). The aim of the authors is to use a management framework to evaluate capacity, and to explore the "immediacy bias" impact on investment stability. This study employs a longitudinal study design, incorporating survey research of the entire population of 68 health departments in the state of Texas. The authors assessed the investment-capacity relationship through several statistical methods. The authors created a structural measure of managerial capacity through principal components analysis, factorizing 10 independent variables and augment this with a perceived readiness level reported from PHP managers. The authors then employ analysis of variance, correlation analyses, and other descriptive statistics. There has been a 539 percent coefficient of variation in funding at the local level between the years 2004 and 2008, and a 63 percent reduction in total resources since the peak of funding, using paired sample data. Results suggest that investment is positively associated with readiness and managerial capacity in local health departments. The authors also find that investment was related to greater community collaboration, higher adoption of Incident Command System (ICS) structure, and more frequent operational drills and exercises. Greater investment is associated with higher levels of capacity and readiness. The authors conclude from this that investment should be stabilized and continued, and not be influenced by historical cognitive biases.

Evaluating capacity-building for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners and researchers.

Science.gov (United States)

Hanlon, C; Semrau, M; Alem, A; Abayneh, S; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Jordans, M; Lempp, H; Mugisha, J; Petersen, I; Shidhaye, R; Thornicroft, G

2018-02-01

Efforts to support the scale-up of integrated mental health care in low- and middle-income countries (LMICs) need to focus on building human resource capacity in health system strengthening, as well as in the direct provision of mental health care. In a companion editorial, we describe a range of capacity-building activities that are being implemented by a multi-country research consortium (Emerald: Emerging mental health systems in low- and middle-income countries) for (1) service users and caregivers, (2) service planners and policy-makers and (3) researchers in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). In this paper, we focus on the methodology being used to evaluate the impact of capacity-building in these three target groups. We first review the evidence base for approaches to evaluation of capacity-building, highlighting the gaps in this area. We then describe the adaptation of best practice for the Emerald capacity-building evaluation. The resulting mixed method evaluation framework was tailored to each target group and to each country context. We identified a need to expand the evidence base on indicators of successful capacity-building across the different target groups. To address this, we developed an evaluation plan to measure the adequacy and usefulness of quantitative capacity-building indicators when compared with qualitative evaluation. We argue that evaluation needs to be an integral part of capacity-building activities and that expertise needs to be built in methods of evaluation. The Emerald evaluation provides a potential model for capacity-building evaluation across key stakeholder groups and promises to extend understanding of useful indicators of success.

The Thai-Australian Health Alliance: developing health management capacity and sustainability for primary health care services.

Science.gov (United States)

Briggs, D S; Tejativaddhana, P; Cruickshank, M; Fraser, J; Campbell, S

2010-11-01

There have been recent calls for a renewed worldwide focus on primary health care. The Thai-Australian Health Alliance addresses this call by developing health care management capability in primary health care professionals in rural Thailand. This paper describes the history and current activities of the Thai-Australian Health Alliance and its approaches to developing health care management capacity for primary care services through international collaborations in research, education and training over a sustained time period. The Alliance's approach is described herein as a distributed network of practices with access to shared knowledge through collaboration. Its research and education approaches involve action research, multi-methods projects, and evaluative studies in the context of workshops and field studies. WHO principles underpin this approach, with countries sharing practical experiences and outcomes, encouraging leadership and management resource networks, creating clearing houses/knowledge centres, and harmonising and aligning partners with their country's health systems. Various evaluations of the Alliance's activities have demonstrated that a capacity building approach that aligns researchers, educators and health practitioners in comparative and reflective activities can be effective in transferring knowledge and skills among a collaboration's partners. Project participants, including primary health care practitioners, health policy makers and academics embraced the need to acquire management skills to sustain primary care units. Participants believe that the approaches described herein were crucial to developing the management skills needed of health care professionals for rural and remote primary health care. The implementation of this initiative was challenged by pre-existing low opinions of the importance of the management role in health care, but with time the Alliance's activities highlighted for all the importance of health care management

Health Departments’ Engagement in Emergency Preparedness Activities: The Influence of Health Informatics Capacity

OpenAIRE

Gulzar H. Shah; Bobbie Newell; Ruth E. Whitworth

2016-01-01

Background: Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs’ informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved em...

Global Disease Detection-Achievements in Applied Public Health Research, Capacity Building, and Public Health Diplomacy, 2001-2016.

Science.gov (United States)

Rao, Carol Y; Goryoka, Grace W; Henao, Olga L; Clarke, Kevin R; Salyer, Stephanie J; Montgomery, Joel M

2017-11-01

The Centers for Disease Control and Prevention has established 10 Global Disease Detection (GDD) Program regional centers around the world that serve as centers of excellence for public health research on emerging and reemerging infectious diseases. The core activities of the GDD Program focus on applied public health research, surveillance, laboratory, public health informatics, and technical capacity building. During 2015-2016, program staff conducted 205 discrete projects on a range of topics, including acute respiratory illnesses, health systems strengthening, infectious diseases at the human-animal interface, and emerging infectious diseases. Projects incorporated multiple core activities, with technical capacity building being most prevalent. Collaborating with host countries to implement such projects promotes public health diplomacy. The GDD Program continues to work with countries to strengthen core capacities so that emerging diseases can be detected and stopped faster and closer to the source, thereby enhancing global health security.

Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

Science.gov (United States)

Adam, Taghreed; Ahmad, Saad; Bigdeli, Maryam; Ghaffar, Abdul; Røttingen, John-Arne

2011-01-01

The past decade has seen several high-level events and documents committing to strengthening the field of health policy and systems research (HPSR) as a critical input to strengthening health systems. Specifically, they called for increased production, capacity to undertake and funding for HPSR. The objective of this paper is to assess the extent to which progress has been achieved, an important feedback for stakeholders in this field. Two sources of data have been used. The first is a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009. The six building blocks of the health system were used to define the scope of this search. The second is a survey of 96 research institutions undertaken in 2010 to assess the capacity and funding availability to undertake HPSR, compared with findings from the same survey undertaken in 2000 and 2008. Both analyses focus on HPSR relevant to low-income and middle-income countries (LMICs). Overall, we found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs). This is consistent with findings from the institutional survey, where despite improvements in infrastructure of research institutions, a minimal change has been seen in the level of experience of researchers within LIC institutions. Funding availability in LICs has increased notably to institutions in Sub-Saharan Africa; nonetheless, the overall increase has been modest in all regions. Although progress has been made in both the production and funding availability for HPSR, capacity to undertake the research locally has grown at a much slower pace, particularly in LICs where there is most need for this research. A firm commitment to dedicate a proportion of all future funding for research to building capacity may be the only solution to turn the tide.

Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

Directory of Open Access Journals (Sweden)

Taghreed Adam

Full Text Available BACKGROUND: The past decade has seen several high-level events and documents committing to strengthening the field of health policy and systems research (HPSR as a critical input to strengthening health systems. Specifically, they called for increased production, capacity to undertake and funding for HPSR. The objective of this paper is to assess the extent to which progress has been achieved, an important feedback for stakeholders in this field. METHODS AND FINDING: Two sources of data have been used. The first is a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009. The six building blocks of the health system were used to define the scope of this search. The second is a survey of 96 research institutions undertaken in 2010 to assess the capacity and funding availability to undertake HPSR, compared with findings from the same survey undertaken in 2000 and 2008. Both analyses focus on HPSR relevant to low-income and middle-income countries (LMICs. Overall, we found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs. This is consistent with findings from the institutional survey, where despite improvements in infrastructure of research institutions, a minimal change has been seen in the level of experience of researchers within LIC institutions. Funding availability in LICs has increased notably to institutions in Sub-Saharan Africa; nonetheless, the overall increase has been modest in all regions. CONCLUSION: Although progress has been made in both the production and funding availability for HPSR, capacity to undertake the research locally has grown at a much slower pace, particularly in LICs where there is most need for this research. A firm commitment to dedicate a proportion of all future funding for research to building capacity may be the only solution to turn the tide.

Organizational capacity for chronic disease prevention: a survey of Canadian public health organizations.

Science.gov (United States)

Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Paradis, Gilles; Cameron, Roy

2010-04-01

There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

Policy Capacity for Health Reform: Necessary but Insufficient; Comment on “Health Reform Requires Policy Capacity”

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Owen Adams

2016-01-01

Full Text Available Forest and colleagues have persuasively made the case that policy capacity is a fundamental prerequisite to health reform. They offer a comprehensive life-cycle definition of policy capacity and stress that it involves much more than problem identification and option development. I would like to offer a Canadian perspective. If we define health reform as re-orienting the health system from acute care to prevention and chronic disease management the consensus is that Canada has been unsuccessful in achieving a major transformation of our 14 health systems (one for each province and territory plus the federal government. I argue that 3 additional things are essential to build health policy capacity in a healthcare federation such as Canada: (a A means of “policy governance” that would promote an approach to cooperative federalism in the health arena; (b The ability to overcome the ”policy inertia” resulting from how Canadian Medicare was implemented and subsequently interpreted; and (c The ability to entertain a long-range thinking and planning horizon. My assessment indicates that Canada falls short on each of these items, and the prospects for achieving them are not bright. However, hope springs eternal and it will be interesting to see if the July, 2015 report of the Advisory Panel on Healthcare Innovation manages to galvanize national attention and stimulate concerted action.

School Mental Health: The Impact of State and Local Capacity-Building Training

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Stephan, Sharon; Paternite, Carl; Grimm, Lindsey; Hurwitz, Laura

2014-01-01

Despite a growing number of collaborative partnerships between schools and community-based organizations to expand school mental health (SMH) service capacity in the United States, there have been relatively few systematic initiatives focused on key strategies for large-scale SMH capacity building with state and local education systems. Based on a…

Unpacking capacity to utilize research: A tale of the Burkina Faso public health association.

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Hamel, Nadia; Schrecker, Ted

2011-01-01

One of the most important challenges in addressing global health is for institutions to monitor and use research in policy-making. In low- and middle-income countries (LMICs), civil society organizations such as health professional associations can be key contributors to effective national health systems. However, there is little empirical data on their capacity to use research. This case study was used to gain insight into the factors that affect the knowledge translation performance of health professional associations in LMICs by describing the organizational elements and processes constituting capacity to use research, and examining the potential determinants of this capacity. Case study methodology was chosen for its flexibility to capture the multiple and often tacit processes within organizational routines. The Burkina Faso Public Health Association (ABSP) was studied, using in-depth, semi-structured interviews and key documents review. Five key dimensions that affect the association's capacity to use research to influence health policy emerged: organizational motivation; catalysts; organizational capacity to acquire and organizational capacity to transform research findings; moderating organizational factors. Also examined were the dissemination strategies used by ABSP and its abilities to enhance its capacity through networking, to advocate for more relevant research and to develop its potential role as knowledge broker, as well as limitations due to scarce resources. We conclude that a better understanding of the organizational capacity to use research of health professional associations in LMICs is needed to assess, improve and reinforce such capacity. Increased knowledge translation potential may leverage research resources and promote knowledge-sharing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Simulations of floor cooling system capacity

International Nuclear Information System (INIS)

Odyjas, Andrzej; Górka, Andrzej

2013-01-01

Floor cooling system capacity depends on its physical and operative parameters. Using numerical simulations, it appears that cooling capacity of the system largely depends on the type of cooling loads occurring in the room. In the case of convective cooling loads capacity of the system is small. However, when radiation flux falls directly on the floor the system significantly increases productivity. The article describes the results of numerical simulations which allow to determine system capacity in steady thermal conditions, depending on the type of physical parameters of the system and the type of cooling load occurring in the room. Moreover, the paper sets out the limits of system capacity while maintaining a minimum temperature of the floor surface equal to 20 °C. The results are helpful for designing system capacity in different type of cooling loads and show maximum system capacity in acceptable thermal comfort condition. -- Highlights: ► We have developed numerical model for simulation of floor cooling system. ► We have described floor system capacity depending on its physical parameters. ► We have described floor system capacity depending on type of cooling loads. ► The most important in the obtained cooling capacities is the type of cooling loads. ► The paper sets out the possible maximum cooling floor system capacity

Health Reform Requires Policy Capacity

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Pierre-Gerlier Forest

2015-05-01

Full Text Available Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility

Community Capacity Building for Health

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Martha Traverso-Yepez

2012-05-01

Full Text Available There is a great deal of literature examining the benefits and relevance of community participation and community capacity building in health promotion and disease prevention endeavors. Academic literature embracing principles and commitment to community participation in health promotion practices often neglects the complexities involved and the flexibility required to work within this approach. This article addresses some of these challenges through a case study of two projects funded by Provincial Wellness Grants in Newfoundland and Labrador, a province in Canada with a strong tradition of community ties and support systems. In addition to addressing the unique circumstances of the community groups, this research allowed the authors to examine the situational context and power relations involved in the provision of services as well as the particular forms of subjectivity and citizenship that the institutional practices support. Recognizing this complex interdependency is an important step in creating more effective intervention practices.

Network Capacity Assessment and Increase in Systems with Intermittent Water Supply

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Amilkar E. Ilaya-Ayza

2016-03-01

Full Text Available Water supply systems have been facing many challenges in recent decades due to the potential effects of climate change and rapid population growth. Water systems need to expand because of demographic growth. Therefore, evaluating and increasing system capacity is crucial. Specifically, we analyze network capacity as one of the main features of a system. When the network capacity starts to decrease, there is a risk that continuous supply will become intermittent. This paper discusses how network expansion carried out throughout the network life span typically reduces network capacity, thus transforming a system originally designed to work with continuous supply into a system with intermittent supply. A method is proposed to expand the network capacity in an environment of economic scarcity through a greedy algorithm that enables the definition of a schedule for pipe modification stages, and thus efficiently expands the network capacity. This method is, at the same time, an important step in the process of changing a water system from intermittent back to continuous supply—an achievement that remains one of the main challenges related to water and health in developing countries.

Place, health, and community attachment: Is community capacity associated with self-rated health at the individual level?

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Lovell, Sarah A; Gray, Andrew R; Boucher, Sara E

2017-12-01

Community-level interventions dominate contemporary public health responses to health inequalities as a lack of political will has discouraged action at a structural level. Health promoters commonly leverage community capacity to achieve programme goals, yet the health implications of low community capacity are unknown. In this study, we analyse perceptions of community capacity at the individual-level to explore how place-based understandings of identity and connectedness are associated with self-rated health. We examine associations between individual community capacity, self-rated health and income using a cross-sectional survey that was disseminated to 303 residents of four small (populations 1500-2000) New Zealand towns. Evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people who rated their community's capacity higher did not have better self-rated health. Much stronger evidence supported the relationship between income and both higher individual community capacity and higher self-rated health. We conclude that individual community capacity may mediate the positive association between income and health, however, overall we find no evidence suggesting that intervening to enhance individual community capacity is likely to improve health outcomes.

Elements for harnessing participatory action research to strengthen health managers' capacity: a critical interpretative synthesis.

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Tetui, Moses; Zulu, Joseph Mumba; Hurtig, Anna-Karin; Ekirapa-Kiracho, Elizabeth; Kiwanuka, Suzanne N; Coe, Anna-Britt

2018-04-19

which the use of PAR can be harnessed, not only to strengthen health managers' capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.

Public health and health promotion capacity at national and regional level: a review of conceptual frameworks

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Christoph Aluttis

2014-04-01

Full Text Available The concept of capacity building for public health has gained much attention during the last decade. National as well as international organizations increasingly focus their efforts on capacity building to improve performance in the health sector. During the past two decades, a variety of conceptual frameworks have been developed which describe relevant dimensions for public health capacity. Notably, these frameworks differ in design and conceptualization. This paper therefore reviews the existing conceptual frameworks and integrates them into one framework, which contains the most relevant dimensions for public health capacity at the country or regional level. A comprehensive literature search was performed to identify frameworks addressing public health capacity building at the national or regional level. We content-analysed these frameworks to identify the core dimensions of public health capacity. The dimensions were subsequently synthesized into a set of thematic areas to construct a conceptual framework which describes the most relevant dimensions for capacities at the national or regional level. The systematic review resulted in the identification of seven core domains for public health capacity: resources, organizational structures, workforce, partnerships, leadership and governance, knowledge development and country specific context. Accordingly, these dimensions were used to construct a framework, which describes these core domains more in detail. Our research shows that although there is no generally agreed upon model of public health capacity, a number of key domains for public health and health promotion capacity are consistently recurring in existing frameworks, regardless of their geographical location or thematic area. As only little work on the core concepts of public health capacities has yet taken place, this study adds value to the discourse by identifying these consistencies across existing frameworks and by synthesising

Place, health, and community attachment: Is community capacity associated with self-rated health at the individual level?

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Sarah A. Lovell

2017-12-01

Full Text Available Community-level interventions dominate contemporary public health responses to health inequalities as a lack of political will has discouraged action at a structural level. Health promoters commonly leverage community capacity to achieve programme goals, yet the health implications of low community capacity are unknown. In this study, we analyse perceptions of community capacity at the individual-level to explore how place-based understandings of identity and connectedness are associated with self-rated health. We examine associations between individual community capacity, self-rated health and income using a cross-sectional survey that was disseminated to 303 residents of four small (populations 1500–2000 New Zealand towns. Evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people who rated their community's capacity higher did not have better self-rated health. Much stronger evidence supported the relationship between income and both higher individual community capacity and higher self-rated health. We conclude that individual community capacity may mediate the positive association between income and health, however, overall we find no evidence suggesting that intervening to enhance individual community capacity is likely to improve health outcomes.

Building research and evaluation capacity in population health: the NSW Health approach.

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Edwards, Barry; Stickney, Beth; Milat, Andrew; Campbell, Danielle; Thackway, Sarah

2016-02-01

Issue addressed An organisational culture that values and uses research and evaluation (R&E) evidence to inform policy and practice is fundamental to improving health outcomes. The 2016 NSW Government Program Evaluation Guidelines recommend investment in training and development to improve evaluation capacity. The purpose of this paper is to outline the approaches taken by the NSW Ministry of Health to develop R&E capacity and assess these against existing models of practice. Method The Ministry of Health's Centre for Epidemiology and Evidence (CEE) takes an evidence-based approach to building R&E capacity in population health. Strategies are informed by: the NSW Population Health Research Strategy, R&E communities of practice across the Ministry and health Pillar agencies and a review of the published evidence on evaluation capacity building (ECB). An internal survey is conducted biennially to monitor research activity within the Ministry's Population and Public Health Division. One representative from each of the six centres that make up the Division coordinates completion of the survey by relevant staff members for their centre. Results The review identified several ECB success factors including: implementing a tailored multifaceted approach; an organisational commitment to R&E; and offering experiential training and ongoing technical support to the workforce. The survey of research activity found that the Division funded a mix of research assets, research funding schemes, research centres and commissioned R&E projects. CEE provides technical advice and support services for staff involved in R&E and in 2015, 22 program evaluations were supported. R&E capacity building also includes a series of guides to assist policy makers, practitioners and researchers to commission, undertake and use policy-relevant R&E. Staff training includes workshops on critical appraisal, program logic and evaluation methods. From January 2013 to June 2014 divisional staff published 84

Research capacity and culture of the Victorian public health allied health workforce is influenced by key research support staff and location.

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Williams, Cylie; Miyazaki, Koki; Borkowski, Donna; McKinstry, Carol; Cotchet, Matthew; Haines, Terry

2015-06-01

The aim of the present study was to identify and understand the self-rated research capacity and culture of the allied health workforce. METHODS. The present study was a cross-sectional survey. The Research Capacity and Culture tool was disseminated to all Victorian public health allied health departments. General demographic data were also collected, including the presence of an organisational allied health research lead. Five hundred and twenty fully completed surveys were returned by participants; all allied health disciplines and all grades were represented. One hundred and eighty-six participants had an organisational allied health research lead and 432 were located in a metropolitan-based health service. There were significant differences (P workforce identifies as a group that is ready to build the evidence to support clinical practice yet requires a whole-systems approach to do so. The results of the present study suggest that the development of key people to build capacity at a higher organisational level has a flow-down effect on research capacity and culture.

From smallpox eradication to contemporary global health initiatives: enhancing human capacity towards a global public health goal.

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Tarantola, Daniel; Foster, Stanley O

2011-12-30

The eradication of smallpox owes its success first and foremost to the thousands of lay health workers and community members who, throughout the campaign and across continents, took on the roles of advocates, educators, vaccinators, care providers and contributors to epidemic surveillance and containment. Bangladesh provides a good example where smallpox eradication and the capacity enhancement needed to achieve this goal resulted in a two-way mutually beneficial process. Smallpox-dedicated staff provided community members with information guidance, support and tools. In turn, communities not only created the enabling environment for smallpox program staff to perform their work but acquired the capacity to perform essential eradication tasks. Contemporary global health programmes can learn much from these core lessons including: the pivotal importance of supporting community aspirations, capacity and resilience; the critical need to enhance commitment, capacity and accountability across the workforce; and the high value of attentive human resources management and support. We owe to subsequent global disease control, elimination and eradication ventures recognition of the need for social and behavioural science to inform public health strategies; the essential roles that civil society organizations and public-private partnerships can play in public health discourse and action; the overall necessity of investing in broad-based health system strengthening; and the utility of applying human rights principles, norms and standards to public health policy and practice. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Case-resolving capacity of dental care of the Unified Health System: the perception of users in a city in the state of São Paulo, Brazil

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Arinilson Moreira Chaves Lima

Full Text Available Abstract The aim of this study was to learn about the users' perceptions concerning the case-resolving capacity of dental care in the Unified Health System and to analyze the associations between solving capacity and both sociodemographic characteristics and access to the service. This was a cross-sectional study with a quantitative approach, in which 461 users responded to individual interviews. The outcome variable was the case-resolving capacity of dental care, obtained through the question: “In your opinion, is the dentist of this health center managing to solve all your oral health problems (Yes/No”. Independent variables were grouped into the following: sociodemographic and related to the access to the service. Most participants reported that their oral health problems were being solved. By using the Poisson regression, the lack of case-resolving capacity was found to be associated to the patients' not considering the dental surgeon's working hours convenient; to the long time they had to wait to get an appointment in the health center; and to the long time they had to wait in the waiting room. The results showed the positive view that users have about the case-resolving capacity of public dental care, and the relationship between access to the service and the said solving capacity.

[Capacity of response of the health system to the expectations of populations in zones exposed to results-based financing in Benin in 2015].

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Salami, Lamidhi; Dona Ouendo, Edgard-Marius; Fayomi, Benjamin

2017-07-10

Introduction: The increased use of results-based financing (RBF) services was the basis for this study designed to evaluate the contribution of RBF to the capacity of response of the health system to the population’s expectations. Methods: This study, conducted in six Benin health zones randomly selected in two strata exposed to RBF (FBR_PRPSS and FBR_PASS) and one zone not exposed to RBF (Non_FBR), examined the seven dimensions of reactivity. A score, followed by weighting of their attributes, was used to calculate the index of reactivity (IR). Results: Sixty-seven health care units and 653 people were observed and interviewed. The FBR_PRPSS and FBR_PASS strata, managed by the new provisions of RBF, displayed good performances for the “rapidity of management” (70% and 80%) and “quality of the health care environment” dimensions, with a more marked improvement for the PRPSS model, which provides greater resources. Poor access to social welfare networks in the three strata led to renouncing of health care. The capacity of response to expectations was moderate and similar in the Non_FBR (IR = 0.53), FBR_PASS (IR = 0.62) and FBR_PRPSS (IR = 0.61) strata (p > 0.05). Conclusion: The FBR_PRPSS and FBR_PASS models have a non-significant effect on the capacity of response. Their success probably depends on the health system context, the combination of targeted interventions, such as universal health insurance, but also the importance and the use of the new resources that they provide.

An Assessment of Epidemiology Capacity in a One Health Team at the Provincial Level in Thailand

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Soawapak Hinjoy

2016-10-01

Full Text Available A multi-sectoral core epidemiology capacity assessment was conducted in provinces that implemented One Health services in order to assess the efficacy of a One Health approach in Thailand. In order to conduct the assessment, four provinces were randomly selected as a study group from a total of 19 Thai provinces that are currently using a One Health approach. As a control group, four additional provinces that never implemented a One Health approach were also sampled. The provincial officers were interviewed on the epidemiologic capacity of their respective provinces. The average score of epidemiologic capacity in the provinces implementing the One Health approach was 66.45%, while the provinces that did not implement this approach earned a score of 54.61%. The epidemiologic capacity of surveillance systems in provinces that utilized the One Health approach earned higher scores in comparison to provinces that did not implement the approach (75.00% vs. 53.13%, p-value 0.13. Although none of the capacity evaluations showed significant differences between the two groups, we found evidence that provinces implementing the One Health approach gained higher scores in both surveillance and outbreak investigation capacities. This may be explained by more efficient capacity when using a One Health approach, specifically in preventing, protecting, and responding to threats in local communities.

Capacity building for global health diplomacy: Thailand's experience of trade and health.

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Thaiprayoon, Suriwan; Smith, Richard

2015-11-01

A rapid expansion of trade liberalization in Thailand during the 1990s raised a critical question for policy transparency from various stakeholders. Particular attention was paid to a bilateral trade negotiation between Thailand and USA concerned with the impact of the 'Trade-Related Aspects of Intellectual Rights (TRIPS) plus' provisions on access to medicines. Other trade liberalization effects on health were also concerning health actors. In response, a number of interagency committees were established to engage with trade negotiations. In this respect, Thailand is often cited as a positive example of a country that has proactively sought, and achieved, trade and health policy coherence. This article investigates this relationship in more depth and suggests lessons for wider study and application of global health diplomacy (GHD). This study involved semi-structured interviews with 20 people involved in trade-related health negotiations, together with observation of 9 meetings concerning trade-related health issues. Capacity to engage with trade negotiations appears to have been developed by health actors through several stages; starting from the Individual (I) understanding of trade effects on health, through Nodes (N) that establish the mechanisms to enhance health interests, Networks (N) to advocate for health within these negotiations, and an Enabling environment (E) to retain health officials and further strengthen their capacities to deal with trade-related health issues. This INNE model seems to have worked well in Thailand. However, other contextual factors are also significant. This article suggests that, in building capacity in GHD, it is essential to educate both health and non-health actors on global health issues and to use a combination of formal and informal mechanisms to participate in GHD. And in developing sustainable capacity in GHD, it requires long term commitment and strong leadership from both health and non-health sectors. Published by

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

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Elizabeth H. Bradley

2015-07-01

Full Text Available Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management – defined here as the process of achieving predetermined objectives through human, financial, and technical resources – is a cross-cutting function necessary for success in all World Health Organization (WHO building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

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Guyon, Ak'ingabe; Perreault, Robert

2016-10-20

Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

Aldo Leopold's land health from a resilience point of view: self-renewal capacity of social-ecological systems.

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Berkes, Fikret; Doubleday, Nancy C; Cumming, Graeme S

2012-09-01

Health approaches to ecology have a strong basis in Aldo Leopold's thinking, and contemporary ecohealth in turn has a strong philosophical basis in Leopold. To commemorate the 125th anniversary of Leopold's birth (1887-1948), we revisit his ideas, specifically the notions of stewardship (land ethic), productive use of ecosystems (land), and ecosystem renewal. We focus on Leopold's perspective on the self-renewal capacity of the land, as understood in terms of integrity and land health, from the contemporary perspective of resilience theory and ecological theory more generally. Using a broad range of literature, we explore insights and implications of Leopold's work for today's human-environment relationships (integrated social-ecological systems), concerns for biodiversity, the development of agency with respect to stewardship, and key challenges of his time and of ours. Leopold's seminal concept of land health can be seen as a triangulation of productive use, self-renewal, and stewardship, and it can be reinterpreted through the resilience lens as the health of social-ecological systems. In contemporary language, this involves the maintenance of biodiversity and ecosystem services, and the ability to exercise agency both for conservation and for environmental justice.

Capacity building for global health diplomacy: Thailand’s experience of trade and health

Science.gov (United States)

Thaiprayoon, Suriwan; Smith, Richard

2015-01-01

A rapid expansion of trade liberalization in Thailand during the 1990s raised a critical question for policy transparency from various stakeholders. Particular attention was paid to a bilateral trade negotiation between Thailand and USA concerned with the impact of the ‘Trade-Related Aspects of Intellectual Rights (TRIPS) plus’ provisions on access to medicines. Other trade liberalization effects on health were also concerning health actors. In response, a number of interagency committees were established to engage with trade negotiations. In this respect, Thailand is often cited as a positive example of a country that has proactively sought, and achieved, trade and health policy coherence. This article investigates this relationship in more depth and suggests lessons for wider study and application of global health diplomacy (GHD). This study involved semi-structured interviews with 20 people involved in trade-related health negotiations, together with observation of 9 meetings concerning trade-related health issues. Capacity to engage with trade negotiations appears to have been developed by health actors through several stages; starting from the Individual (I) understanding of trade effects on health, through Nodes (N) that establish the mechanisms to enhance health interests, Networks (N) to advocate for health within these negotiations, and an Enabling environment (E) to retain health officials and further strengthen their capacities to deal with trade-related health issues. This INNE model seems to have worked well in Thailand. However, other contextual factors are also significant. This article suggests that, in building capacity in GHD, it is essential to educate both health and non-health actors on global health issues and to use a combination of formal and informal mechanisms to participate in GHD. And in developing sustainable capacity in GHD, it requires long term commitment and strong leadership from both health and non-health sectors. PMID

Does Health Coaching Grow Capacity in Cancer Survivors? A Systematic Review.

Science.gov (United States)

Barakat, Suzette; Boehmer, Kasey; Abdelrahim, Marwan; Ahn, Sangwoo; Al-Khateeb, Abdulrahman A; Villalobos, Neri Álvarez; Prokop, Larry; Erwin, Patricia J; Fleming, Kirsten; Serrano, Valentina; Spencer-Bonilla, Gabriela; Murad, Mohammad Hassan

2018-02-01

Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.

Good collaborative practice: reforming capacity building governance of international health research partnerships.

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Ward, Claire Leonie; Shaw, David; Sprumont, Dominique; Sankoh, Osman; Tanner, Marcel; Elger, Bernice

2018-01-08

In line with the policy objectives of the United Nations Sustainable Development Goals, this commentary seeks to examine the extent to which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. Our evaluation finds that governance of collaborative research partnerships, and in particular capacity building, in resource-constrained settings is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health-related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS) (2016). However, more clarity is needed in national legislation, industry and ethics guidelines, and regulatory provisions to address the structural inequities and power imbalances inherent in international health research partnerships. Most notably, ethical partnership governance is not supported by the principal industry ethics guidelines - the International Conference on Harmonization Technical Requirements for Registration of Pharmaceutical for Human Use (ICH) Good Clinical Practice (ICH-GCP). Given the strategic value of ICH-GCP guidelines in defining the role and responsibility of global health research partners, we conclude that such governance should stipulate the minimal requirements for creating an equitable environment of inclusion, mutual learning, transparency and accountability. Procedurally, this can be supported by i) shared research agenda setting with local leadership, ii) capacity assessments, and iii) construction of a memorandum of understanding (MoU). Moreover, the requirement of capacity building needs to be coordinated amongst partners to support good collaborative practice and deliver on the public health goals of the research enterprise; improving local conditions of health and reducing global health inequality. In this respect, and in order to develop consistency between sources of research governance, ICH

Seriously Implementing Health Capacity Strengthening Programs in Africa; Comment on “Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique”

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Luis Velez Lapão

2015-10-01

Full Text Available Faced with the challenges of healthcare reform, skills and new capabilities are needed to support the reform and it is of crucial importance in Africa where shortages affects the health system resilience. Edwards et al provides a good example of the challenge of implementing a mentoring program in one province in a sub-Saharan country. From this example, various aspects of strengthening the capacity of managers in healthcare are examined based on our experience in action-training in Africa, as mentoring shares many characteristics with action-training. What practical lessons can be drawn to promote the strengthening so that managers can better intervene in complex contexts? Deeper involvement of health authorities and more rigorous approaches are seriously desirable for the proper development of health capacity strengthening programs in Africa.

Assessing Capacity of Faith-Based Organizations for Health Promotion Activities.

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Tagai, Erin Kelly; Scheirer, Mary Ann; Santos, Sherie Lou Z; Haider, Muhiuddin; Bowie, Janice; Slade, Jimmie; Whitehead, Tony L; Wang, Min Qi; Holt, Cheryl L

2017-10-01

Faith-based organizations (FBOs) are important venues for health promotion, particularly in medically underserved communities. These organizations vary considerably in their structural capacities, which may be linked to variability in implementation success for health promotion initiatives. Lacking an existing validated assessment of organizational capacity specific to FBOs, an initial prototype assessment was developed. The Faith-Based Organization Capacity Inventory (FBO-CI) assesses three structural areas of capacity: Staffing and Space, Health Promotion Experience, and External Collaboration. The multidisciplinary team, including FBO leaders, codeveloped the initial instrument. The initial reliability from a convenience sample of 34 African American churches including descriptions of FBOs representing three capacity levels is reported. The FBO-CI demonstrated feasibility of administration using an in-person interview format, and the three subscales had acceptable internal reliability (α ~ .70). Most churches had an established health ministry (n = 23) and had conducted activities across an average of seven health areas in the previous 2 years. This initial FBO-CI prototype is promising, and future work should consider validation with a larger sample of churches and domain expansion based on the conceptual model. The FBO-CI has a number of potential uses for researchers, FBO leaders, and practitioners working with FBOs in health promotion initiatives.

Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam.

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Van Minh, Hoang; Tuan Anh, Tran; Rocklöv, Joacim; Bao Giang, Kim; Trang, Le Quynh; Sahlen, Klas-Göran; Nilsson, Maria; Weinehall, Lars

2014-01-01

As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease

Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam

Directory of Open Access Journals (Sweden)

Hoang Van Minh

2014-12-01

Full Text Available Background: As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. Objective: This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. Design: This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions were used to broaden understanding of the quantitative material and to get additional information on actions taken. Results: 1 Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2 Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3 Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4 Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5 Information and research: Data that can be used for planning and management (including population and epidemiological

Governance of Health Systems Comment on “A Network Based Theory of Health Systems and Cycles of Well-Being”

OpenAIRE

Blanchet, Karl

2013-01-01

Health systems research aims to understand the governance of health systems (i.e. how health systems function and perform and how their actors interact with each other). This can be achieved by applying innovative methodologies and concepts that are going to capture the complexity and dynamics of health systems when they are affected by shocks. The capacity of health systems to adapt to shocks (i.e. the resilience of health systems) is a new area of investigation. Social network analysis is a...

African Health Economics and Policy Research Capacity Building ...

International Development Research Centre (IDRC) Digital Library (Canada)

African Health Economics and Policy Research Capacity Building and Dissemination. As African countries move toward universal health coverage, it is clear there is a shortage of African experts with applied research skills in health financing such as fiscal space analysis, needs-based resource allocation methods, and ...

Strengthening core public health capacity based on the implementation of the International Health Regulations (IHR) (2005): Chinese lessons

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Liu, Bin; Sun, Yan; Dong, Qian; Zhang, Zongjiu; Zhang, Liang

2015-01-01

As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China. PMID:26029897

Strengthening Core Public Health Capacity Based on the Implementation of the International Health Regulations (IHR (2005: Chinese Lessons

Directory of Open Access Journals (Sweden)

Bin Liu

2015-06-01

Full Text Available As an international legal instrument, the International Health Regulations (IHR is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO. The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC. In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety, radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China.

Public and private maternal health service capacity and patient flows in Southern Tanzania: using a geographic information system to link hospital and national census data.

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Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

2014-01-01

Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase

Motivators, enablers, and barriers to building allied health research capacity

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Pager, Susan; Holden, Libby; Golenko, Xanthe

2012-01-01

Purpose A sound, scientific base of high quality research is needed to inform service planning and decision making and enable improved policy and practice. However, some areas of health practice, particularly many of the allied health areas, are generally considered to have a low evidence base. In order to successfully build research capacity in allied health, a clearer understanding is required of what assists and encourages research as well as the barriers and challenges. Participants and methods This study used written surveys to collect data relating to motivators, enablers, and barriers to research capacity building. Respondents were asked to answer questions relating to them as individuals and other questions relating to their team. Allied health professionals were recruited from multidisciplinary primary health care teams in Queensland Health. Eighty-five participants from ten healthcare teams completed a written version of the research capacity and culture survey. Results The results of this study indicate that individual allied health professionals are more likely to report being motivated to do research by intrinsic factors such as a strong interest in research. Barriers they identified to research are more likely to be extrinsic factors such as workload and lack of time. Allied health professionals identified some additional factors that impact on their research capacity than those reported in the literature, such as a desire to keep at the “cutting edge” and a lack of exposure to research. Some of the factors influencing individuals to do research were different to those influencing teams. These results are discussed with reference to organizational behavior and theories of motivation. Conclusion Supporting already motivated allied health professional individuals and teams to conduct research by increased skills training, infrastructure, and quarantined time is likely to produce better outcomes for research capacity building investment. PMID

Evaluation of capacity-building program of district health managers in India: a contextualized theoretical framework.

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Prashanth, N S; Marchal, Bruno; Kegels, Guy; Criel, Bart

2014-01-01

Performance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many low- and middle-income countries, health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the south Indian Tumkur district, a consortium of five non-governmental organizations partnered with the state government to organize a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months. In this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organizational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention. In the refined program theory of the intervention, we identified various factors at individual, institutional, and environmental levels that could interact with the hypothesized mechanisms of organizational change, such as staff's perceived self-efficacy and commitment to their organizations. Based on this program theory, we formulated context-mechanism-outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions. We discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.

Health research capacity building in Georgia: a case-based needs assessment.

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Squires, A; Chitashvili, T; Djibuti, M; Ridge, L; Chyun, D

2017-06-01

Research capacity building in the health sciences in low- and middle-income countries (LMICs) has typically focused on bench-science capacity, but research examining health service delivery and health workforce is equally necessary to determine the best ways to deliver care. The Republic of Georgia, formerly a part of the Soviet Union, has multiple issues within its healthcare system that would benefit from expended research capacity, but the current research environment needs to be explored prior to examining research-focused activities. The purpose of this project was to conduct a needs assessment focused on developing research capacity in the Republic of Georgia with an emphasis on workforce and network development. A case study approach guided by a needs assessment format. We conducted in-country, informal, semi-structured interviews in English with key informants and focus groups with faculty, students, and representatives of local non-governmental organizations. Purposive and snowball sampling approaches were used to recruit participants, with key informant interviews scheduled prior to arrival in country. Documents relevant to research capacity building were also included. Interview results were coded via content analysis. Final results were organized into a SWOT (strengths, weaknesses, opportunities, threat) analysis format, with the report shared with participants. There is widespread interest among students and faculty in Georgia around building research capacity. Lack of funding was identified by many informants as a barrier to research. Many critical research skills, such as proposal development, qualitative research skills, and statistical analysis, were reported as very limited. Participants expressed concerns about the ethics of research, with some suggesting that research is undertaken to punish or 'expose' subjects. However, students and faculty are highly motivated to improve their skills, are open to a variety of learning modalities, and have

Organizational capacity for change in health care: Development and validation of a scale.

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Spaulding, Aaron; Kash, Bita A; Johnson, Christopher E; Gamm, Larry

We do not have a strong understanding of a health care organization's capacity for attempting and completing multiple and sometimes competing change initiatives. Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment. The aim of this study was to develop and validate a tool to measure health care organizations' capacity to change by building upon previous conceptualizations of absorptive capacity and organizational readiness for change. A multistep process was used to develop the organizational capacity for change survey. The survey was sent to two populations requesting answers to questions about the organization's leadership, culture, and technologies in use throughout the organization. Exploratory and confirmatory factor analyses were conducted to validate the survey as a measurement tool for organizational capacity for change in the health care setting. The resulting organizational capacity for change measurement tool proves to be a valid and reliable method of evaluating a hospital's capacity for change through the measurement of the population's perceptions related to leadership, culture, and organizational technologies. The organizational capacity for change measurement tool can help health care managers and leaders evaluate the capacity of employees, departments, and teams for change before large-scale implementation.

Claim Your Space: Leadership Development as a Research Capacity Building Goal in Global Health

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Airhihenbuwa, Collins O.; Ogedegbe, Gbenga; Iwelunmor, Juliet; Jean-Louis, Girardin; Williams, Natasha; Zizi, Freddy; Okuyemi, Kolawole

2016-01-01

As the burden of noncommunicable diseases (NCDs) rises in settings with an equally high burden of infectious diseases in the Global South, a new sense of urgency has developed around research capacity building to promote more effective and sustainable public health and health care systems. In 2010, NCDs accounted for more than 2.06 million deaths…

The system capacity view of aging and longevity

Institute of Scientific and Technical Information of China (English)

Jing-Dong J.Han; Lei Hou; Na Sun; Chi Xu; Joseph McDermott; Dan Wang

2017-01-01

Background:Aging is a complex systems level problem that needs a systems level solution.However,system models of aging and longevity,although urgently needed,are still lacking,largely due to the paucity of conceptual frameworks for modeling such a complex process.Results:We propose that aging can be viewed as a decline in system capacity,defined as the maximum level of output that a system produces to fulfill demands.Classical aging hallmarks and anti-aging strategies can be well-aligned to system capacity.Genetic variants responsible for lifespan variation across individuals or species can also be explained by their roles in system capacity.We further propose promising directions to develop systems approaches to modulate system capacity and thus extend both healthspan and lifespan.Conclusions:The system capacity model of aging provides an opportunity to examine aging at the systems level.This model predicts that the extent to which aging can be modulated is normally limited by the upper bound of the system capacity of a species.Within such a boundary,aging can be delayed by moderately increasing an individual's system capacity.Beyond such a boundary,increasing the upper bound is required,which is not unrealistic given the unlimited potential of regenerative medicine in the future,but it requires increasing the capacity of the whole system instead of only part of it.

School-Based Health Education Programmes, Health-Learning Capacity and Child Oral Health--related Quality of Life

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Freeman, Ruth; Gibson, Barry; Humphris, Gerry; Leonard, Helen; Yuan, Siyang; Whelton, Helen

2016-01-01

Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health-related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster…

Building capacity for public and population health research in Africa: the consortium for advanced research training in Africa (CARTA) model

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Ezeh, Alex C.; Izugbara, Chimaraoke O.; Kabiru, Caroline W.; Fonn, Sharon; Kahn, Kathleen; Manderson, Lenore; Undieh, Ashiwel S.; Omigbodun, Akinyinka; Thorogood, Margaret

2010-01-01

Background Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region's socio-economic and health problems. Objective and program overview We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from West, East, Central, and Southern Africa, and select northern universities and training institutes. CARTA's program of activities comprises two primary, interrelated, and mutually reinforcing objectives: to strengthen research infrastructure and capacity at African universities; and to support doctoral training through the creation of a collaborative doctoral training program in population and public health. The ultimate goal of CARTA is to build local research capacity to understand the determinants of population health and effectively intervene to improve health outcomes and health systems. Conclusions CARTA's focus on the local production of networked and high-skilled researchers committed to working in sub-Saharan Africa, and on the concomitant increase in local research and training capacity of African universities and research institutes addresses the inability of existing programs to create a critical mass of well-trained and networked researchers across the continent. The initiative's goal of strengthening human resources and university-wide systems critical to the success and sustainability of research productivity in public and population health will rejuvenate institutional teaching, research, and administrative systems. PMID:21085517

Building capacity for public and population health research in Africa: the consortium for advanced research training in Africa (CARTA model

Directory of Open Access Journals (Sweden)

Alex C. Ezeh

2010-11-01

Full Text Available Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region's socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA, which brings together a network of nine academic and four research institutions from West, East, Central, and Southern Africa, and select northern universities and training institutes. CARTA's program of activities comprises two primary, interrelated, and mutually reinforcing objectives: to strengthen research infrastructure and capacity at African universities; and to support doctoral training through the creation of a collaborative doctoral training program in population and public health. The ultimate goal of CARTA is to build local research capacity to understand the determinants of population health and effectively intervene to improve health outcomes and health systems. Conclusions: CARTA's focus on the local production of networked and high-skilled researchers committed to working in sub-Saharan Africa, and on the concomitant increase in local research and training capacity of African universities and research institutes addresses the inability of existing programs to create a critical mass of well-trained and networked researchers across the continent. The initiative's goal of strengthening human resources and university-wide systems critical to the success and sustainability of research productivity in public and population health will rejuvenate institutional teaching, research, and administrative systems.

Legal and regulatory capacity to support the global health security agenda.

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Morhard, Ryan; Katz, Rebecca

2014-01-01

On February 13, 2014, 27 nations, along with 3 international organizations, launched the Global Health Security Agenda (GHSA). The intent of GHSA is to accelerate progress in enabling countries around the world to prevent, detect, and respond to public health emergencies-capacities to be achieved through 9 core objectives. Building national, regional, and international capacity includes creating strong legal and regulatory regimes to support national and international capacities to prevent, detect, and respond to public health emergencies. Accordingly, establishing and reinforcing international and national-level legal preparedness is central to advancing elements of each of the 9 objectives of the GHSA.

Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project.

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Yeatman, H R; Nove, T

2002-12-01

This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotion. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organization. It was identified that the critically important elements in achieving the aims of the project-partnership, leadership and commitment-were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion.

Harnessing the sun: Developing capacity to sustain local solar energy systems

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Olarewaju, Olufemi

2011-12-01

Use of solar photovoltaic (PV) and other renewable sources to meet rising electricity demand by a growing world population has gained traction in many countries in recent years. In rural Sub-Saharan Africa, where 86 percent of the populace has no access to electricity, solar energy systems represent partial solutions to demand, especially in support of rural development initiatives to supply potable water, health care services and education. Unfortunately, development of human and organizational capacity to maintain solar technology has not kept pace with the rate of installation, causing many to fall into disrepair and disuse. This has stimulated interest in capacity development processes required to make solar systems sustainable. To cast light on the practical meanings and challenges of capacity development for solar energy, this study compares the experiences of two rural projects, one in Lagos State (Nigeria) that disregarded the importance of capacity development, and the other in Texas (United States) that, in contrast, made such development the centerpiece of its operations. Based largely on interviews with 60 key actors, findings underscore the crucial importance of sustained investment in capacity development to assurance of durable power supply from renewable sources.

Organizational capacities for health promotion implementation: results from an international hospital study.

Science.gov (United States)

Röthlin, Florian; Schmied, Hermann; Dietscher, Christina

2015-06-01

In this article, organizational structures in hospitals are discussed as possible capacities for hospital health promotion (HP) implementation, based on data from the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals & Health Services (HPH-Network) and was conducted in 2008-2012. Data from 159 acute care hospitals were used in the analysis. Twelve organizational structures, which were denoted as possible organizational health promotion capacities in previous literature, were tested for their association with certain strategic HP implementation approaches. Four organizational structures were significantly (p = 0.05) associated with one or more elaborate and comprehensive strategic HP implementation approaches: (1) a health promotion specific quality assessment routine; (2) an official hospital health promotion team; (3) a fulltime hospital health promotion coordinator; and (4) officially documented health promotion policies, strategies or standards. The results add further evidence to the importance of organizational capacity structures for hospital health promotion and identify four tangible structures as likely candidates for organizational HP capacities in hospitals. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Indicators of sustainable capacity building for health research: analysis of four African case studies.

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Bates, Imelda; Taegtmeyer, Miriam; Squire, S Bertel; Ansong, Daniel; Nhlema-Simwaka, Bertha; Baba, Amuda; Theobald, Sally

2011-03-28

Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, we aimed to identify evidence that could indicate that capacity building was likely to be sustainable. Four projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. By mapping the capacity building activities in each case study onto a framework previously used for evaluating health research capacity in Ghana, we were able to identify activities that were common to all projects. We used these activities to derive indicators which could be used in other projects to monitor progress towards building sustainable research capacity. Indicators of sustainable capacity building increased in complexity as projects matured and included- early engagement of stakeholders; explicit plans for scale up; strategies for influencing policies; quality assessments (awareness and experiential stages)- improved resources; institutionalisation of activities; innovation (expansion stage)- funding for core activities secured; management and decision-making led by southern partners (consolidation stage).Projects became sustainable after a median of 66 months. The main challenges to achieving sustainability were high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development. Our indicators of sustainable capacity building need to be tested prospectively in a variety of projects to assess their usefulness. For each project the evidence required to show that indicators have been achieved should evolve with the project and they should be determined prospectively in collaboration with stakeholders.

CAPACITY BUILDING PROCESS IN ENVIRONMENTAL AND HEALTH IMPACT ASSESSMENT FOR A THAI COMMUNITY.

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Chaithui, Suthat; Sithisarankul, Pornchai; Hengpraprom, Sarunya

2017-03-01

This research aimed at exploring the development of the capacitybuilding process in environmental and health impact assessment, including the consideration of subsequent, capacity-building achievements. Data were gathered through questionnaires, participatory observations, in-depth interviews, focus group discussions, and capacity building checklist forms. These data were analyzed using content analysis, descriptive statistics, and inferential statistics. Our study used the components of the final draft for capacity-building processes consisting of ten steps that were formulated by synthesis from each respective process. Additionally, the evaluation of capacity building levels was performed using 10-item evaluation criteria for nine communities. The results indicated that the communities performed well under these criteria. Finally, exploration of the factors influencing capacity building in environmental and health impact assessment indicated that the learning of community members by knowledge exchange via activities and study visits were the most influential factors of the capacity building processes in environmental and health impact assessment. The final revised version of capacitybuilding process in environmental and health impact assessment could serve as a basis for the consideration of interventions in similar areas, so that they increased capacity in environmental and health impact assessments.

Research capacity and culture in podiatry: early observations within Queensland Health

Science.gov (United States)

2013-01-01

Background Research is a major driver of health care improvement and evidence-based practice is becoming the foundation of health care delivery. For health professions to develop within emerging models of health care delivery, it would seem imperative to develop and monitor the research capacity and evidence-based literacy of the health care workforce. This observational paper aims to report the research capacity levels of statewide populations of public-sector podiatrists at two different time points twelve-months apart. Methods The Research Capacity & Culture (RCC) survey was electronically distributed to all Queensland Health (Australia) employed podiatrists in January 2011 (n = 58) and January 2012 (n = 60). The RCC is a validated tool designed to measure indicators of research skill in health professionals. Participants rate skill levels against each individual, team and organisation statement on a 10-point scale (one = lowest, ten = highest). Chi-squared and Mann Whitney U tests were used to determine any differences between the results of the two survey samples. A minimum significance of p  6). Whereas, most reported their organisation’s skills to perform and support research at much higher levels (Median > 6). The 2012 survey respondents reported significantly higher skill ratings compared to the 2011 survey in individuals’ ability to secure research funding, submit ethics applications, and provide research advice, plus, in their organisation’s skills to support, fund, monitor, mentor and engage universities to partner their research (p < 0.05). Conclusions This study appears to report the research capacity levels of the largest populations of podiatrists published. The 2011 survey findings indicate podiatrists have similarly low research capacity skill levels to those reported in the allied health literature. The 2012 survey, compared to the 2011 survey, suggests podiatrists perceived higher skills and support to initiate

Research capacity and culture in podiatry: early observations within Queensland Health

Directory of Open Access Journals (Sweden)

Lazzarini Peter A

2013-01-01

Full Text Available Abstract Background Research is a major driver of health care improvement and evidence-based practice is becoming the foundation of health care delivery. For health professions to develop within emerging models of health care delivery, it would seem imperative to develop and monitor the research capacity and evidence-based literacy of the health care workforce. This observational paper aims to report the research capacity levels of statewide populations of public-sector podiatrists at two different time points twelve-months apart. Methods The Research Capacity & Culture (RCC survey was electronically distributed to all Queensland Health (Australia employed podiatrists in January 2011 (n = 58 and January 2012 (n = 60. The RCC is a validated tool designed to measure indicators of research skill in health professionals. Participants rate skill levels against each individual, team and organisation statement on a 10-point scale (one = lowest, ten = highest. Chi-squared and Mann Whitney U tests were used to determine any differences between the results of the two survey samples. A minimum significance of p  Results Thirty-seven (64% podiatrists responded to the 2011 survey and 33 (55% the 2012 survey. The 2011 survey respondents reported low skill levels (Median  6. Whereas, most reported their organisation’s skills to perform and support research at much higher levels (Median > 6. The 2012 survey respondents reported significantly higher skill ratings compared to the 2011 survey in individuals’ ability to secure research funding, submit ethics applications, and provide research advice, plus, in their organisation’s skills to support, fund, monitor, mentor and engage universities to partner their research (p  Conclusions This study appears to report the research capacity levels of the largest populations of podiatrists published. The 2011 survey findings indicate podiatrists have similarly low research capacity skill

"It takes more than a fellowship program": reflections on capacity strengthening for health systems research in sub-Saharan Africa.

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Izugbara, Chimaraoke O; Kabiru, Caroline W; Amendah, Djesika; Dimbuene, Zacharie Tsala; Donfouet, Hermann Pythagore Pierre; Atake, Esso-Hanam; Ingabire, Marie-Gloriose; Maluka, Stephen; Mumah, Joyce N; Mwau, Matilu; Ndinya, Mollyne; Ngure, Kenneth; Sidze, Estelle M; Sossa, Charles; Soura, Abdramane; Ezeh, Alex C

2017-12-04

Sub-Saharan Africa (SSA) experiences an acute dearth of well-trained and skilled researchers. This dearth constrains the region's capacity to identify and address the root causes of its poor social, health, development, and other outcomes. Building sustainable research capacity in SSA requires, among other things, locally led and run initiatives that draw on existing regional capacities as well as mutually beneficial global collaborations. This paper describes a regional research capacity strengthening initiative-the African Doctoral Dissertation Research Fellowship (ADDRF) program. This Africa-based and African-led initiative has emerged as a practical and tested platform for producing and nurturing research leaders, strengthening university-wide systems for quality research training and productivity, and building a critical mass of highly-trained African scholars and researchers. The program deploys different interventions to ensure the success of fellows. These interventions include research methods and scientific writing workshops, research and reentry support grants, post-doctoral research support and placements, as well as grants for networking and scholarly conferences attendance. Across the region, ADDRF graduates are emerging as research leaders, showing signs of becoming the next generation of world-class researchers, and supporting the transformations of their home-institutions. While the contributions of the ADDRF program to research capacity strengthening in the region are significant, the sustainability of the initiative and other research and training fellowship programs on the continent requires significant investments from local sources and, especially, governments and the private sector in Africa. The ADDRF experience demonstrates that research capacity building in Africa is possible through innovative, multifaceted interventions that support graduate students to develop different critical capacities and transferable skills and build, expand, and

Association between Organizational Capacity and Involvement in Chronic Disease Prevention Programming among Canadian Public Health Organizations

Science.gov (United States)

Hanusaik, Nancy; Sabiston, Catherine M.; Kishchuk, Natalie; Maximova, Katerina; O'Loughlin, Jennifer

2015-01-01

In the context of the emerging field of public health services and systems research, this study (i) tested a model of the relationships between public health organizational capacity (OC) for chronic disease prevention, its determinants (organizational supports for evaluation, partnership effectiveness) and one possible outcome of OC (involvement…

Decision Space and Capacities in the Decentralization of Health Services in FijiComment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis".

Science.gov (United States)

Bossert, Thomas J

2016-05-08

The study of decentralization in Fiji shows that increasing capacities is not necessarily related to increasing decision space of local officials, which is in contrast with earlier studies in Pakistan. Future studies should address the relationship among decision space, capacities, and health system performance. © 2016 by Kerman University of Medical Sciences.

Policy Capacity Meets Politics; Comment on “Health Reform Requires Policy Capacity”

Directory of Open Access Journals (Sweden)

Patrick Fafard

2015-10-01

Full Text Available It is difficult to disagree with the general argument that successful health reform requires a significant degree of policy capacity or that all players in the policy game need to move beyond self-interested advocacy. However, an overly broad definition of policy capacity is a problem. More important perhaps, health reform inevitably requires not just policy capacity but political leadership and compromise.

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments.

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Tabak, Rachel G; Duggan, Katie; Smith, Carson; Aisaka, Kristelle; Moreland-Russell, Sarah; Brownson, Ross C

2016-01-01

Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs. Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. Case study interviews from June to July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. Six geographically diverse LHD's (selected from 3 of high and 3 of low capacity) : 35 LHD practitioners. Thematic reports explored the 8 domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training when compared with low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High- and low-capacity LHDs described strategic planning, but high-capacity

Assessing capacity for sustainability of effective programs and policies in local health departments

Science.gov (United States)

Tabak, Rachel G.; Duggan, Katie; Smith, Carson; Aisaka, Kristelle; Moreland-Russell, Sarah; Brownson, Ross C.

2015-01-01

Context Sustainability has been defined as the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based public health and is important in local health departments (LHDs) to retain the benefits of effective programs. Objective Explore the applicability of the Program Sustainability Framework in high- and low-capacity LHDs as defined by national performance standards. Design Case study interviews from June-July 2013. Standard qualitative methodology was used to code transcripts; codes were developed inductively and deductively. Setting Six geographically diverse LHD’s (selected from three high- and three low-capacity) Participants 35 LHD practitioners Main Outcome Measures Thematic reports explored the eight domains (Organizational Capacity, Program Adaptation, Program Evaluation, Communications, Strategic Planning, Funding Stability, Environmental Support, and Partnerships) of the Program Sustainability Framework. Results High-capacity LHDs described having environmental support, while low-capacity LHDs reported this was lacking. Both high- and low-capacity LHDs described limited funding; however, high-capacity LHDs reported greater funding flexibility. Partnerships were important to high- and low-capacity LHDs, and both described building partnerships to sustain programming. Regarding organizational capacity, high-capacity LHDs reported better access to and support for adequate staff and staff training compared to low-capacity LHDs. While high-capacity LHDs described integration of program evaluation into implementation and sustainability, low-capacity LHDs reported limited capacity for measurement specifically and evaluation generally. When high-capacity LHDs described program adoption, they discussed an opportunity to adapt and evaluate. Low-capacity LHDs struggled with programs requiring adaptation. High-capacity LHDs described higher quality communication than low-capacity LHDs. High

Overcoming Barriers to Rural Children's Mental Health: An Interconnected Systems Public Health Model

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Huber, Brenda J.; Austen, Julie M.; Tobin, Renée M.; Meyers, Adena B.; Shelvin, Kristal H.; Wells, Michael

2016-01-01

A large, Midwestern county implemented a four-tiered public health model of children's mental health with an interconnected systems approach involving education, health care, juvenile justice and community mental health sectors. The community sought to promote protective factors in the lives of all youth, while improving the capacity,…

Mapping health research capacity in 17 countries of the former Soviet Union and south-eastern Europe: an exploratory study.

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Santoro, Alessio; Glonti, Ketevan; Bertollini, Roberto; Ricciardi, Walter; McKee, Martin

2016-04-01

Policies to improve health status, tackle disease and ensure equitable access to healthcare should be informed by evidence derived from high-quality research. However, health research capacity is unevenly distributed across countries, as revealed by mapping exercises that have been undertaken to provide a basis for concerted action to strengthen capacity. This study systematically describes capacity to undertake health research in the countries of the former Soviet Union and south-eastern Europe and identifies the elements required to create a national health research system. The mapping exercise comprised two elements: a survey of key informants in the respective countries and a bibliometric analysis of scientific publications in the field of public health. Our results confirm that health research remains a low priority in some countries of the WHO European Region. In these countries, most of the literature was produced by researchers outside the country, often to inform international donors. This study provides important information for countries seeking to initiate action to strengthen their research capacity. There is a need for a comprehensive strategy with sustained investment in training and career development of researchers. There is also a need to create new funding systems to provide financial support to those undertaking policy-relevant research. International collaboration and investment in mechanisms to bridge the gap between research and policy are urgently required. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Understanding the impact of global trade liberalization on health systems pursuing universal health coverage.

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Missoni, Eduardo

2013-01-01

In the context of reemerging universalistic approaches to health care, the objective of this article was to contribute to the discussion by highlighting the potential influence of global trade liberalization on the balance between health demand and the capacity of health systems pursuing universal health coverage (UHC) to supply adequate health care. Being identified as a defining feature of globalization affecting health, trade liberalization is analyzed as a complex and multidimensional influence on the implementation of UHC. The analysis adopts a systems-thinking approach and refers to the six building blocks of World Health Organization's current "framework for action," emphasizing their interconnectedness. While offering new opportunities to increase access to health information and care, in the absence of global governance mechanisms ensuring adequate health protection and promotion, global trade tends to have negative effects on health systems' capacity to ensure UHC, both by causing higher demand and by interfering with the interconnected functioning of health systems' building blocks. The prevention of such an impact and the effective implementation of UHC would highly benefit from a more consistent commitment and stronger leadership by the World Health Organization in protecting health in global policymaking fora in all sectors. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Capacity-building for health research in developing countries: a manager's approach

Directory of Open Access Journals (Sweden)

Franklin White

2002-09-01

Full Text Available Research may be viewed as rigorous inquiry to advance knowledge and improve practices. An international commission has argued that strengthening research capacity is one of the most powerful, cost-effective, and sustainable means of advancing health and development. However, the global effort to promote research in developing countries has been mostly policy driven, and largely at the initiative of donor agencies based in developed countries. This policy approach, although essential, both contrasts with and is complementary to that of research managers, who must build capacity "from the ground up" in a variety of health service settings within countries and with differing mandates, resources, and constraints. In health organizations the concept of research is broad, and practices vary widely. However, building research capacity is not altogether different from building other kinds of organizational capacity, and it involves two major dimensions: strategic and operational. In organizations in the health field, if reference to research is not in the mission statement, then developing a relevant research capacity is made vastly more difficult. Research capacities that take years to develop can be easily damaged through inadequate support, poor management, or other negative influences associated with both internal and external environments. This paper draws from key international research policy documents and observations on the behavior of research and donor agencies in relation to developing countries. It examines capacity-building primarily as a challenge for research managers, realities underlying operational effectiveness and efficiency, approaches to resource mobilization, and the need for marketing the research enterprise. Selected examples from South Asia and Latin America and the Caribbean are presented.

Community Health Workers Promote Civic Engagement and Organizational Capacity to Impact Policy.

Science.gov (United States)

Sabo, Samantha; Flores, Melissa; Wennerstrom, Ashley; Bell, Melanie L; Verdugo, Lorena; Carvajal, Scott; Ingram, Maia

2017-12-01

Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.

Bargaining and idle public sector capacity in health care

OpenAIRE

Barros, Pedro Pita

2005-01-01

A feature present in countries with a National Health Service is the co−existence of a públic and a private sector. Often, the public payer contracts with private providers while holding idle capacity. This is often seen as inefficiency from the management of public facilities. We present here a different rationale for the existence of such idle capacity: the public sector may opt to have idle capacity as a way to gain bargaining power vis−à−vis the private provider, under the assumption of a...

Bargaining and idle public sector capacity in health care

OpenAIRE

Xavier Martinez-Giralt; Barros Pedro Pita

2005-01-01

A feature present in countries with a National Health Service is the co-existence of a public and a private sector. Often, the public payer contracts with private providers while holding idle capacity. This is often seen as inefficiency from the management of public facilities. We present here a different rationale for the existence of such idle capacity: the public sector may opt to have idle capacity as a way to gain bargaining power vis-Ã -vis the private provider, under the assumption of ...

Building Sustainable Local Capacity for Global Health Research in West Africa.

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Sam-Agudu, Nadia A; Paintsil, Elijah; Aliyu, Muktar H; Kwara, Awewura; Ogunsola, Folasade; Afrane, Yaw A; Onoka, Chima; Awandare, Gordon A; Amponsah, Gladys; Cornelius, Llewellyn J; Mendy, Gabou; Sturke, Rachel; Ghansah, Anita; Siberry, George K; Ezeanolue, Echezona E

Global health research in resource-limited countries has been largely sponsored and led by foreign institutions. Thus, these countries' training capacity and productivity in global health research is limited. Local participation at all levels of global health knowledge generation promotes equitable access to evidence-based solutions. Additionally, leadership inclusive of competent local professionals promotes best outcomes for local contextualization and implementation of successful global health solutions. Among the sub-Saharan African regions, West Africa in particular lags in research infrastructure, productivity, and impact in global health research. In this paper, experts discuss strategies for scaling up West Africa's participation in global health evidence generation using examples from Ghana and Nigeria. We conducted an online and professional network search to identify grants awarded for global health research and research education in Ghana and Nigeria. Principal investigators, global health educators, and representatives of funding institutions were invited to add their knowledge and expertise with regard to strengthening research capacity in West Africa. While there has been some progress in obtaining foreign funding, foreign institutions still dominate local research. Local research funding opportunities in the 2 countries were found to be insufficient, disjointed, poorly sustained, and inadequately publicized, indicating weak infrastructure. As a result, research training programs produce graduates who ultimately fail to launch independent investigator careers because of lack of mentoring and poor infrastructural support. Research funding and training opportunities in Ghana and Nigeria remain inadequate. We recommend systems-level changes in mentoring, collaboration, and funding to drive the global health research agenda in these countries. Additionally, research training programs should be evaluated not only by numbers of individuals graduated but

North-south collaboration and capacity development in global health research in low- and middle-income countries - the ARCADE projects.

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Atkins, Salla; Marsden, Sophie; Diwan, Vishal; Zwarenstein, Merrick

2016-01-01

Research capacity enhancement is needed in low- and middle-income countries (LMICs) for improved health, wellbeing, and health systems' development. In this article, we discuss two capacity-building projects, the African/Asian Regional Capacity Development (ARCADE) in Health Systems and Services Research (HSSR) and Research on Social Determinants of Health (RSDH), implemented from 2011 to 2015. The two projects focussed on providing courses in HSSR and social determinants of health research, and on developing collaborations between universities, along with capacity in LMIC universities to manage research grant submissions, financing, and reporting. Both face-to-face and sustainable online teaching and learning resources were used in training at higher postgraduate levels (Masters and Doctoral level). We collated project meeting and discussion minutes along with project periodic reports and deliverables. We extracted key outcomes from these, reflected on these in discussions, and summarised them for this paper. Nearly 55 courses and modules were developed that were delivered to over 920 postgraduate students in Africa, Asia, and Europe. Junior researchers were mentored in presenting, developing, and delivering courses, and in preparing research proposals. In total, 60 collaborative funding proposals were prepared. The consortia also developed institutional capacity in research dissemination and grants management through webinars and workshops. ARCADE HSSR and ARCADE RSDH were comprehensive programmes, focussing on developing the research skills, knowledge, and capabilities of junior researchers. One of the main strengths of these programmes was the focus on network building amongst the partner institutions, where each partner brought skills, expertise, and diverse work cultures into the consortium. Through these efforts, the projects improved both the capacity of junior researchers and the research environment in Africa, Asia, and Europe.

Theories, models and frameworks used in capacity building interventions relevant to public health: a systematic review.

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Bergeron, Kim; Abdi, Samiya; DeCorby, Kara; Mensah, Gloria; Rempel, Benjamin; Manson, Heather

2017-11-28

There is limited research on capacity building interventions that include theoretical foundations. The purpose of this systematic review is to identify underlying theories, models and frameworks used to support capacity building interventions relevant to public health practice. The aim is to inform and improve capacity building practices and services offered by public health organizations. Four search strategies were used: 1) electronic database searching; 2) reference lists of included papers; 3) key informant consultation; and 4) grey literature searching. Inclusion and exclusion criteria are outlined with included papers focusing on capacity building, learning plans, professional development plans in combination with tools, resources, processes, procedures, steps, model, framework, guideline, described in a public health or healthcare setting, or non-government, government, or community organizations as they relate to healthcare, and explicitly or implicitly mention a theory, model and/or framework that grounds the type of capacity building approach developed. Quality assessment were performed on all included articles. Data analysis included a process for synthesizing, analyzing and presenting descriptive summaries, categorizing theoretical foundations according to which theory, model and/or framework was used and whether or not the theory, model or framework was implied or explicitly identified. Nineteen articles were included in this review. A total of 28 theories, models and frameworks were identified. Of this number, two theories (Diffusion of Innovations and Transformational Learning), two models (Ecological and Interactive Systems Framework for Dissemination and Implementation) and one framework (Bloom's Taxonomy of Learning) were identified as the most frequently cited. This review identifies specific theories, models and frameworks to support capacity building interventions relevant to public health organizations. It provides public health practitioners

Strengthening health promotion in hospitals with capacity building: a Taiwanese case study.

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Lee, Chiachi Bonnie; Chen, Michael S; Chien, Sou-Hsin; Pelikan, Jürgen M; Wang, Ying Wei; Chu, Cordia Ming-Yeuk

2015-09-01

Organizational capacity building for health promotion (HP) is beneficial to the effective implementation of HP in organizational settings. The World Health Organization (WHO) Health Promoting Hospitals' (HPHs) initiative encourages hospitals to promote the health of their stakeholders by developing organizational capacity. This study analyzes an application case of one hospital of the HPH initiative in Taiwan, characterizes actions aiming at building organizational support to strengthen health gains and identifies facilitators of and barriers to the implementation of the HP in this hospital. Case study methodology was used with a triangulation of various sources; thematic analysis was used to analyze qualitative information. This study found a positive impact of the HPH initiative on the case hospital, such as more support from leadership, a fine-tuned HP mission and strategy, cultivated pro-HP habits of physical activities, a supportive intramural structure, an HP-inclusive system, improved management practices and enhanced staff participation. Transformational and transactional enablers are of equal importance in implementing HPH. However, it was also found that the case hospital encountered more transactional barriers than transformational ones. This hospital was hindered by insufficient support from external environments, leadership with limited autonomy and authority, a preference for ideals over professionalism, insufficient participation by physicians, a lack of manpower and time, a merit system with limited stimulating effect, ineffective management practices in weak central project management, a lack of integration, insufficient communication and an inability to inculcate the staff on the importance of HP, and inadequate staff participation. Several implications for other hospitals are suggested. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An “All Teach, All Learn” Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement

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McPhail-Bell, Karen; Matthews, Veronica; Bainbridge, Roxanne; Redman-MacLaren, Michelle Louise; Askew, Deborah; Ramanathan, Shanthi; Bailie, Jodie; Bailie, Ross; Matthews, Veronica

2018-01-01

In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators—all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity “strengthening”. New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care. PMID:29761095

Challenges and opportunities in building health research capacity in ...

African Journals Online (AJOL)

Capacity building is considered a priority for health research institutions in developing countries to achieve the Millennium Development Goals by 2015. However, in many countries including Tanzania, much emphasis has been directed towards human resources for health with the total exclusion of human resources for ...

Qualitative study to develop processes and tools for the assessment and tracking of African institutions' capacity for operational health research.

Science.gov (United States)

Wallis, Selina; Cole, Donald C; Gaye, Oumar; Mmbaga, Blandina T; Mwapasa, Victor; Tagbor, Harry; Bates, Imelda

2017-09-05

Research is key to achieving global development goals. Our objectives were to develop and test an evidence-informed process for assessing health research management and support systems (RMSS) in four African universities and for tracking interventions to address capacity gaps. Four African universities. 83 university staff and students from 11 cadres. A literature-informed 'benchmark' was developed and used to itemise all components of a university's health RMSS. Data on all components were collected during site visits to four African universities using interview guides, document reviews and facilities observation guides. Gaps in RMSS capacity were identified against the benchmark and institutional action plans developed to remedy gaps. Progress against indicators was tracked over 15 months and common challenges and successes identified. Common gaps in operational health research capacity included no accessible research strategy, a lack of research e-tracking capability and inadequate quality checks for proposal submissions and contracts. Feedback indicated that the capacity assessment was comprehensive and generated practical actions, several of which were no-cost. Regular follow-up helped to maintain focus on activities to strengthen health research capacity in the face of challenges. Identification of each institutions' strengths and weaknesses against an evidence-informed benchmark enabled them to identify gaps in in their operational health research systems, to develop prioritised action plans, to justify resource requests to fulfil the plans and to track progress in strengthening RMSS. Use of a standard benchmark, approach and tools enabled comparisons across institutions which has accelerated production of evidence about the science of research capacity strengthening. The tools could be used by institutions seeking to understand their strengths and to address gaps in research capacity. Research capacity gaps that were common to several institutions could be

Assessing the capacity of the healthcare system to use additional mechanical ventilators during a large-scale public health emergency (PHE)

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Ajao, Adebola; Nystrom, Scott V.; Koonin, Lisa M.; Patel, Anita; Howell, David R.; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I.

2015-01-01

A large-scale Public Health Emergency (PHE), like a severe influenza pandemic can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the healthcare system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (i.e. conventional, contingency and crisis) and determined the constraining key component at each capacity level. Our study results showed that U.S. hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or identify alternatives to manage overwhelming critical care need. PMID:26450633

Insights in public health: systems thinking: basic constructs, application challenges, misuse in health, and how public health leaders can pave the way forward.

Science.gov (United States)

Canyon, Deon V

2013-12-01

The strengthening of health systems is fundamental to improving health outcomes, crisis preparedness, and our capacity to meet global challenges, such as accelerating progress towards the Millennium Development Goals, reducing maternal and child mortality, combating HIV, malaria and other diseases, limiting the effects of a new influenza pandemic, and responding appropriately to climate change. To meet these complex needs, the Association of Schools and Programs in Public Health, the World Health Organization, and the Institute of Medicine promote systems thinking as the only sensible means to respond to issues that greatly exceed the normal capacity of health and medical services. This paper agrees with the application of systems thinking but argues that health organizations have misunderstood and misapplied systems thinking to the extent that the term has become meaningless. This paper presents the basic constructs of systems thinking, explains why systems thinking has been misapplied, examines some misapplications of systems thinking in health, and suggests how the concept can be applied correctly to medicine and public health to achieve the reason it was adopted in the first place.

Organizational capacity for community development in regional health authorities: a conceptual model.

Science.gov (United States)

Germann, Kathy; Wilson, Doug

2004-09-01

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.

Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries

OpenAIRE

Amde, Woldekidan Kifle; Sanders, David; Lehmann, Uta

2014-01-01

Introduction Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Maste...

Feeling hindered by health problems and functional capacity at 60 years and above.

Science.gov (United States)

Fagerström, Cecilia; Holst, Göran; Hallberg, Ingalill R

2007-01-01

It is common to use activities of daily living (ADL) rating scales to identify the impact of health problems such as diseases, impaired eyesight or hearing on daily life. However, for various reasons people with health problems might feel hindered in daily life before limitations in ability to perform ADL have occurred. In addition, there is sparse knowledge of what makes people feel hindered by health problems in relation to their ADL capacity. The aim was to investigate feeling hindered by health problems among 1297 people aged 60-89 living at home in relation to ADL capacity, health problems, life satisfaction, self-esteem, and social and financial resources, using a self-reported questionnaire, including questions from Older Americans' Resources and Services schedule (OARS), Rosenberg's self-esteem and Life Satisfaction Index Z (LSIZ). People feeling greatly hindered by health problems rarely had anyone who could help when they needed support, had lower life satisfaction and self-esteem than those not feeling hindered. Feeling hindered by health problems appeared to take on a different meaning depending on ADL capacity, knowledge that seems essential to include when accomplishing health promotion and rehabilitation interventions, especially at the early stages of reduced ADL capacity.

[Implementation of the International Health Regulations in Cuba: evaluation of basic capacities of the health sector in selected provinces].

Science.gov (United States)

Gala, Ángela; Toledo, María Eugenia; Arias, Yanisnubia; Díaz González, Manuel; Alvarez Valdez, Angel Manuel; Estévez, Gonzalo; Abreu, Rolando Miyar; Flores, Gustavo Kourí

2012-09-01

Obtain baseline information on the status of the basic capacities of the health sector at the local, municipal, and provincial levels in order to facilitate identification of priorities and guide public policies that aim to comply with the requirements and capacities established in Annex 1A of the International Health Regulations 2005 (IHR-2005). A descriptive cross-sectional study was conducted by application of an instrument of evaluation of basic capacities referring to legal and institutional autonomy, the surveillance and research process, and the response to health emergencies in 36 entities involved in international sanitary control at the local, municipal, and provincial levels in the provinces of Havana, Cienfuegos, and Santiago de Cuba. The polyclinics and provincial centers of health and epidemiology in the three provinces had more than 75% of the basic capacities required. Twelve out of 36 units had implemented 50% of the legal and institutional framework. There was variable availability of routine surveillance and research, whereas the entities in Havana had more than 40% of the basic capacities in the area of events response. The provinces evaluated have integrated the basic capacities that will allow implementation of IHR-2005 within the period established by the World Health Organization. It is necessary to develop and establish effective action plans to consolidate surveillance as an essential activity of national and international security in terms of public health.

Improving public health training and research capacity in Africa: a replicable model for linking training to health and socio-demographic surveillance data

Directory of Open Access Journals (Sweden)

Jill R. Williams

2010-08-01

Full Text Available Background: Research training for public health professionals is key to the future of public health and policy in Africa. A growing number of schools of public health are connected to health and socio-demographic surveillance system field sites in developing countries, in Africa and Asia in particular. Linking training programs with these sites provides important opportunities to improve training, build local research capacity, foreground local health priorities, and increase the relevance of research to local health policy. Objective: To increase research training capacity in public health programs by providing targeted training to students and increasing the accessibility of existing data. Design: This report is a case study of an approach to linking public health research and training at the University of the Witwatersrand. We discuss the development of a sample training database from the Agincourt Health and Socio-demographic Surveillance System in South Africa and outline a concordant transnational intensive short course on longitudinal data analysis offered by the University of the Witwatersrand and the University of Colorado-Boulder. This case study highlights ways common barriers to linking research and training can be overcome. Results and Conclusions: This collaborative effort demonstrates that linking training to ongoing data collection can improve student research, accelerate student training, and connect students to an international network of scholars. Importantly, the approach can be adapted to other partnerships between schools of public health and longitudinal research sites.

Public health program capacity for sustainability: a new framework.

Science.gov (United States)

Schell, Sarah F; Luke, Douglas A; Schooley, Michael W; Elliott, Michael B; Herbers, Stephanie H; Mueller, Nancy B; Bunger, Alicia C

2013-02-01

Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program's capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity-89% of the individual items composing the framework had specific support in the sustainability literature. The sustainability framework presented here suggests that a number of selected factors may be related to a program's ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing

Meeting the International Health Regulations (2005) surveillance core capacity requirements at the subnational level in Europe

DEFF Research Database (Denmark)

Ziemann, Alexandra; Rosenkötter, Nicole; Riesgo, Luis Garcia-Castrillo

2015-01-01

BACKGROUND: The revised World Health Organization's International Health Regulations (2005) request a timely and all-hazard approach towards surveillance, especially at the subnational level. We discuss three questions of syndromic surveillance application in the European context for assessing...... public health emergencies of international concern: (i) can syndromic surveillance support countries, especially the subnational level, to meet the International Health Regulations (2005) core surveillance capacity requirements, (ii) are European syndromic surveillance systems comparable to enable cross...... effect of different types of public health emergencies in a timely manner as required by the International Health Regulations (2005)....

A multi-sector assessment of community organizational capacity for promotion of Chinese immigrant worker health.

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Tsai, Jenny H-C; Thompson, Elaine A

2017-12-01

Community-based collaborative approaches have received increased attention as a means for addressing occupational health disparities. Organizational capacity, highly relevant to engaging and sustaining community partnerships, however, is rarely considered in occupational health research. To characterize community organizational capacity specifically relevant to Chinese immigrant worker health, we used a cross-sectional, descriptive design with 36 agencies from six community sectors in King County, Washington. Joint interviews, conducted with two representatives from each agency, addressed three dimensions of organizational capacity: organizational commitment, resources, and flexibility. Descriptive statistics were used to capture the patterning of these dimensions by community sector. Organizational capacity varied widely across and within sectors. Chinese and Pan-Asian service sectors indicated higher capacity for Chinese immigrant worker health than did Chinese faith-based, labor union, public, and Pan-ethnic nonprofit sectors. Variation in organizational capacity in community sectors can inform selection of collaborators for community-based, immigrant worker health interventions. © 2017 Wiley Periodicals, Inc.

Strengthening public health laboratory capacity in Thailand for International Health Regulations (IHR) (2005).

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Peruski, Anne Harwood; Birmingham, Maureen; Tantinimitkul, Chawalit; Chungsamanukool, Ladawan; Chungsamanukool, Preecha; Guntapong, Ratigorn; Pulsrikarn, Chaiwat; Saengklai, Ladapan; Supawat, Krongkaew; Thattiyaphong, Aree; Wongsommart, Duangdao; Wootta, Wattanapong; Nikiema, Abdoulaye; Pierson, Antoine; Peruski, Leonard F; Liu, Xin; Rayfield, Mark A

2014-07-01

Thailand conducted a national laboratory assessment of core capacities related to the International Health Regulations (IHR) (2005), and thereby established a baseline to measure future progress. The assessment was limited to public laboratories found within the Thai Bureau of Quality and Safety of Food, National Institute of Health and regional medical science centres. The World Health Organization (WHO) laboratory assessment tool was adapted to Thailand through a participatory approach. This adapted version employed a specific scoring matrix and comprised 16 modules with a quantitative output. Two teams jointly performed the on-site assessments in December 2010 over a two-week period, in 17 public health laboratories in Thailand. The assessment focused on the capacity to identify and accurately detect pathogens mentioned in Annex 2 of the IHR (2005) in a timely manner, as well as other public health priority pathogens for Thailand. Performance of quality management, budget and finance, data management and communications was considered strong (>90%); premises quality, specimen collection, biosafety, public health functions, supplies management and equipment availability were judged as very good (>70% but ≤90%); while microbiological capacity, staffing, training and supervision, and information technology needed improvement (>60% but ≤70%). This assessment is a major step in Thailand towards development of an optimized and standardized national laboratory network for the detection and reporting of infectious disease that would be compliant with IHR (2005). The participatory strategy employed to adapt an international tool to the Thai context can also serve as a model for use by other countries in the Region. The participatory approach probably ensured better quality and ownership of the results, while providing critical information to help decision-makers determine where best to invest finite resources.

The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health

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Paniagua-Avila, Maria Alejandra; Messenger, Elizabeth; Nelson, Caroline A.; Calgua, Erwin; Barg, Frances K.; Bream, Kent W.; Compher, Charlene; Dean, Anthony J.; Martinez-Siekavizza, Sergio; Puac-Polanco, Victor; Richmond, Therese S.; Roth, Rudolf R.; Branas, Charles C.

2017-01-01

Population health outcomes are directly related to robust public health programs, access to basic health services, and a well-trained health-care workforce. Effective health services need to systematically identify solutions, scientifically test these solutions, and share generated knowledge. The World Health Organization (WHO)’s Global Healthcare Workforce Alliance states that the capacity to perform research is an essential factor for well-functioning public health systems. Low- and middle-income countries have greater health-care worker shortages and lower research capacity than higher-income countries. International global health partnerships between higher-income countries and low-middle-income countries aim to directly address such inequalities through capacity building, a process by which human and institutional resources are strengthened and developed, allowing them to perform high-level functions, solve complex problems, and achieve important objectives. The Guatemala–Penn Partners (GPP) is a collaboration among academic centers in Guatemala and the University of Pennsylvania (Penn), in Philadelphia, Pennsylvania that echoes the vision of the WHO’s Global Healthcare Workforce Alliance. This article describes the historical development and present organization of the GPP according to its three guiding principles: university-to-university connections, dual autonomies with locally led capacity building, and mutually beneficial exchanges. It describes the GPP activities within the domains of science, health-care education, and public health, emphasizing implementation factors, such as sustainability and scalability, in relation to the guiding principles. Successes and limitations of this innovative model are also analyzed in the hope that the lessons learned may be applied to similar partnerships across the globe. PMID:28443274

Claim Your Space: Leadership Development as a Research Capacity Building Goal in Global Health.

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Airhihenbuwa, Collins O; Ogedegbe, Gbenga; Iwelunmor, Juliet; Jean-Louis, Girardin; Williams, Natasha; Zizi, Freddy; Okuyemi, Kolawole

2016-04-01

As the burden of noncommunicable diseases (NCDs) rises in settings with an equally high burden of infectious diseases in the Global South, a new sense of urgency has developed around research capacity building to promote more effective and sustainable public health and health care systems. In 2010, NCDs accounted for more than 2.06 million deaths in sub-Saharan Africa. Available evidence suggests that the number of people in sub-Saharan Africa with hypertension, a major risk factor for cardiovascular diseases, will increase by 68% from 75 million in 2008 to 126 million in 2025. Furthermore, about 27.5 million people currently live with diabetes in Africa, and it is estimated that 49.7 million people living with diabetes will reside in Africa by 2030. It is therefore necessary to centralize leadership as a key aspect of research capacity building and strengthening in the Global South in ways that enables researchers to claim their spaces in their own locations. We believe that building capacity for transformative leadership in research will lead to the development of effective and appropriate responses to the multiple burdens of NCDs that coexist with infectious diseases in Africa and the rest of the Global South. © 2016 Society for Public Health Education.

A practical and systematic approach to organisational capacity strengthening for research in the health sector in Africa.

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Bates, Imelda; Boyd, Alan; Smith, Helen; Cole, Donald C

2014-03-03

Despite increasing investment in health research capacity strengthening efforts in low and middle income countries, published evidence to guide the systematic design and monitoring of such interventions is very limited. Systematic processes are important to underpin capacity strengthening interventions because they provide stepwise guidance and allow for continual improvement. Our objective here was to use evidence to inform the design of a replicable but flexible process to guide health research capacity strengthening that could be customized for different contexts, and to provide a framework for planning, collecting information, making decisions, and improving performance. We used peer-reviewed and grey literature to develop a five-step pathway for designing and evaluating health research capacity strengthening programmes, tested in a variety of contexts in Africa. The five steps are: i) defining the goal of the capacity strengthening effort, ii) describing the optimal capacity needed to achieve the goal, iii) determining the existing capacity gaps compared to the optimum, iv) devising an action plan to fill the gaps and associated indicators of change, and v) adapting the plan and indicators as the programme matures. Our paper describes three contrasting case studies of organisational research capacity strengthening to illustrate how our five-step approach works in practice. Our five-step pathway starts with a clear goal and objectives, making explicit the capacity required to achieve the goal. Strategies for promoting sustainability are agreed with partners and incorporated from the outset. Our pathway for designing capacity strengthening programmes focuses not only on technical, managerial, and financial processes within organisations, but also on the individuals within organisations and the wider system within which organisations are coordinated, financed, and managed. Our five-step approach is flexible enough to generate and utilise ongoing learning. We have

System of Health Accounts and Health Satellite Accounts : Application in Low- and Middle-Income Countries

NARCIS (Netherlands)

Nakhimovsky, S.; Hernandez-Peña, P.; van Mosseveld, C.; Palacios, A.

2014-01-01

Health accounting data that show economic and financial resource flows within a health system are critical to informing health and economic policy – at both national and international levels. However, countries vary widely in their health accounting histories as well as the demand for and capacity

Estimating cell capacity for multi-cell electrical energy system

Science.gov (United States)

Hashemi, Iman Ahari

A Multi-Cell Electrical Energy System is a set of batteries that are connected in series. The series batteries provide the required voltage necessary for the contraption. After using the energy that is provided by the batteries, some cells within the system tend to have a lower voltage than the other cells. Also, other factors, such as the number of times a battery has been charged or discharged, how long it has been within the system and many other factors, result in some cells having a lesser capacity compared to the other cells within the system. The outcome is that it lowers the required capacity that the electrical energy system is required to provide. By having an unknown cell capacity within the system, it is unknown how much of a charge can be provided to the system so that the cells are not overcharged or undercharged. Therefore, it is necessary to know the cells capacity within the system. Hence, if we were dealing with a single cell, the capacity could be obtained by a full charge and discharge of the cell. In a series system that contains multiple cells a full charging or discharging cannot happen as it might result in deteriorating the structure of some cells within the system. Hence, to find the capacity of a single cell within an electrical energy system it is required to obtain a method that can estimate the value of each cell within the electrical energy system. To approach this method an electrical energy system is required. The electrical energy system consists of rechargeable non-equal capacity batteries to provide the required energy to the system, a battery management system (BMS) board to monitor the cells voltages, an Arduino board that provides the required communication to BMS board, and the PC, and a software that is able to deliver the required data obtained from the Arduino board to the PC. The outcome, estimating the capacity of a cell within a multi-cell system, can be used in many battery related technologies to obtain unknown

Health promotion capacity building in South Africa.

Science.gov (United States)

Wills, Jane; Rudolph, Michael

2010-09-01

Health promotion in South Africa is in its early stages and while there is some institutional development and capacity building for managers, there has been relative disregard and lack of attention of the wider health promotion workforce who carry out community-based health promotion activities. This article describes one regional education and training programme for health promoters as well as the limited available evidence on the impact of the project on learners and organizations. Marked differences before and after the implementation of the training activities were reported in relation to behaviour change communication and project planning, in addition to self-reported positive change in knowledge, confidence and a high level of participant satisfaction. Investment in individual skills development needs to be accompanied by wider workforce development with organizational/institutional development and recognised competencies frameworks.

Promoting evaluation capacity building in a complex adaptive system.

Science.gov (United States)

Lawrenz, Frances; Kollmann, Elizabeth Kunz; King, Jean A; Bequette, Marjorie; Pattison, Scott; Nelson, Amy Grack; Cohn, Sarah; Cardiel, Christopher L B; Iacovelli, Stephanie; Eliou, Gayra Ostgaard; Goss, Juli; Causey, Lauren; Sinkey, Anne; Beyer, Marta; Francisco, Melanie

2018-04-10

This study provides results from an NSF funded, four year, case study about evaluation capacity building in a complex adaptive system, the Nanoscale Informal Science Education Network (NISE Net). The results of the Complex Adaptive Systems as a Model for Network Evaluations (CASNET) project indicate that complex adaptive system concepts help to explain evaluation capacity building in a network. The NISE Network was found to be a complex learning system that was supportive of evaluation capacity building through feedback loops that provided for information sharing and interaction. Participants in the system had different levels of and sources of evaluation knowledge. To be successful at building capacity, the system needed to have a balance between both centralized and decentralized control, coherence, redundancy, and diversity. Embeddedness of individuals within the system also provided support and moved the capacity of the system forward. Finally, success depended on attention being paid to the control of resources. Implications of these findings are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Sexual Health Promotion Programme: Participants' Perspectives on Capacity Building

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Keogh, Brian; Daly, Louise; Sharek, Danika; De Vries, Jan; McCann, Edward; Higgins, Agnes

2016-01-01

Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in…

SDH-NET: a South-North-South collaboration to build sustainable research capacities on social determinants of health in low- and middle-income countries.

Science.gov (United States)

Cash-Gibson, Lucinda; Guerra, German; Salgado-de-Snyder, V Nelly

2015-10-22

It is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South-North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice. The implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research. The implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open

Quantitative safety assessment of air traffic control systems through system control capacity

Science.gov (United States)

Guo, Jingjing

Quantitative Safety Assessments (QSA) are essential to safety benefit verification and regulations of developmental changes in safety critical systems like the Air Traffic Control (ATC) systems. Effectiveness of the assessments is particularly desirable today in the safe implementations of revolutionary ATC overhauls like NextGen and SESAR. QSA of ATC systems are however challenged by system complexity and lack of accident data. Extending from the idea "safety is a control problem" in the literature, this research proposes to assess system safety from the control perspective, through quantifying a system's "control capacity". A system's safety performance correlates to this "control capacity" in the control of "safety critical processes". To examine this idea in QSA of the ATC systems, a Control-capacity Based Safety Assessment Framework (CBSAF) is developed which includes two control capacity metrics and a procedural method. The two metrics are Probabilistic System Control-capacity (PSC) and Temporal System Control-capacity (TSC); each addresses an aspect of a system's control capacity. And the procedural method consists three general stages: I) identification of safety critical processes, II) development of system control models and III) evaluation of system control capacity. The CBSAF was tested in two case studies. The first one assesses an en-route collision avoidance scenario and compares three hypothetical configurations. The CBSAF was able to capture the uncoordinated behavior between two means of control, as was observed in a historic midair collision accident. The second case study compares CBSAF with an existing risk based QSA method in assessing the safety benefits of introducing a runway incursion alert system. Similar conclusions are reached between the two methods, while the CBSAF has the advantage of simplicity and provides a new control-based perspective and interpretation to the assessments. The case studies are intended to investigate the

Four centuries on from Bacon: progress in building health research systems to improve health systems?

Science.gov (United States)

Hanney, Stephen R; González-Block, Miguel A

2014-09-23

In 1627, Francis Bacon's New Atlantis described a utopian society in which an embryonic research system contributed to meeting the needs of the society. In this editorial, we use some of the aspirations described in New Atlantis to provide a context within which to consider recent progress in building health research systems to improve health systems and population health. In particular, we reflect on efforts to build research capacity, link research to policy, identify the wider impacts made by the science, and generally build fully functioning research systems to address the needs identified. In 2014, Health Research Policy and Systems has continued to publish one-off papers and article collections covering a range of these issues in both high income countries and low- and middle-income countries. Analysis of these contributions, in the context of some earlier ones, is brought together to identify achievements, challenges and possible ways forward. We show how 2014 is likely to be a pivotal year in the development of ways to assess the impact of health research on policies, practice, health systems, population health, and economic benefits.We demonstrate how the increasing focus on health research systems will contribute to realising the hopes expressed in the World Health Report, 2013, namely that all nations would take a systematic approach to evaluating the outputs and applications resulting from their research investment.

Capacity building improve Malaysia's inspection and monitoring system for aquaculture and fishery products

NARCIS (Netherlands)

Gevers, G.J.M.; Zoontjes, P.W.; Essers, M.L.; Klijnstra, M.; Gerssen, A.

2012-01-01

The project aimed to help build a credible inspection and monitoring system that can guarantee safe quality products of Ministry of Health (MoH) and Department of Fisheries (DoF) by upgrading the analytical capacity of the laboratory staff directly involved in the analysis and detection of forbidden

Building policy capacities: an interactive approach for linking knowledge to action in health promotion.

Science.gov (United States)

Rütten, Alfred; Gelius, Peter

2014-09-01

This article outlines a theoretical framework for an interactive, research-driven approach to building policy capacities in health promotion. First, it illustrates how two important issues in the recent public health debate, capacity building and linking scientific knowledge to policy action, are connected to each other theoretically. It then introduces an international study on an interactive approach to capacity building in health promotion policy. The approach combines the ADEPT model of policy capacities with a co-operative planning process to foster the exchange of knowledge between policy-makers and researchers, thus improving intra- and inter-organizational capacities. A regional-level physical activity promotion project involving governmental and public-law institutions, NGOs and university researchers serves as a case study to illustrate the potential of the approach for capacity building. Analysis and comparison with a similar local-level project indicate that the approach provides an effective means of linking scientific knowledge to policy action and to planning concrete measures for capacity building in health promotion, but that it requires sufficiently long timelines and adequate resources to achieve adequate implementation and sustainability. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health system challenges of NCDs in Tunisia.

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Ben Romdhane, Habiba; Tlili, Faten; Skhiri, Afef; Zaman, Shahaduz; Phillimore, Peter

2015-01-01

The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.

Strengthening global health security by embedding the International Health Regulations requirements into national health systems.

Science.gov (United States)

Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin

2018-01-01

The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.

Capacity analysis of spectrum sharing spatial multiplexing MIMO systems

KAUST Repository

Yang, Liang

2014-12-01

This paper considers a spectrum sharing (SS) multiple-input multiple-output (MIMO) system operating in a Rayleigh fading environment. First the capacity of a single-user SS spatial multiplexing system is investigated in two scenarios that assume different receivers. To explicitly show the capacity scaling law of SS MIMO systems, some approximate capacity expressions for the two scenarios are derived. Next, we extend our analysis to a multiple user system with zero-forcing receivers (ZF) under spatially-independent scheduling and analyze the sum-rate. Furthermore, we provide an asymptotic sum-rate analysis to investigate the effects of different parameters on the multiuser diversity gain. Our results show that the secondary system with a smaller number of transmit antennas Nt and a larger number of receive antennas Nr can achieve higher capacity at lower interference temperature Q, but at high Q the capacity follows the scaling law of the conventional MIMO systems. However, for a ZF SS spatial multiplexing system, the secondary system with small Nt and large Nr can achieve the highest capacity throughout the entire region of Q. For a ZF SS spatial multiplexing system with scheduling, the asymptotic sum-rate scales like Ntlog2(Q(KNtNp-1)/Nt), where Np denotes the number of antennas of the primary receiver and K represents the number of secondary transmitters.

Capacity of Commune Health Stations in Chi Linh District, Hai Duong Province, for Prevention and Control of Noncommunicable Diseases.

Science.gov (United States)

Thi Thuy Nga, Nguyen; Thi My Anh, Bui; Nguyen Ngoc, Nguyen; Minh Diem, Dang; Duy Kien, Vu; Bich Phuong, Tran; Quynh Anh, Tran; Van Minh, Hoang

2017-07-01

The primary health care system in Vietnam has been playing an important role in prevention and control of diseases. This study aimed to describe the capacity of commune health stations in Chi Linh district, Hai Duong province for prevention and control of noncommunicable diseases (NCDs). A mixed-methods (quantitative and qualitative approaches) approach was applied to collect data in 20 commune health stations. The participants, including health workers, stakeholders, and patients with NCDs, were selected for the study. The findings reported that the main activities of prevention and control of NCDs at commune health stations (CHSs) still focused on information-education-community (IECs), unqualified for providing screening, diagnosis, and treatments of NCDs. The capacity for prevention and control of NCDs in CHSs was inadequate to provide health care services related to prevention and control of NCDs and unmet with the community's demands. In order to ensure the role and implementation of primary care level, there is an urgent need to improve the capacity of CHSs for prevention and control of NCDs, particularly a national budget for NCDs prevention and control, the essential equipment and medicines recommended by the World Health Organization should be provided and available at the CHSs.

Prepared to react? Assessing the functional capacity of the primary health care system in rural Orissa, India to respond to the devastating flood of September 2008

Directory of Open Access Journals (Sweden)

Michael Marx

2012-03-01

Full Text Available Background: Early detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary. Objective: The objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008. Methods: An onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA® 10. Results: Data from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods. Conclusion: The 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

Science.gov (United States)

Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E

2013-01-01

The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation

Cardio-respiratory capacity as an important biomarker of health

Directory of Open Access Journals (Sweden)

Jaroslav Novák

2016-12-01

Full Text Available Background: Cardio-respiratory capacity is an important factor in human health. It's quality depends on many objective factors (such as age and gender, but it can be influenced also by others (physical activity, nutrition. Low level of cardio-respiratory capacity significantly correlates with numerous health failures. Objective: Evaluation of the cardio-respiratory capacity in athletes enables a prediction of performance. In a non-sporting population a critically low level of cardio-respiratory capacity could be a warning signal of a high risk of diseases. The Spiroergometric examination needs very sophisticated technical equipment including O2-CO2 analyzer. The aim of the study was to examine the possibility of how to replace direct measurement of oxygen consumption by the method. Methods: 2 777 protocols from the data base of examinations performed in the period of 1994 till 2015 were used. Cardio-respiratory capacity in all examinations was evaluated according to maximal oxygen uptake VO2max, physical working capacity W170 and maximal performance on the cyclo-ergometer. Step-vice increased workload on cyclo-ergometer based on procedure used in International Biological Program was applied to obtain the characteristics of cardio-respiratory capacity of each subject (2 015 men and 762 women. Results: Correlation coefficients r and regression equations of cardio-respiratory capacity characteristics (W170, W170/kg, VO2max, VO2max/kg, Wmax, Wmax/kg were calculated. The highest correlation was found between VO2max and Wmax and between VO2max/kg and Wmax/kg, both in men and women (r = .89 in men and r = .85 in women for VO2max and Wmax. The most important regression equations are: (men VO2max = 0.0095 . Wmax + 0.54 (l/min (r = .89, VO2max/kg = 8.3 . Wmax/kg + 13 (ml/min/kg (r = .83; (women VO2max = 0.0083 . Wmax + 0.67 (l/min (r = .85, VO2max/kg = 8.0 . max/kg + 13 (ml/min/kg (r = .83. Conclusions: It was proved that VO2max and VO2max/kg values

Increasing Community Research Capacity to Address Health Disparities.

Science.gov (United States)

Komaie, Goldie; Ekenga, Christine C; Sanders Thompson, Vetta L; Goodman, Melody S

2017-02-01

The Community Research Fellows Training program is designed to enhance capacity for community-based participatory research; program participants completed a 15-week, Master of Public Health curriculum. We conducted qualitative, semistructured interviews with 81 participants from two cohorts to evaluate the learning environment and how the program improved participants' knowledge of public health research. Key areas that provided a conducive learning environment included the once-a-week schedule, faculty and participant diversity, and community-focused homework assignments. Participants discussed how the program enhanced their understanding of the research process and raised awareness of public health-related issues for application in their personal lives, professional occupations, and in their communities. These findings highlight key programmatic elements of a successful public health training program for community residents.

Assessment of management capacity to improve the value of health-care systems: a survey

OpenAIRE

Rebecca L Weintraub, MD; Keri Wachter, BA; Jennifer Goldsmith, MS; Marie J Teichman, BA; Eda Algur; Julie D Rosenberg, MPH

2017-01-01

Background: Strong management is important for high-value health-care systems if returns on global health investments are to be delivered and the Sustainable Development Goals met by 2030. Managers are responsible for care delivery systems and strategies, making sure that health services benefit the population they intend to serve. Most managers in resource-limited settings work at the district level and below, with little training in non-clinical skills. They are often health care providers ...

Impact of community capacity on the health status of residents: understanding with the contextual multilevel model.

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Jung, Minsoo; Choi, Mankyu

2013-01-01

There has been little conceptual understanding as to how community capacity works, although it allows for an important, population-based health promotional strategy. In this study, the mechanism of community capacity was studied through literature reviews to suggest a comprehensive conceptual model. The research results found that the key to community capacity prevailed in how actively the capacities of individuals and their communities are able to interact with one another. Under active interactions, community-based organizations, which are a type of voluntary association, were created within the community, and cohesion among residents was enhanced. In addition, people were more willing to address community issues. During the process, many services were initiated to meet the people's health needs and strengthen their social and psychological ties. The characteristics of community capacity were named as the contextual multilevel effects. Because an increase in community capacity contributes to a boosted health status, encourages health behaviors, and eventually leads to the overall prosperity of the community, more public health-related attention is required.

Building district-level capacity for continuous improvement in maternal and newborn health.

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Stover, Kim Ethier; Tesfaye, Solomon; Frew, Aynalem Hailemichael; Mohammed, Hajira; Barry, Danika; Alamineh, Lamesgin; Teshome, Abebe; Hepburn, Kenneth; Sibley, Lynn M

2014-01-01

The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The

Strengthening mental health systems in low- and middle-income countries: the Emerald programme.

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Semrau, Maya; Evans-Lacko, Sara; Alem, Atalay; Ayuso-Mateos, Jose Luis; Chisholm, Dan; Gureje, Oye; Hanlon, Charlotte; Jordans, Mark; Kigozi, Fred; Lempp, Heidi; Lund, Crick; Petersen, Inge; Shidhaye, Rahul; Thornicroft, Graham

2015-04-10

There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The 'Emerging mental health systems in LMICs' (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.

Building and measuring infrastructure and capacity for community health assessment and health improvement planning in Florida.

Science.gov (United States)

Abarca, Christine; Grigg, C Meade; Steele, Jo Ann; Osgood, Laurie; Keating, Heidi

2009-01-01

COMPASS (Comprehensive Assessment, Strategic Success) is the Florida Department of Health's community health assessment and health improvement planning initiative. Since 2002, COMPASS built state and county health department infrastructure to support a comprehensive, systematic, and integrated approach to community health assessment and planning. To assess the capacity of Florida's 67 county health departments (CHDs) to conduct community health assessment and planning and to identify training and technical assistance needs, COMPASS surveyed the CHDs using a Web-based instrument annually from 2004 through 2008. Response rate to the survey was 100 percent annually. In 2007, 96 percent of CHDs reported conducting assessment and planning within the past 3 years; 74 percent used the MAPP (Mobilizing for Action through Planning and Partnerships) framework. Progress was greater for the organizational and assessment phases of the MAPP-based work; only 10 CHDs had identified strategic priorities in 2007, and even fewer had implemented strategies for improving health. In 2007, the most frequently requested types of training were measuring success, developing goals and action plans, and using qualitative data; technical assistance was most frequently requested for program evaluation and writing community health status reports. Florida's CHDs have increased their capacity to conduct community health assessment and planning. Questions remain about sustaining these gains with limited resources.

Heat capacity for systems with excited-state quantum phase transitions

Energy Technology Data Exchange (ETDEWEB)

Cejnar, Pavel; Stránský, Pavel, E-mail: stransky@ipnp.troja.mff.cuni.cz

2017-03-18

Heat capacities of model systems with finite numbers of effective degrees of freedom are evaluated using canonical and microcanonical thermodynamics. Discrepancies between both approaches, which are observed even in the infinite-size limit, are particularly large in systems that exhibit an excited-state quantum phase transition. The corresponding irregularity of the spectrum generates a singularity in the microcanonical heat capacity and affects smoothly the canonical heat capacity. - Highlights: • Thermodynamics of systems with excited-state quantum phase transitions • ESQPT-generated singularities of the microcanonical heat capacity • Non-monotonous dependences of the canonical heat capacity • Discord between canonical and microcanonical pictures in the infinite-size limit.

A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda.

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Tetui, Moses; Coe, Anna-Britt; Hurtig, Anna-Karin; Bennett, Sara; Kiwanuka, Suzanne N; George, Asha; Kiracho, Elizabeth Ekirapa

2017-12-28

Many approaches to improving health managers' capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers' capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers' capacity in Eastern Uganda. This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers' capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. The findings indicate that the participatory action research approach enhanced health managers' capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Improved health manager capacity is

Approaches to developing the capacity of health policy analysis institutes: a comparative case study

Directory of Open Access Journals (Sweden)

Bennett Sara

2012-03-01

Full Text Available Abstract Objectives To review and assess (i the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and (ii the nature of external support for capacity development provided to such institutes. Methods Comparative case studies of six health policy analysis institutes (3 from Asia and 3 from Africa were conducted. In each region an NGO institute, an institute linked to government and a university based institute were included. Data collection comprised document review, semi-structured interviews with stakeholders and discussion of preliminary findings with institute staff. Findings The findings are organized around four key themes: (i Financial resources: three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii Human resources: the retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. In particular staff often moved to better paid positions elsewhere once having acquired necessary skills and experience, leaving remaining senior staff with heavy workloads. (iii Governance and management: board structures and roles varied according to the nature of institute ownership. Boards made important contributions to organizational capacity through promoting continuity, independence and fund raising. Routine management systems were typically perceived to be strong. (iv Networks: linkages to policy makers helped promote policy influences. External networks with other research organizations, particularly where these were longer term institutional collaborations helped promote capacity. Conclusions The development of strong in-country analytical and research capacity to guide health policy development is critical, yet

Building Capacity for Workplace Health Promotion: Findings From the Work@Health® Train-the-Trainer Program

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Lang, Jason; Cluff, Laurie; Rineer, Jennifer; Brown, Darigg; Jones-Jack, Nkenge

2017-01-01

Small- and mid-sized employers are less likely to have expertise, capacity, or resources to implement workplace health promotion programs, compared with large employers. In response, the Centers for Disease Control and Prevention developed the Work@Health® employer training program to determine the best way to deliver skill-based training to employers of all sizes. The core curriculum was designed to increase employers’ knowledge of the design, implementation, and evaluation of workplace health strategies. The first arm of the program was direct employer training. In this article, we describe the results of the second arm—the program’s train-the-trainer (T3) component, which was designed to prepare new certified trainers to provide core workplace health training to other employers. Of the 103 participants who began the T3 program, 87 fully completed it and delivered the Work@Health core training to 233 other employers. Key indicators of T3 participants’ knowledge and attitudes significantly improved after training. The curriculum delivered through the T3 model has the potential to increase the health promotion capacity of employers across the nation, as well as organizations that work with employers, such as health departments and business coalitions. PMID:28829622

Building capacity in health facility management: guiding principles for skills transfer in Liberia.

Science.gov (United States)

Rowe, Laura A; Brillant, Sister Barbara; Cleveland, Emily; Dahn, Bernice T; Ramanadhan, Shoba; Podesta, Mae; Bradley, Elizabeth H

2010-03-18

Management training is fundamental to developing human resources for health. Particularly as Liberia revives its health delivery system, facility and county health team managers are central to progress. Nevertheless, such management skills are rarely prioritized in health training, and sustained capacity building in this area is limited. We describe a health management delivery program in which a north and south institution collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustained management development in Liberia. We developed and implemented a 6-month training program in health management skills (i.e. strategic problem solving, financial management, human resource management and leadership) delivered by Yale University and Mother Patern College from Liberia, with support from the Clinton HIV/AIDS Initiative. Over three 6-month cycles, responsibility for course instruction was transferred from the north institution to the south institution. A self-administered survey was conducted of all participants completing the course to measure changes in self-rated management skills, the degree to which the course was helpful and met its stated objectives, and faculty members' responsiveness to participant needs as the transfer process occurred. Respondents (n=93, response rate 95.9%) reported substantial improvement in self-reported management skills, and rated the helpfulness of the course and the degree to which the course met its objectives highly. Levels of improvement and course ratings were similar over the three cohorts as the course was transferred to the south institution. We suggest a framework of five elements for implementing successful management training programs that can be transferred and sustained in resource-limited settings, including: 1) use a short-course format focusing on four key skill areas with practical tools; 2) include didactic training, on-site projects, and on-site mentoring; 3

Building capacity in health facility management: guiding principles for skills transfer in Liberia

Directory of Open Access Journals (Sweden)

Dahn Bernice T

2010-03-01

Full Text Available Abstract Background Management training is fundamental to developing human resources for health. Particularly as Liberia revives its health delivery system, facility and county health team managers are central to progress. Nevertheless, such management skills are rarely prioritized in health training, and sustained capacity building in this area is limited. We describe a health management delivery program in which a north and south institution collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustained management development in Liberia. Methods We developed and implemented a 6-month training program in health management skills (i.e. strategic problem solving, financial management, human resource management and leadership delivered by Yale University and Mother Patern College from Liberia, with support from the Clinton HIV/AIDS Initiative. Over three 6-month cycles, responsibility for course instruction was transferred from the north institution to the south institution. A self-administered survey was conducted of all participants completing the course to measure changes in self-rated management skills, the degree to which the course was helpful and met its stated objectives, and faculty members' responsiveness to participant needs as the transfer process occurred. Results Respondents (n = 93, response rate 95.9% reported substantial improvement in self-reported management skills, and rated the helpfulness of the course and the degree to which the course met its objectives highly. Levels of improvement and course ratings were similar over the three cohorts as the course was transferred to the south institution. We suggest a framework of five elements for implementing successful management training programs that can be transferred and sustained in resource-limited settings, including: 1 use a short-course format focusing on four key skill areas with practical tools; 2 include

Activation of zero-error classical capacity in low-dimensional quantum systems

Science.gov (United States)

Park, Jeonghoon; Heo, Jun

2018-06-01

Channel capacities of quantum channels can be nonadditive even if one of two quantum channels has no channel capacity. We call this phenomenon activation of the channel capacity. In this paper, we show that when we use a quantum channel on a qubit system, only a noiseless qubit channel can generate the activation of the zero-error classical capacity. In particular, we show that the zero-error classical capacity of two quantum channels on qubit systems cannot be activated. Furthermore, we present a class of examples showing the activation of the zero-error classical capacity in low-dimensional systems.

Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

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Fusheini, Adam; Eyles, John

2016-10-07

Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously

Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries.

Science.gov (United States)

Amde, Woldekidan Kifle; Sanders, David; Lehmann, Uta

2014-05-30

Health systems in many low-income countries remain fragile, and the record of human resource planning and management in Ministries of Health very uneven. Public health training institutions face the dual challenge of building human resources capacity in ministries and health services while alleviating and improving their own capacity constraints. This paper reports on an initiative aimed at addressing this dual challenge through the development and implementation of a joint Masters in Public Health (MPH) programme with a focus on health workforce development by four academic institutions from East and Southern Africa and the building of a joint teaching platform. Data were obtained through interviews and group discussions with stakeholders, direct and participant observations, and reviews of publications and project documents. Data were analysed using thematic analysis. The institutions developed and collaboratively implemented a 'Masters Degree programme with a focus on health workforce development'. It was geared towards strengthening the leadership capacity of Health ministries to develop expertise in health human resources (HRH) planning and management, and simultaneously build capacity of faculty in curriculum development and innovative educational practices to teach health workforce development. The initiative was configured to facilitate sharing of experience and resources. The implementation of this initiative has been complex, straddling multiple and changing contexts, actors and agendas. Some of these are common to postgraduate programmes with working learners, while others are unique to this particular partnership, such as weak institutional capacity to champion and embed new programmes and approaches to teaching. The partnership, despite significant inherent challenges, has potential for providing real opportunities for building the field and community of practice, and strengthening the staff and organizational capacity of participant institutions. Key

Comparative Study Between Internal Ohmic Resistance and Capacity for Battery State of Health Estimation

Directory of Open Access Journals (Sweden)

M. Nisvo Ramadan

2015-12-01

Full Text Available In order to avoid battery failure, a battery management system (BMS is necessary. Battery state of charge (SOC and state of health (SOH are part of information provided by a BMS. This research analyzes methods to estimate SOH based lithium polymer battery on change of its internal resistance and its capacity. Recursive least square (RLS algorithm was used to estimate internal ohmic resistance while coloumb counting was used to predict the change in the battery capacity. For the estimation algorithm, the battery terminal voltage and current are set as the input variables. Some tests including static capacity test, pulse test, pulse variation test and before charge-discharge test have been conducted to obtain the required data. After comparing the two methods, the obtained results show that SOH estimation based on coloumb counting provides better accuracy than SOH estimation based on internal ohmic resistance. However, the SOH estimation based on internal ohmic resistance is faster and more reliable for real application

Principles of capacity management, applied in the mental health context.

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Zeitz, Kathryn; Watson, Darryl

2017-06-22

Objective The aim of the paper was to describe a suite of capacity management principles that have been applied in the mental health setting that resulted in a significant reduction in time spent in two emergency departments (ED) and improved throughput. Methods The project consisted of a multifocal change approach over three phases that included: (1) the implementation of a suite of fundamental capacity management activities led by the service and clinical director; (2) a targeted Winter Demand Plan supported by McKinsey and Co.; and (3) a sustainability of change phase. Descriptive statistics was used to analyse the performance data that was collected through-out the project. Results This capacity management project has resulted in sustained patient flow improvement. There was a reduction in the average length of stay (LOS) in the ED for consumers with mental health presentations to the ED. At the commencement of the project, in July 2014, the average LOS was 20.5h compared with 8.5h in December 2015 post the sustainability phase. In July 2014, the percentage of consumers staying longer than 24h was 26% (n=112); in November and December 2015, this had reduced to 6% and 7 5% respectively (less than one consumer per day). Conclusion Improving patient flow is multifactorial. Increased attendances in public EDs by people with mental health problems and the lengthening boarding in the ED affect the overall ED throughput. Key strategies to improve mental health consumer flow need to focus on engagement, leadership, embedding fundamentals, managing and target setting. What is known about the topic? Improving patient flow in the acute sector is an emerging topic in the health literature in response to increasing pressures of access block in EDs. What does this paper add? This paper describes the application of a suite of patient flow improvement principles that were applied in the mental health setting that significantly reduced the waiting time for consumers in two EDs

[Evaluation of the capacity of elderly patients to make decisions about their health].

Science.gov (United States)

Atienza-Martín, F J; Garrido-Lozano, M; Losada-Ruiz, C; Rodríguez-Fernández, L M; Revuelta-Pérez, F; Marín-Andrés, G

2013-09-01

To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

The Economics of Public Health: Missing Pieces to the Puzzle of Health System Reform.

Science.gov (United States)

Mays, Glen P; Atherly, Adam J; Zaslavsky, Alan M

2017-12-01

The United States continues to experiment with health care delivery and financing innovations, but relatively little attention is given to the public health system and its capacity for improving health status in the U.S. population at large. The public health system operates as a multisector enterprise in which government agencies work in conjunction with private and voluntary organizations to identify health risks in the population and to mobilize community-wide actions that prevent and contain these risks. The Affordable Care Act and related health reform initiatives are generating new interest in the question of how best to expand and integrate public health approaches into the larger U.S. health system. The research articles featured in this issue of Health Services Research cluster around two broad topics: how public health agencies can deliver services efficiently and how public health agencies can interact productively with other elements of the health system. The results suggest promising avenues for aligning medical care and public health practices. © Health Research and Educational Trust.

Switching the poles in sexual and reproductive health research: implementing a research capacity-strengthening network in West and North Africa.

Science.gov (United States)

Dossou, Jean-Paul; Assarag, Bouchra; Delamou, Alexandre; Van der Veken, Karen; Belaid, Loubna; Ouédraogo, Moctar; Khalfallah, Sonia; Aouras, Hayet; Diadhiou, Mohamed; Fassassi, Raïmi; Delvaux, Thérèse

2016-08-08

Health research capacities have been improved in Africa but still remain weak as compared to other regions of the World. To strengthen these research capacities, international collaboration and networking for knowledge and capacity transfer are needed. In this commentary, we present the Network for Scientific Support in the field of Sexual and Reproductive Health in West and North Africa, its priority research topics and discuss its implementation process. Established in January 2014, the Network aims at generating human rights and gender-based research fully carried out and driven by South based institutions. It is composed of 12 institutions including the Institute of Tropical Medicine of Antwerp (Belgium) and 11 institutions from eight Francophone West and North African countries. The key areas of interest of this network are health policies analysis and health system research in family planning, HIV prevention among vulnerable groups, quality of care and breast cancers. Since it started, seventeen research proposals based on locally relevant research questions have been developed. Among the seventeen proposals, eleven have been implemented. Several research institutions enhanced linkages with local representations of international partners such as UNFPA. The network is committed to strengthening methodological research capacities and soft skills such as fundraising, advocacy and leadership. Such competencies are strongly needed for developing an effective South-based leadership in Sexual and Reproductive Health research, and for achieving the Sustainable Development Goals.

From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.

Science.gov (United States)

Barasa, Edwine W; Cloete, Keith; Gilson, Lucy

2017-11-01

Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Tax levy financing for local public health: fiscal allocation, effort, and capacity.

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Riley, William J; Gearin, Kimberly J; Parrotta, Carmen D; Briggs, Jill; Gyllstrom, M Elizabeth

2013-12-01

Local health departments (LHDs) rely on a wide variety of funding sources, and the level of financing is associated with both LHD performance in essential public health services and population health outcomes. Although it has been shown that funding sources vary across LHDs, there is no evidence regarding the relationship between fiscal allocation (local tax levy); fiscal effort (tax capacity); and fiscal capacity (community wealth). The purpose of this study is to analyze local tax levy support for LHD funding. Three research questions are addressed: (1) What are tax levy trends in LHD fiscal allocation? (2) What is the role of tax levy in overall LHD financing? and (3) How do local community fiscal capacity and fiscal effort relate to LHD tax levy fiscal allocation? This study focuses on 74 LHDs eligible for local tax levy funding in Minnesota. Funding and expenditure data for 5 years (2006 to 2010) were compiled from four governmental databases, including the Minnesota Department of Health, the State Auditor, the State Demographer, and the Metropolitan Council. Trends in various funding sources and expenditures are described for the time frame of interest. Data were analyzed in 2012. During the 2006-2010 time period, total average LHD per capita expenditures increased 13%, from $50.98 to $57.63. Although the overall tax levy increase in Minnesota was 25%, the local tax levy for public health increased 5.6% during the same period. There is a direct relationship between fiscal effort and LHD expenditures. Local funding reflects LHD community priorities and the relative importance in comparison to funding other local programs with tax dollars. In Minnesota, local tax levy support for local public health services is not keeping pace with local tax support for other local government services. These results raise important questions about the relationship between tax levy resource effort, resource allocation, and fiscal capacity as they relate to public health

Health systems research in the time of health system reform in India: a review.

Science.gov (United States)

Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

2014-08-09

Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

Pilgrimage to Wellness: An Exploratory Report of Rural African American Clergy Perceptions of Church Health Promotion Capacity

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Carter-Edwards, Lori; Hooten, Elizabeth Gerken; Bruce, Marino A.; Toms, Forrest; Lloyd, Cheryl LeMay; Ellison, Calvin

2013-01-01

Churches serve a vital role in African American communities and may be effective vehicles for health promotion in rural areas where disease burden is disproportionately greater and healthcare access is more limited than other communities. Endorsement by church leadership is often necessary for the approval of programs and activities within churches; however, little is known about how church leaders perceive their respective churches as health promotion organizations. The purpose of this exploratory pilot was to report perceptions of church capacity to promote health among African American clergy leaders of predominantly African American rural churches. The analysis sample included 27 pastors of churches in Eastern NC who completed a survey on church health promotion capacity and perceived impact on their own health. Capacities assessed included perceived need and impact of health promotion activities, church preparedness to promote health, health promotion actions to take, and the existence and importance of health ministry attributes. The results from this pilot study indicated a perceived need to increase the capacity of their churches to promote health. Conducting health programs, displaying health information, collaborations within the church (i.e., kitchen committee working with the health ministry), partnerships outside of the church, and funding were most commonly reported needed capacities. Findings from this exploratory work lay the foundation for the development of future, larger observational studies that can specify some of the key factors associated with organizational change and ultimately health promotion in these rural church settings. PMID:22694157

Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research.

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Li, Ryan; Ruiz, Francis; Culyer, Anthony J; Chalkidou, Kalipso; Hofman, Karen J

2017-01-01

Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders - not only the technical capacity to "do" research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers' needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England's National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity

Building evaluation capacity in Ontario's public health units: promising practices and strategies.

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Bourgeois, I; Simmons, L; Buetti, D

2018-03-26

This article presents the findings of a project focusing on building evaluation capacity in 10 Ontario public health units. The study sought to identify effective strategies that lead to increased evaluation capacity in the participating organizations. This study used a qualitative, multiple case research design. An action research methodology was used to design customized evaluation capacity building (ECB) strategies for each participating organization, based on its specific context and needs. This methodological approach also enabled monitoring and assessment of each strategy, based on a common set of reporting templates. A multiple case study was used to analyze the findings from the 10 participating organizations and derive higher level findings. The main findings of the study show that most of the strategies used to increase evaluation capacity in public health units are promising, especially those focusing on developing the knowledge, skills, and attitudes of health unit staff and managers. Facilitators to ECB strategies were the engagement of all staff members, the support of leadership, and the existence of organizational tools and infrastructure to support evaluation. It is also essential to recognize that ECB takes time and resources to be successful. The design and implementation of ECB strategies should be based on organizational needs. These can be assessed using a standardized instrument, as well as interviews and staff surveys. The implementation of a multicomponent approach (i.e. several strategies implemented simultaneously) is also linked to better ECB outcomes in organizations. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Assessing the criminal capacity of children: a challenge to the capacity of mental health professionals.

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Pillay, Anthony L; Willows, Clive

2015-01-01

With increasing numbers of juveniles accused of serious crimes international concern is growing around the procedural consequences for affected individuals within the context of the law and criminal justice. Issues of culpability in children and adolescents are often raised, with much deliberation and insufficient agreement among legal and child development experts. Exactly when and to what extent juveniles can be held responsible for their action is a matter requiring careful consideration to avoid substantial erring in either direction. Although some international guiding standards and principles have been established, these are rather broad and unable to provide specific prescriptions. In addition, the assessment of criminal capacity in juveniles is a complex task, and one that is not wholly without reliability and validity problems. As in the case of South Africa and a few other countries, mental health specialists are often tasked with conducting developmental assessments to provide courts with expert evidence regarding criminal capacity. This paper examines the concept of criminal capacity in the context of the theory, controversies and challenges that affect this area of psychological focus.

Reorienting health services in the Northern Territory of Australia: a conceptual model for building health promotion capacity in the workforce.

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Judd, Jenni; Keleher, Helen

2013-06-01

Reorienting work practices to include health promotion and prevention is complex and requires specific strategies and interventions. This paper presents original research that used 'real-world' practice to demonstrate that knowledge gathered from practice is relevant for the development of practice-based evidence. The paper shows how practitioners can inform and influence improvements in health promotion practice. Practitioner-informed evidence necessarily incorporates qualitative research to capture the richness of their reflective experiences. Using a participatory action research (PAR) approach, the research question asked 'what are the core dimensions of building health promotion capacity in a primary health care workforce in a real-world setting?' PAR is a method in which the researcher operates in full collaboration with members of the organisation being studied for the purposes of achieving some kind of change, in this case to increase the amount of health promotion and prevention practice within this community health setting. The PAR process involved six reflection and action cycles over two years. Data collection processes included: survey; in-depth interviews; a training intervention; observations of practice; workplace diaries; and two nominal groups. The listen/reflect/act process enabled lessons from practice to inform future capacity-building processes. This research strengthened and supported the development of health promotion to inform 'better health' practices through respectful change processes based on research, practitioner-informed evidence, and capacity-building strategies. A conceptual model for building health promotion capacity in the primary health care workforce was informed by the PAR processes and recognised the importance of the determinants approach. Practitioner-informed evidence is the missing link in the evidence debate and provides the links between evidence and its translation to practice. New models of health promotion service

The development of ORACLe: a measure of an organisation's capacity to engage in evidence-informed health policy.

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Makkar, Steve R; Turner, Tari; Williamson, Anna; Louviere, Jordan; Redman, Sally; Haynes, Abby; Green, Sally; Brennan, Sue

2016-01-14

Evidence-informed policymaking is more likely if organisations have cultures that promote research use and invest in resources that facilitate staff engagement with research. Measures of organisations' research use culture and capacity are needed to assess current capacity, identify opportunities for improvement, and examine the impact of capacity-building interventions. The aim of the current study was to develop a comprehensive system to measure and score organisations' capacity to engage with and use research in policymaking, which we entitled ORACLe (Organisational Research Access, Culture, and Leadership). We used a multifaceted approach to develop ORACLe. Firstly, we reviewed the available literature to identify key domains of organisational tools and systems that may facilitate research use by staff. We interviewed senior health policymakers to verify the relevance and applicability of these domains. This information was used to generate an interview schedule that focused on seven key domains of organisational capacity. The interview was pilot-tested within four Australian policy agencies. A discrete choice experiment (DCE) was then undertaken using an expert sample to establish the relative importance of these domains. This data was used to produce a scoring system for ORACLe. The ORACLe interview was developed, comprised of 23 questions addressing seven domains of organisational capacity and tools that support research use, including (1) documented processes for policymaking; (2) leadership training; (3) staff training; (4) research resources (e.g. database access); and systems to (5) generate new research, (6) undertake evaluations, and (7) strengthen relationships with researchers. From the DCE data, a conditional logit model was estimated to calculate total scores that took into account the relative importance of the seven domains. The model indicated that our expert sample placed the greatest importance on domains (2), (3) and (4). We utilised

Reaching consensus: a review on sexual health training modules for professional capacity building

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Zahra Karimian

2018-01-01

Full Text Available Background: Professional capacity building (PCB is the focus point in health-related subjects.The present study was conducted to systematically review the existing sexual health training modules for health care providers.Methods: The following keywords were used to search: training, education, professional capacity, practitioner, sexual health, skill education, module, course, package and curriculum.The term MESH is referred to Medical Subject Headings and the following databases were investigated: MEDLINE, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL, The Cochrane Library and Web of Science, Scopus, Google Scholar, SID,Magiran, and Iranmedex. All articles from 1980 to 2015 were extracted. Online modules were excluded. Considering that lesson plan was the basis of instruction, the modules were selected based on the characteristics of the lesson plans.Results: A total number of 38 published training modules in the field of sexuality we redetermined. In total, more than half of the modules (58% were designed for medical doctor sand allied health professionals and the remaining (42% were for nurses and midwives. Almost all the modules (97% were introduced and utilized in developed countries, and only 3% were disseminated in developing countries.Conclusion: There are invaluable modules to build professional capacity in the field of sexual health. As a number of modules have been designed for nurses and midwifes, as the first-line health care providers, the use of these groups in sexual counseling and empowerment for sexual health is essential. No sexual health training program was designed in Iran. Therefore, designing such modules according to Iranian culture is strongly recommended.

Reaching consensus: a review on sexual health training modules for professional capacity building.

Science.gov (United States)

Karimian, Zahra; Azin, Seied Ali; Javid, Nasrin; Araban, Marzieh; Maasoumi, Raziyeh; Aghayan, Shahrokh; Merghati Khoie, Effat

2018-01-01

Background: Professional capacity building (PCB) is the focus point in health-related subjects.The present study was conducted to systematically review the existing sexual health training modules for health care providers. Methods: The following keywords were used to search: training, education, professional capacity, practitioner, sexual health, skill education, module, course, package and curriculum.The term MESH is referred to Medical Subject Headings and the following databases were investigated: MEDLINE, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library and Web of Science, Scopus, Google Scholar, SID,Magiran, and Iranmedex. All articles from 1980 to 2015 were extracted. Online modules were excluded. Considering that lesson plan was the basis of instruction, the modules were selected based on the characteristics of the lesson plans. Results: A total number of 38 published training modules in the field of sexuality we redetermined. In total, more than half of the modules (58%) were designed for medical doctor sand allied health professionals and the remaining (42%) were for nurses and midwives. Almost all the modules (97%) were introduced and utilized in developed countries, and only 3% were disseminated in developing countries. Conclusion: There are invaluable modules to build professional capacity in the field of sexual health. As a number of modules have been designed for nurses and midwifes, as the first-line health care providers, the use of these groups in sexual counseling and empowerment for sexual health is essential. No sexual health training program was designed in Iran. Therefore, designing such modules according to Iranian culture is strongly recommended.

A socioecological analysis of the determinants of national public health nutrition work force capacity: Australia as a case study.

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Hughes, Roger

2006-01-01

This article uses a socioecological analytical approach to assess the capacity of the public health nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective public health nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian public health nutrition work force's capacity to effectively address priority nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.

North–south collaboration and capacity development in global health research in low- and middle-income countries – the ARCADE projects

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Salla Atkins

2016-10-01

Full Text Available Background: Research capacity enhancement is needed in low- and middle-income countries (LMICs for improved health, wellbeing, and health systems’ development. In this article, we discuss two capacity-building projects, the African/Asian Regional Capacity Development (ARCADE in Health Systems and Services Research (HSSR and Research on Social Determinants of Health (RSDH, implemented from 2011 to 2015. The two projects focussed on providing courses in HSSR and social determinants of health research, and on developing collaborations between universities, along with capacity in LMIC universities to manage research grant submissions, financing, and reporting. Both face-to-face and sustainable online teaching and learning resources were used in training at higher postgraduate levels (Masters and Doctoral level. Design: We collated project meeting and discussion minutes along with project periodic reports and deliverables. We extracted key outcomes from these, reflected on these in discussions, and summarised them for this paper. Results: Nearly 55 courses and modules were developed that were delivered to over 920 postgraduate students in Africa, Asia, and Europe. Junior researchers were mentored in presenting, developing, and delivering courses, and in preparing research proposals. In total, 60 collaborative funding proposals were prepared. The consortia also developed institutional capacity in research dissemination and grants management through webinars and workshops. Discussion: ARCADE HSSR and ARCADE RSDH were comprehensive programmes, focussing on developing the research skills, knowledge, and capabilities of junior researchers. One of the main strengths of these programmes was the focus on network building amongst the partner institutions, where each partner brought skills, expertise, and diverse work cultures into the consortium. Through these efforts, the projects improved both the capacity of junior researchers and the research

The Health System Dynamics Framework: The introduction of an analytical model for health system analysis and its application to two case-studies

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J van Olmen

2012-03-01

Full Text Available Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1 consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2 emphasizes the importance of values; 3 a central axis linking governance, human resources, service delivery and population, and 4 taking into account the key elements of complexity in analysis and strategy development. We urge  the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening. 

Does community capacity influence self-rated health? Multilevel contextual effects in Seoul, Korea.

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Jung, Minsoo; Viswanath, K

2013-01-01

This study examined the relationship between community-level contextual effects and self-rated health (SRH) based on the perspective of community capacity rather than social capital. Community capacity for mobilization is broad cooperation for networking among indigenous social agents and grassroots organizations that may serve as potential resources. The idea of community capacity is rooted in the philosophy that a community not only faces problems but also possesses the necessary resources to solve its problems. We used nationally representative data from South Korea, 2010, drawing on 14,228 residents in 404 communities. Community capacity was measured at two levels: an individual-level indicator of community satisfaction, and community-level indicators of participation rate in community organizations, number of community-based organizations (CBOs), and number of volunteer work camps (VWCs). The outcome variable was SRH, which was categorized into two groups: the low-SRH and high-SRH groups. Confounders included gender, age, and income at the individual level, and aggregate length of residency, financial independence ratio, and aggregate income at the community level. We estimated the effects of community capacity on SRH using hierarchical generalized linear models. The likelihood of belonging to the group having low-SRH is significantly high among those respondents living in places with lower community capacity at the community level, that report lower community satisfaction, and that have lower income at the individual level. After controlling for socio-economic confounders, the odds ratios were attenuated but remained significant in the final model, which included the gender-specific model. This study revealed that SRH is related to the level of community capacity for mobilization. It is probably because CBOs and VWCs not only provide necessary information and complementary services but also play an active role in identifying and resolving health problems

Critical issues in the development of health information systems in supporting environmental health: a case study of ciguatera.

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Goater, Sarah; Derne, Bonnie; Weinstein, Philip

2011-05-01

Emerging environmental pressures resulting from climate change and globalization challenge the capacity of health information systems (HIS) in the Pacific to inform future policy and public health interventions. Ciguatera, a globally common marine food-borne illness, is used here to illustrate specific HIS challenges in the Pacific and how these might be overcome proactively to meet the changing surveillance needs resulting from environmental change. We review and highlight inefficiencies in the reactive nature of existing HIS in the Pacific to collect, collate, and communicate ciguatera fish poisoning data currently used to inform public health intervention. Further, we review the capacity of existing HIS to respond to new data needs associated with shifts in ciguatera disease burden likely to result from coral reef habitat disruption. Improved knowledge on the ecological drivers of ciguatera prevalence at local and regional levels is needed, combined with enhanced surveillance techniques and data management systems, to capture environmental drivers as well as health outcomes data. The capacity of public HIS to detect and prevent future outbreaks is largely dependent on the future development of governance strategies that promote proactive surveillance and health action. Accordingly, we present an innovative framework from which to stimulate scientific debate on how this might be achieved by using existing larger scale data sets and multidisciplinary collaborations.

One Health/EcoHealth capacity building programs in South and South East Asia: a mixed method rapid systematic review.

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Chatterjee, Pranab; Chauhan, Abhimanyu Singh; Joseph, Jessy; Kakkar, Manish

2017-09-29

Although One Health (OH) or EcoHealth (EH) have been acknowledged to provide comprehensive and holistic approaches to study complex problems, like zoonoses and emerging infectious diseases, there remains multiple challenges in implementing them in a problem-solving paradigm. One of the most commonly encountered barriers, especially in low- and middle-income countries, is limited capacity to undertake OH/EH inquiries. A rapid review was undertaken to conduct a situation analysis of the existing OH/EH capacity building programs, with a focused analysis of those programs with extensive OH engagement, to help map the current efforts in this area. A listing of the OH/EH projects/initiatives implemented in South Asia (SA) and South East Asia (SEA) was done, followed by analysis of documents related to the projects, available from peer-reviewed or grey literature sources. Quantitative data was extracted using a data extraction format, and a free listing of qualitative themes was undertaken. In SEA, 13 unique OH/EH projects, with 37 capacity building programs, were identified. In contrast, in SA, the numbers were 8 and 11 respectively. In SA, programs were oriented to develop careers in program management, whereas, in SEA, the emphasis was on research. Two thirds of the programs in SEA had extensive OH engagement, whereas only one third of those in SA did. The target for the SEA programs was wider, including a population more representative of OH stakes. SEA program themes reveal utilization of multiple approaches, usually in shorter terms, and are growing towards integration with the traditional curricula. Such convergence of themes was lacking in SA programs. In both regions, the programs were driven by external donor agencies, with minimal local buy-in. There is limited investment in research capacity building in both SA and SEA. The situation appears to be more stark in SA, whilst SEA has been able to use the systematic investment and support to develop the OH

Boosting capacity for health research in Africa | CRDI - Centre de ...

International Development Research Centre (IDRC) Digital Library (Canada)

9 mai 2013 ... Africa's progress is linked to its capacity to generate, adapt, and use scientific knowledge to meet regional health and development needs. ... opportunity for timely completion of their doctoral training; and; strengthen Fellows' research skills by providing research methodology and scientific writing training.

Applying a global justice lens to health systems research ethics: an initial exploration.

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Pratt, Bridget; Hyder, Adnan A

2015-03-01

Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches.

A simulation study of capacity utilization to predict future capacity for manufacturing system sustainability

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Rimo, Tan Hauw Sen; Chai Tin, Ong

2017-12-01

Capacity utilization (CU) measurement is an important task in a manufacturing system, especially in make-to-order (MTO) type manufacturing system with product customization, in predicting capacity to meet future demand. A stochastic discrete-event simulation is developed using ARENA software to determine CU and capacity gap (CG) in short run production function. This study focused on machinery breakdown and product defective rate as random variables in the simulation. The study found that the manufacturing system run in 68.01% CU and 31.99% CG. It is revealed that machinery breakdown and product defective rate have a direct relationship with CU. By improving product defective rate into zero defect, manufacturing system can improve CU up to 73.56% and CG decrease to 26.44%. While improving machinery breakdown into zero breakdowns will improve CU up to 93.99% and the CG decrease to 6.01%. This study helps operation level to study CU using “what-if” analysis in order to meet future demand in more practical and easier method by using simulation approach. Further study is recommended by including other random variables that affect CU to make the simulation closer with the real-life situation for a better decision.

Network Capacity Assessment and Increase in Systems with Intermittent Water Supply

OpenAIRE

Ilaya-Ayza, Amilkar Ernesto; Campbell-Gonzalez, Enrique; Pérez García, Rafael; Izquierdo Sebastián, Joaquín

2016-01-01

[EN] Water supply systems have been facing many challenges in recent decades due to the potential effects of climate change and rapid population growth. Water systems need to expand because of demographic growth. Therefore, evaluating and increasing system capacity is crucial. Specifically, we analyze network capacity as one of the main features of a system. When the network capacity starts to decrease, there is a risk that continuous supply will become intermittent. This paper discusses how...

Framework for assessing the capacity of a health ministry to conduct health policy processes--a case study from Tajikistan.

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Mirzoev, Tolib N; Green, Andrew; Van Kalliecharan, Ricky

2015-01-01

An adequate capacity of ministries of health (MOH) to develop and implement policies is essential. However, no frameworks were found assessing MOH capacity to conduct health policy processes within developing countries. This paper presents a conceptual framework for assessing MOH capacity to conduct policy processes based on a study from Tajikistan, a former Soviet republic where independence highlighted capacity challenges. The data collection for this qualitative study included in-depth interviews, document reviews and observations of policy events. Framework approach for analysis was used. The conceptual framework was informed by existing literature, guided the data collection and analysis, and was subsequently refined following insights from the study. The Tajik MOH capacity, while gradually improving, remains weak. There is poor recognition of wider contextual influences, ineffective leadership and governance as reflected in centralised decision-making, limited use of evidence, inadequate actors' participation and ineffective use of resources to conduct policy processes. However, the question is whether this is a reflection of lack of MOH ability or evidence of constraining environment or both. The conceptual framework identifies five determinants of robust policy processes, each with specific capacity needs: policy context, MOH leadership and governance, involvement of policy actors, the role of evidence and effective resource use for policy processes. Three underlying considerations are important for applying the capacity to policy processes: the need for clear focus, recognition of capacity levels and elements, and both ability and enabling environment. The proposed framework can be used in assessing and strengthening of the capacity of different policy actors. Copyright © 2013 John Wiley & Sons, Ltd.

Medicaid Expansion And Grant Funding Increases Helped Improve Community Health Center Capacity.

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Han, Xinxin; Luo, Qian; Ku, Leighton

2017-01-01

Through the expansion of Medicaid eligibility and increases in core federal grant funding, the Affordable Care Act (ACA) sought to increase the capacity of community health centers to provide primary care to low-income populations. We examined the effects of the ACA Medicaid expansion and changes in federal grant levels on the centers' numbers of patients, percentages of patients by type of insurance, and numbers of visits from 2012 to 2015. In the period after expansion (2014-15), health centers in expansion states had a 5 percent higher total patient volume, larger shares of Medicaid patients, smaller shares of uninsured patients, and increases in overall visits and mental health visits, compared to centers in nonexpansion states. Increases in federal grant funding levels were associated with increases in numbers of patients and of overall, medical, and preventive service visits. If federal grant levels are not sustained after 2017, there could be marked reductions in health center capacity in both expansion and nonexpansion states. Project HOPE—The People-to-People Health Foundation, Inc.

The challenge of benchmarking health systems: is ICT innovation capacity more systemic than organizational dependent?

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Lapão, Luís Velez

2015-01-01

The article by Catan et al. presents a benchmarking exercise comparing Israel and Portugal on the implementation of Information and Communication Technologies in the healthcare sector. Special attention was given to e-Health and m-Health. The authors collected information via a set of interviews with key stakeholders. They compared two different cultures and societies, which have reached slightly different implementation outcomes. Although the comparison is very enlightening, it is also challenging. Benchmarking exercises present a set of challenges, such as the choice of methodologies and the assessment of the impact on organizational strategy. Precise benchmarking methodology is a valid tool for eliciting information about alternatives for improving health systems. However, many beneficial interventions, which benchmark as effective, fail to translate into meaningful healthcare outcomes across contexts. There is a relationship between results and the innovational and competitive environments. Differences in healthcare governance and financing models are well known; but little is known about their impact on Information and Communication Technology implementation. The article by Catan et al. provides interesting clues about this issue. Public systems (such as those of Portugal, UK, Sweden, Spain, etc.) present specific advantages and disadvantages concerning Information and Communication Technology development and implementation. Meanwhile, private systems based fundamentally on insurance packages, (such as Israel, Germany, Netherlands or USA) present a different set of advantages and disadvantages - especially a more open context for innovation. Challenging issues from both the Portuguese and Israeli cases will be addressed. Clearly, more research is needed on both benchmarking methodologies and on ICT implementation strategies.

Health system resilience: Lebanon and the Syrian refugee crisis

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Ammar, Walid; Kdouh, Ola; Hammoud, Rawan; Hamadeh, Randa; Harb, Hilda; Ammar, Zeina; Atun, Rifat; Christiani, David; Zalloua, Pierre A

2016-01-01

Background Between 2011 and 2013, the Lebanese population increased by 30% due to the influx of Syrian refugees. While a sudden increase of such magnitude represents a shock to the health system, threatening the continuity of service delivery and destabilizing governance, it also offers a unique opportunity to study resilience of a health system amidst ongoing crisis. Methods We conceptualized resilience as the capacity of a health system to absorb internal or external shocks (for example prevent or contain disease outbreaks and maintain functional health institutions) while sustaining achievements. We explored factors contributing to the resilience of the Lebanese health system, including networking with stakeholders, diversification of the health system, adequate infrastructure and health human resources, a comprehensive communicable disease response and the integration of the refugees within the health system. Results In studying the case of Lebanon we used input–process–output–outcome approach to assess the resilience of the Lebanese health system. This approach provided us with a holistic view of the health system, as it captured not only the sustained and improved outcomes, but also the inputs and processes leading to them. Conclusion Our study indicates that the Lebanese health system was resilient as its institutions sustained their performance during the crisis and even improved. PMID:28154758

BUFFER CAPACITY IN HETEROGENEOUS MULTICOMPONENT SYSTEMS. REVIEW

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Oxana Spinu

2015-12-01

Full Text Available The quantitative basis of the theory of buffer properties for two-phase acid-base buffer systems and for multicomponent heterogeneous systems has been derived. The analytical equations with respect to all components for diverse multicomponent systems were deduced. It has been established, that the buffer capacities of components are mutually proportional.

Health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: an integrative review.

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Lamont, Scott; Jeon, Yun-Hee; Chiarella, Mary

2013-09-01

This integrative review aims to provide a synthesis of research findings of health-care professionals' knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, 'snowballing' and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice.

Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research.

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Brownson, Ross C; Fielding, Jonathan E; Green, Lawrence W

2018-04-01

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice.

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership.

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Drobac, Peter C; Basinga, Paulin; Condo, Jeanine; Farmer, Paul E; Finnegan, Karen E; Hamon, Jessie K; Amoroso, Cheryl; Hirschhorn, Lisa R; Kakoma, Jean Baptise; Lu, Chunling; Murangwa, Yusuf; Murray, Megan; Ngabo, Fidele; Rich, Michael; Thomson, Dana; Binagwaho, Agnes

2013-01-01

Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women's Hospital. The PHIT Partnership's health systems support aligns with the World Health Organization's six health systems building blocks. HSS activities focus across all levels of the health system - community, health center, hospital, and district leadership - to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers. The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific

Attention capacity in European adolescents: role of different health-related factors. The HELENA study.

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Esteban-Cornejo, Irene; Cadenas-Sanchez, Cristina; Vanhelst, Jérémy; Michels, Nathalie; Lambrinou, Christina-Paulina; González-Gross, Marcela; Widhalm, Kurt; Kersting, Mathilde; de la O Puerta, Alejandro; Kafatos, Anthony; Moreno, Luis A; Ortega, Francisco B

2017-10-01

We compared the level of attention capacity between adolescents from the center and south of Europe. The study included 627 European adolescents (54% girls), aged 12.5-17.5 years, who participated in the HELENA Study. The d2 Test of Attention was administered to assess attention capacity. The main results showed that adolescents from the south of Europe had significantly higher score in attention capacity compared with adolescents from central Europe (score + 8.1; 95%CI, 2.44-13.61) after adjustment for age, sex, socioeconomic indicators, body mass index, cardiorespiratory fitness and diet quality index (p = 0.012). Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from central Europe independently of sociodemographic and health-related factors. These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities. What is Known? • Attention is a crucial capacity during adolescence. • Several health-related factors (i.e., physical activity, fitness or fatness) may influence attention capacity in adolescents. What is New? • Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from the center, after accounting for socioeconomic factors, fitness, fatness and quality of diet. • These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities.

Physical capacity and risk for long-term sickness absence: a prospective cohort study among 8664 female health care workers.

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Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas

2015-05-01

To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. Low physical capacity increases the risk of long-term sickness absence among female health care workers.

Health care capacity and allocations among South Africa's provinces: infrastructure-inequality traps after the end of apartheid.

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Stuckler, David; Basu, Sanjay; McKee, Martin

2011-01-01

We assessed the determinants of health care funding allocations among South Africa's provinces and their effects on health care from 1996 through 2007. We performed multivariate regression of funding allocation data against measures of disease burden and health system infrastructure by province. Disease burden was increasingly negatively correlated with funding allocations and explained less than one quarter of the variation in allocations among provinces. Nearly three quarters of the variation in allocations was explained by preexisting hospital infrastructure and health care workers. The density of private hospitals in the preceding year was associated with greater government allocations (b(private) = 0.12; 95% confidence interval [CI] = 0.08, 0.15), but public hospital density in the preceding year was not (b(public) = 0.05; 95% CI = -0.02, 0.11). Greater allocations were associated with a higher number of doctors (b = 0.54; 95% CI = 0.34, 0.75) but fewer nurses (b = -0.37; 95% CI = -0.72,-0.25) in the same year. Regions with a greater capacity to spend funds received more funding and created more infrastructure than those with greater health needs. Historical infrastructure inequalities may have created an infrastructure-inequality trap, in which the distribution of funds to those with greater "absorptive capacity" exacerbates inequalities.

Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health.

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Spagnolo, Jessica; Champagne, François; Leduc, Nicole; Piat, Myra; Melki, Wahid; Charfi, Fatma; Laporta, Marc

2017-01-17

In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation. First, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes. In Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in

Results of the Community Health Applied Research Network (CHARN) National Research Capacity Survey of Community Health Centers.

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Song, Hui; Li, Vivian; Gillespie, Suzanne; Laws, Reesa; Massimino, Stefan; Nelson, Christine; Singal, Robbie; Wagaw, Fikirte; Jester, Michelle; Weir, Rosy Chang

2015-01-01

The mission of the Community Health Applied Research Network (CHARN) is to build capacity to carry out Patient-Centered Outcomes Research at community health centers (CHCs), with the ultimate goal to improve health care for vulnerable populations. The CHARN Needs Assessment Staff Survey investigates CHCs' involvement in research, as well as their need for research training and resources. Results will be used to guide future training. The survey was developed and implemented in partnership with CHARN CHCs. Data were collected across CHARN CHCs. Data analysis and reports were conducted by the CHARN data coordinating center (DCC). Survey results highlighted gaps in staff research training, and these gaps varied by staff role. There is considerable variation in research involvement, partnerships, and focus both within and across CHCs. Development of training programs to increase research capacity should be tailored to address the specific needs and roles of staff involved in research.

Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

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Leon Natalie

2012-11-01

Full Text Available Abstract Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT, the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains

Covariation in community- and individual-based community capacity and health behavior: a multilevel analysis of populations in Seoul, South Korea.

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Jung, Minsoo

2012-01-01

Community capacity is defined as the degree to which the human, physical, and potential resources of a neighborhood are organized based on mutual solidarity among the residents. The aim of this study was to elucidate the relationship between community capacity and health behaviors in Seoul, South Korea. Multilevel models controlling for socioeconomic variables were used to measure the association between community capacity and health behaviors in 25 districts and 404 subdistricts (n = 14 228). Community capacity was determined to be significant at the more local community level, as it was a significant variable in the subdistrict analysis for explaining health behaviors such as smoking, drinking, and exercising. Community capacity exists not only at the individual level but also at the community level. High community capacity further enhanced the positive effects of individual capacity on health behavior and further weakened the negative effects.

Improving skills and institutional capacity to strengthen adolescent immunisation programmes and health systems in African countries through HPV vaccine introduction

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Carine Dochez

2017-12-01

Full Text Available Several African countries have recently introduced or are currently introducing the HPV vaccine, either nationwide or through demonstration projects, while some countries are planning for introduction. A collaborative project was developed to strengthen country adolescent immunisation programmes and health systems in the African Region, addressing unique public health considerations of HPV vaccination: adolescents as the primary target group, delivery platforms (e.g. school-based and facility based, socio-behavioural issues, and the opportunity to deliver other health interventions alongside HPV vaccination.Following a successful “taking-stock” meeting, a training programme was drafted to assist countries to strengthen the integration of adolescent health interventions using HPV vaccination as an entry point. Two workshops were conducted in the Eastern and Southern African Regions. All countries reported on progress made during a final joint symposium.Of the 20 countries invited to participate in either of the workshops and/or final symposium, 17 countries participated: Angola, Botswana, Ethiopia, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Countries that are currently implementing HPV vaccination programmes, either nationally or through demonstration projects, reported varying degrees of integration with other adolescent health interventions. The most commonly reported adolescent health interventions alongside HPV vaccination include health education (including sexually transmitted infections, deworming and delivering of other vaccines like tetanus toxoid (TT or tetanus diphtheria (Td.The project has successfully (a established an African-based network that will advocate for incorporating the HPV vaccine into national immunisation programmes; (b created a platform for experience exchange and thereby contributed to novel ideas of

The health professions and the performance of future health systems in low-income countries: support or obstacle?

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Dussault, Gilles

2008-05-01

This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

Managing the Newsvendor Modeled Product System with Random Capacity and Capacity-Dependent Price

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Qingying Li

2015-01-01

Full Text Available We consider a newsvendor modeled product system, where the firm provides products to the market. The supply capacity of the product is random, so the firm receives either the amount of order quantity or the realized capacity, whichever is smaller. The market price is capacity dependent. We consider two types of production cost structures: the procurement case and the in-house production case. The firm pays for the received quantity in the former case and for the ordered quantity in the latter case. We obtain the optimal order quantities for both cases. Comparing with the traditional newsvendor model, we find that the optimal order quantity in both the procurement case and the in-house production case are no greater than that in the traditional newsvendor model with a fixed selling price. We also find that the optimal order quantity for the procurement case is greater than that for the in-house production case. Numerical study is conducted to investigate the sensitivity of the optimal solution versus the distribution of the random capacity/demand.

Central African Field Epidemiology and Laboratory Training Program: building and strengthening regional workforce capacity in public health.

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Andze, Gervais Ondobo; Namsenmo, Abel; Illunga, Benoit Kebella; Kazambu, Ditu; Delissaint, Dieula; Kuaban, Christopher; Mbopi-Kéou, Francois-Xavier; Gabsa, Wilfred; Mulumba, Leopold; Bangamingo, Jean Pierre; Ngulefac, John; Dahlke, Melissa; Mukanga, David; Nsubuga, Peter

2011-01-01

The Central African Field Epidemiology and Laboratory Training Program (CAFELTP) is a 2-year public health leadership capacity building training program. It was established in October 2010 to enhance capacity for applied epidemiology and public health laboratory services in three countries: Cameroon, Central African Republic, and the Democratic Republic of Congo. The aim of the program is to develop a trained public health workforce to assure that acute public health events are detected, investigated, and responded to quickly and effectively. The program consists of 25% didactic and 75% practical training (field based activities). Although the program is still in its infancy, the residents have already responded to six outbreak investigations in the region, evaluated 18 public health surveillance systems and public health programs, and completed 18 management projects. Through these various activities, information is shared to understand similarities and differences in the region leading to new and innovative approaches in public health. The program provides opportunities for regional and international networking in field epidemiology and laboratory activities, and is particularly beneficial for countries that may not have the immediate resources to host an individual country program. Several of the trainees from the first cohort already hold leadership positions within the ministries of health and national laboratories, and will return to their assignments better equipped to face the public health challenges in the region. They bring with them knowledge, practical training, and experiences gained through the program to shape the future of the public health landscape in their countries.

Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh

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Ao, Trong T.; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M. Jahangir; Haider, Sabbir; Alamgir, A.S.M.; Sobel, Jeremy; Luby, Stephen P.

2016-01-01

We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005. PMID:26981877

Capacity of the legal framework of public health institutions in Mexico to support their functional integration

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Ignacio Ibarra

2013-05-01

Full Text Available Objective. Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes –otherwise known as functional integration–, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. Materials and methods. Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. Results. Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. Conclusions. It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

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Ozalp Ozge

2012-06-01

Full Text Available Abstract Background There are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis. Methods Twenty patients with bronchiectasis (43.5 ± 14.1 years and 20 healthy subjects (43.0 ± 10.9 years participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP, and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC were determined. A six-minute walk test (6MWT was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS and the Leicester Cough Questionnaire (LCQ, respectively. Results Number of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p p p p p  Conclusions Peripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

Building capacity for health promotion--a case study from China.

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Tang, Kwok-Cho; Nutbeam, Don; Kong, Lingzhi; Wang, Ruotao; Yan, Jun

2005-09-01

During the period 1997-2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In

National public health law: a role for WHO in capacity-building and promoting transparency.

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Marks-Sultan, Géraldine; Tsai, Feng-Jen; Anderson, Evan; Kastler, Florian; Sprumont, Dominique; Burris, Scott

2016-07-01

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries' legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law - from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance.

National public health law: a role for WHO in capacity-building and promoting transparency

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Tsai, Feng-jen; Anderson, Evan; Kastler, Florian; Sprumont,, Dominique; Burris, Scott

2016-01-01

Abstract A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries’ legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law – from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance. PMID:27429492

On the High Altitude Platform (HAP W-CDMA System Capacity

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L. de Haro-Ariet

2004-06-01

Full Text Available The performance of a downlink power control model, based on a n-thpower distance law, is evaluated for high altitude platform station(HAPS W-CDMA systems. The downlink capacity using this model iscompared with the uplink capacity. It is shown that the uplink capacityis higher than the downlink capacity.

Determination of SMES capacity to enhance the dynamic stability of power system

International Nuclear Information System (INIS)

Shi, J.; Tang, Y.; Dai, T.; Ren, L.; Li, J.; Cheng, S.

2010-01-01

This paper proposes the principle of SMES capacity determination for power system stable operation. Adopting the energy function method, the mechanism of SMES damping power oscillation in the classical single-machine infinite-bus (SMIB) system is analyzed. The released kinetic energy during disturbance is the original of power system oscillation, which is taken as the principle of SMES capacity determination. Then, the influence of fault type, fault position, and fault clearing time on the SMES capacity determination are discussed. Using MATLAB simulation, the principle of SMES capacity determination is evaluated.

A review of health leadership and management capacity in the Solomon Islands.

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Asante, Augustine; Roberts, Graham; Hall, John

2012-04-01

and to Ministry of Finance and Public Service Division regulations. The delineation of central and provincial health authorities' responsibilities requires guidelines in a changing system, where both population-based and targeted vertical programs are implemented at local levels. NUMBER AND DISTRIBUTION OF MANAGERS: Nine of the 10 positions of Provincial Health Director have experienced high turnover, which reportedly occurs without adequate handover to incoming appointees, most of whom are recent clinical graduates. Health services in the Honiara urban area are provided through the Honiara City Council. Church health services are staffed by government employees. COMPETENCE OF DISTRICT HEALTH MANAGERS: Management skills are reportedly weak at the provincial level. The Regional Assistance Mission to Solomon Islands provides governance training inputs to provincial government staff. Provincial health departments have limited financial and human resource management capacity. They also have clinical backgrounds and no training in public health planning or health services management, other than that provided by donors, the Regional Assistance Mission itself and the MHMS. MANAGEMENT WORKING ENVIRONMENT: Provincial health directors have limited control over health staff. Little supportive supervision in management is provided to new provincial health directors. No performance management systems are in place to ensure that staff are properly assessed and supported to do their best Large numbers of non-government organisations working at the provincial level in youth and women's programs require coordination by Provincial health directors to avoid duplication or implementation of programs that will require ongoing funding, but this is not done. FUNCTIONING OF MANAGEMENT SUPPORT SYSTEMS: Management support systems for budgeting and finance, management information and procurement and supply do not function adequately to support provincial health directors to manage effectively

Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk.

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McCraty, Rollin; Shaffer, Fred

2015-01-01

Heart rate variability, the change in the time intervals between adjacent heartbeats, is an emergent property of interdependent regulatory systems that operates on different time scales to adapt to environmental and psychological challenges. This article briefly reviews neural regulation of the heart and offers some new perspectives on mechanisms underlying the very low frequency rhythm of heart rate variability. Interpretation of heart rate variability rhythms in the context of health risk and physiological and psychological self-regulatory capacity assessment is discussed. The cardiovascular regulatory centers in the spinal cord and medulla integrate inputs from higher brain centers with afferent cardiovascular system inputs to adjust heart rate and blood pressure via sympathetic and parasympathetic efferent pathways. We also discuss the intrinsic cardiac nervous system and the heart-brain connection pathways, through which afferent information can influence activity in the subcortical, frontocortical, and motor cortex areas. In addition, the use of real-time HRV feedback to increase self-regulatory capacity is reviewed. We conclude that the heart's rhythms are characterized by both complexity and stability over longer time scales that reflect both physiological and psychological functional status of these internal self-regulatory systems.

Looking for capacities rather than vulnerabilities: The moderating effect of health assets on the associations between adverse social position and health.

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Roy, Mathieu; Levasseur, Mélanie; Doré, Isabelle; St-Hilaire, France; Michallet, Bernard; Couturier, Yves; Maltais, Danielle; Lindström, Bengt; Généreux, Mélissa

2018-05-01

To increase capacities and control over health, it is necessary to foster assets (i.e. factors enhancing abilities of individuals or communities). Acting as a buffer, assets build foundations for overcoming adverse conditions and improving health. However, little is known about the distribution of assets and their associations with social position and health. In this study, we documented the distribution of health assets and examined whether these assets moderate associations between adverse social position and self-reported health. A representative population-based cross-sectional survey of adults in the Eastern Townships, Quebec, Canada (n = 8737) was conducted in 2014. Measures included assets (i.e. resilience, sense of community belonging, positive mental health, social participation), self-reported health (i.e. perceived health, psychological distress), and indicators of social position. Distribution of assets was studied in relation to gender and social position. Logistic regressions examined whether each asset moderated associations between adverse social position and self-reported health. Different distributions of assets were observed with different social positions. Women were more likely to participate in social activities while men were more resilient. Resilience and social participation were moderators of associations between adverse social position (i.e. living alone, lower household income) and self-reported health. Having assets contributes to better health by increasing capacities. Interventions that foster assets and complement current public health services are needed, especially for people in unfavorable situations. Health and social services decision-makers and practitioners could use these findings to increase capacities and resources rather than focusing primarily on preventing diseases and reducing risk factors. Copyright © 2018 Elsevier Inc. All rights reserved.

Applications of system dynamics modelling to support health policy.

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Atkinson, Jo-An M; Wells, Robert; Page, Andrew; Dominello, Amanda; Haines, Mary; Wilson, Andrew

2015-07-09

The value of systems science modelling methods in the health sector is increasingly being recognised. Of particular promise is the potential of these methods to improve operational aspects of healthcare capacity and delivery, analyse policy options for health system reform and guide investments to address complex public health problems. Because it lends itself to a participatory approach, system dynamics modelling has been a particularly appealing method that aims to align stakeholder understanding of the underlying causes of a problem and achieve consensus for action. The aim of this review is to determine the effectiveness of system dynamics modelling for health policy, and explore the range and nature of its application. A systematic search was conducted to identify articles published up to April 2015 from the PubMed, Web of Knowledge, Embase, ScienceDirect and Google Scholar databases. The grey literature was also searched. Papers eligible for inclusion were those that described applications of system dynamics modelling to support health policy at any level of government. Six papers were identified, comprising eight case studies of the application of system dynamics modelling to support health policy. No analytic studies were found that examined the effectiveness of this type of modelling. Only three examples engaged multidisciplinary stakeholders in collective model building. Stakeholder participation in model building reportedly facilitated development of a common 'mental map' of the health problem, resulting in consensus about optimal policy strategy and garnering support for collaborative action. The paucity of relevant papers indicates that, although the volume of descriptive literature advocating the value of system dynamics modelling is considerable, its practical application to inform health policy making is yet to be routinely applied and rigorously evaluated. Advances in software are allowing the participatory model building approach to be extended to

Thermal performance analysis of reciprocating compressor with stepless capacity control system

International Nuclear Information System (INIS)

Bin, Tang; Yuanyang, Zhao; Liansheng, Li; Guangbin, Liu; Le, Wang; Qichao, Yang; Haiping, Xu; Feng, Zhu; Wenhui, Meng

2013-01-01

On the basic principle of stepless capacity control system for large reciprocating compressor, the thermal cycle was analyzed. The equations for the process of suction, reverse flow, compression, discharge and expansion of clearance gas were established. According to these equations, p–V diagrams at various situations were simulated. An experimental platform was setup and the compressor with designed stepless capacity control system run well. The experimental results show that the capacity of compressor can be regulated steplessly, and the motor power is reduced proportionally with respect to the reduction of capacity. During the suction process, both the flow resistance of valve and the pressure fluctuation in cylinder can be reduced by opening the suction valves with the actuators. The simulated and experimental results showed good coincidence. The clearance volume and valve clearance Mach number had a negative influence on the thermal performance of compressor with stepless capacity control system. -- Highlights: ► Flow resistance of valve can be reduced and pressure fluctuation can be reduced. ► Equivalent Mach number of reverse flow is much higher than that of suction process. ► Response of stepless capacity control system is important for regulation accuracy. ► Clearance and valve clearance Mach number have influence on thermal performance

THE E-HEALTH SYSTEMS IN POLAND

Directory of Open Access Journals (Sweden)

Zdzisław PÓLKOWSKI

2013-11-01

Full Text Available Information Technologies are disruptive technologies that have caused major changes in health system in Poland. Current digital economy is driven by modern information and new IT tools, which offer hospitals, doctors and patient access to any type of information, regardless of its form of existence, storage type or geographical location. These tools encourage the development of new activities, health services. The purpose of this article is to analyze the the current state of development of e-services in Poland in the context of nowadays health system. In the first part of the paper, the authors present various programmes, which enable the access to the medical services and patients’ data online. The next part of the paper is devoted to examining the technical aspects of the said programmes and presenting their advantages as well as the areas which might be improved.The last part of the work will be focused on the websites of the selected health institutions. According to the authors, WWW services provide much information on how the process of computer systems are being implemented, what data the services include and the capacity of the equipment as well as the software, human resources and the knowledge in this sphere. Moreover this section highlights the latest trends in e-health with particular emphasis on aspects such as the use of private and public cloud computer and t heir integration with web sites of health institutions. This study brings its contribution to the understanding of the change of health system in Poland behavior by using a new perspective e-health systems and IT tools above by doctors, officers and patients.

Multi-dimensional knowledge translation: enabling health informatics capacity audits using patient journey models.

Science.gov (United States)

Catley, Christina; McGregor, Carolyn; Percival, Jennifer; Curry, Joanne; James, Andrew

2008-01-01

This paper presents a multi-dimensional approach to knowledge translation, enabling results obtained from a survey evaluating the uptake of Information Technology within Neonatal Intensive Care Units to be translated into knowledge, in the form of health informatics capacity audits. Survey data, having multiple roles, patient care scenarios, levels, and hospitals, is translated using a structured data modeling approach, into patient journey models. The data model is defined such that users can develop queries to generate patient journey models based on a pre-defined Patient Journey Model architecture (PaJMa). PaJMa models are then analyzed to build capacity audits. Capacity audits offer a sophisticated view of health informatics usage, providing not only details of what IT solutions a hospital utilizes, but also answering the questions: when, how and why, by determining when the IT solutions are integrated into the patient journey, how they support the patient information flow, and why they improve the patient journey.

[Comparison of mental health state and psychological capacities between college students with and without siblings].

Science.gov (United States)

Zhang, Xiao-yuan; Yu, Shou-yi; Zhao, Jiu-bo; Li, Jian-ming; Xiao, Rong

2007-04-01

To compare the differences in mental health state and psychological capacities between Chinese college students with and without siblings. The psychological status and capacities were evaluated with SCL-90, the Self-Esteem Scale, Spheres of Control Scale, Security Questionnaire and Cattell 16-PF Questionnaire in 427 college students, and among the students who presented valid responses, 139 with and 139 without siblings were selected for this comparative study. The total score and average score of SCL-90 in college students without siblings were significantly lower than those in students with siblings (Psiblings (Pmental health state and some of the psychological capacities are generally better in college students with siblings than in those without siblings.

Institution-to-Institution Mentoring to Build Capacity in 24 Local US Health Departments: Best Practices and Lessons Learned

OpenAIRE

Veatch, Maggie; Goldstein, Gail P.; Sacks, Rachel; Lent, Megan; Van Wye, Gretchen

2014-01-01

Introduction Institutional mentoring may be a useful capacity-building model to support local health departments facing public health challenges. The New York City Department of Health and Mental Hygiene conducted a qualitative evaluation of an institutional mentoring program designed to increase capacity of health departments seeking to address chronic disease prevention. The mentoring program included 2 program models, a one-to-one model and a collaborative model, developed and implemented ...

A survey tool for measuring evidence-based decision making capacity in public health agencies

Directory of Open Access Journals (Sweden)

Jacobs Julie A

2012-03-01

Full Text Available Abstract Background While increasing attention is placed on using evidence-based decision making (EBDM to improve public health, there is little research assessing the current EBDM capacity of the public health workforce. Public health agencies serve a wide range of populations with varying levels of resources. Our survey tool allows an individual agency to collect data that reflects its unique workforce. Methods Health department leaders and academic researchers collaboratively developed and conducted cross-sectional surveys in Kansas and Mississippi (USA to assess EBDM capacity. Surveys were delivered to state- and local-level practitioners and community partners working in chronic disease control and prevention. The core component of the surveys was adopted from a previously tested instrument and measured gaps (importance versus availability in competencies for EBDM in chronic disease. Other survey questions addressed expectations and incentives for using EBDM, self-efficacy in three EBDM skills, and estimates of EBDM within the agency. Results In both states, participants identified communication with policymakers, use of economic evaluation, and translation of research to practice as top competency gaps. Self-efficacy in developing evidence-based chronic disease control programs was lower than in finding or using data. Public health practitioners estimated that approximately two-thirds of programs in their agency were evidence-based. Mississippi participants indicated that health department leaders' expectations for the use of EBDM was approximately twice that of co-workers' expectations and that the use of EBDM could be increased with training and leadership prioritization. Conclusions The assessment of EBDM capacity in Kansas and Mississippi built upon previous nationwide findings to identify top gaps in core competencies for EBDM in chronic disease and to estimate a percentage of programs in U.S. health departments that are evidence

Use of Google Earth to strengthen public health capacity and facilitate management of vector-borne diseases in resource-poor environments.

Science.gov (United States)

Lozano-Fuentes, Saul; Elizondo-Quiroga, Darwin; Farfan-Ale, Jose Arturo; Loroño-Pino, Maria Alba; Garcia-Rejon, Julian; Gomez-Carro, Salvador; Lira-Zumbardo, Victor; Najera-Vazquez, Rosario; Fernandez-Salas, Ildefonso; Calderon-Martinez, Joaquin; Dominguez-Galera, Marco; Mis-Avila, Pedro; Morris, Natashia; Coleman, Michael; Moore, Chester G; Beaty, Barry J; Eisen, Lars

2008-09-01

Novel, inexpensive solutions are needed for improved management of vector-borne and other diseases in resource-poor environments. Emerging free software providing access to satellite imagery and simple editing tools (e.g. Google Earth) complement existing geographic information system (GIS) software and provide new opportunities for: (i) strengthening overall public health capacity through development of information for city infrastructures; and (ii) display of public health data directly on an image of the physical environment. We used freely accessible satellite imagery and a set of feature-making tools included in the software (allowing for production of polygons, lines and points) to generate information for city infrastructure and to display disease data in a dengue decision support system (DDSS) framework. Two cities in Mexico (Chetumal and Merida) were used to demonstrate that a basic representation of city infrastructure useful as a spatial backbone in a DDSS can be rapidly developed at minimal cost. Data layers generated included labelled polygons representing city blocks, lines representing streets, and points showing the locations of schools and health clinics. City blocks were colour-coded to show presence of dengue cases. The data layers were successfully imported in a format known as shapefile into a GIS software. The combination of Google Earth and free GIS software (e.g. HealthMapper, developed by WHO, and SIGEpi, developed by PAHO) has tremendous potential to strengthen overall public health capacity and facilitate decision support system approaches to prevention and control of vector-borne diseases in resource-poor environments.

Enhancing public health practice through a capacity-building educational programme: an evaluation.

Science.gov (United States)

Negandhi, Preeti; Negandhi, Himanshu; Sharma, Kavya; Wild, Sarah; Zodpey, Sanjay

2015-05-13

The Post-Graduate Diploma in Public Health Management, launched by the Govt. of India under the aegis of the National Rural Health Mission in 2008, aims to enhance the managerial capabilities of public health professionals to improve the public health system. The Govt. of India invested enormous resources into this programme and requested an evaluation to understand the current processes, assess the graduates' work performance and identify areas for improvement. Quantitative telephone surveys as well as qualitative in-depth interviews were used. Graduates from the first three batches, their supervisors, peers and subordinates and faculty members were interviewed. Quantitative data were analysed using proportions, means and interpretative descriptions. Qualitative analyses involved transcription, translation, sorting, coding and filing into domains. Of the 363 graduates whose contact details were available, 138 could not be contacted. Two hundred twenty-three (223) graduates (61.43% of eligible participants) were interviewed by telephone; 52 in-depth interviews were conducted. Of the graduates who joined, 63.8% graduates were motivated to join the programme for career advancement and gaining public health knowledge. The content was theoretically good, informative and well-designed. Graduates expressed need for more practical and group work. After graduating, they reported being equipped with some new skills to implement programmes effectively. They reported that attitudes and healthcare delivery practices had improved; they had better self-esteem, increased confidence, better communication skills and implementation capacity. While they were able to apply some skills, they encountered some barriers, such as governance, placements, lack of support from the system and community, inadequate implementation authority and lack of planning by the state government. Incentives (both monetary and non-monetary) played a major role in motivating them to deliver public health

Building capacity without disrupting health services: public health education for Africa through distance learning

Directory of Open Access Journals (Sweden)

Igumbor Ehi

2009-04-01

Full Text Available Abstract The human resources crisis in Africa is especially acute in the public health field. Through distance education, the School of Public Health of the University of the Western Cape, South Africa, has provided access to master's level public health education for health professionals from more than 20 African countries while they remain in post. Since 2000, interest has increased overwhelmingly to a point where four times more applications are received than can be accommodated. This home-grown programme remains sensitive to the needs of the target learners while engaging them in high-quality learning applied in their own work contexts. This brief paper describes the innovative aspects of the programme, offering some evaluative indications of its impact, and reviews how the delivery of text-led distance learning has facilitated the realization of the objectives of public health training. Strategies are proposed for scaling up such a programme to meet the growing need in this essential area of health human resource capacity development in Africa.

Operationalising and piloting the IUHPE European accreditation system for health promotion.

Science.gov (United States)

Battel-Kirk, Barbara; Barry, Margaret M; van der Zanden, Gerard; Contu, Paolo; Gallardo, Carmen; Martinez, Ana; Speller, Viv; Debenedetti, Sara

2015-09-01

The International Union for Health Promotion and Education (IUHPE) European Accreditation System for Health Promotion aims to promote quality assurance in health promotion practice, education and training. The System is designed to be flexible and sensitive to the different contexts for health promotion practice, education and training in Europe, while maintaining robust criteria. These competency-based criteria were developed in the CompHP Project (2009-2012) that developed core competencies, professional standards and an accreditation framework for health promotion practice, education and training in the context of workforce capacity development in Europe.This paper describes how consultations undertaken with the health promotion community informed the structure and processes of the IUHPE Accreditation System. An overview of its development, key functions and the piloting of its implementation, which was co-funded by the European Union in the context of the EU Health Programme, is presented.Feedback from consultations with key health promotion stakeholders in Europe indicated overall support for the development of an accreditation system for health promotion. However, a number of potential barriers to its implementation were noted including: absence of dedicated practitioners and professional bodies in some countries; lack of clarity about professional boundaries; lack of financial resources required to facilitate capacity building; and concerns about the costs, objectivity and transparency of the system. Feedback from the consultations shaped and informed the process of designing an operational accreditation system to ensure that it would be responsive to potential users' needs and concerns.Based on the agreed structures and processes, a web-based application system was developed and managed at IUHPE headquarters. A governance structure was established together with agreed policies and procedures for the System. During the pilot period, applications from 20

Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts.

Science.gov (United States)

Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

2014-08-26

This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

Science.gov (United States)

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-12-01

Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women's use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities' capacity to provide newborn care services in low and middle income countries. In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally-representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn-related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential

A theory-informed approach to mental health care capacity building for pharmacists.

Science.gov (United States)

Murphy, Andrea L; Gardner, David M; Kutcher, Stan P; Martin-Misener, Ruth

2014-01-01

Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists' efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program's development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program. Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.

A Case for Open Network Health Systems: Systems as Networks in Public Mental Health.

Science.gov (United States)

Rhodes, Michael Grant; de Vries, Marten W

2017-01-08

Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH) services in the Netherlands. Decentralized under the (Community) Participation Act (2014), local governments must find resources to compensate for reduced central funding to such services or "innovate." But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional "health system" definitions, literature and narratives, and operating assumptions in public (mental) health are 'locked in' constraining technical and organization innovations. If we view a "health system" as an adaptive system of economic and social "networks," it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a "centralized hierarchical" or "tree" network. An overlooked alternative that breaks out of the established policy narratives is the view of a 'health systems' as a non-hierarchical organizational structure or 'Open Network.' In turn, this opens new technological and

Optimum capacity determination of stand-alone hybrid generation system considering cost and reliability

International Nuclear Information System (INIS)

Chen, Hung-Cheng

2013-01-01

Highlights: ► This paper presents a methodology for the installation capacity optimization. ► Hybrid generation system is optimized by application of adaptive genetic algorithm. ► A cost investigation is made under various conditions and component characteristics. ► The optimization scheme is validated to meet the annual power load demand. -- Abstract: The aim of this work is to present an optimization methodology for the installation capacity of a stand-alone hybrid generation system, taking into consideration the cost and reliability. Firstly, on the basis of derived steady state models of a wind generator (WG), a photovoltaic array (PV), a battery and an inverter, the hybrid generation system is modeled for the purpose of capacity optimization. Secondly, the power system is analyzed for determining both the system structure and the operation control strategy. Thirdly, according to hourly weather database of wind speed, temperature and solar irradiation, annual power generation capacity is estimated for the system match design in order that an annual power load demand can be met. The capacity determination of a hybrid generation system becomes complicated as a result of the uncertainty in the renewable energy together with load demand and the nonlinearity of system components. Aimed at the power system reliability and the cost minimization, the capacity of a hybrid generation system is optimized by application of an adaptive genetic algorithm (AGA) to individual power generation units. A total cost investigation is made under various conditions, such as wind generator power curves, battery discharge depth and the loss of load probability (LOLP). At the end of this work, the capacity of a hybrid generation system is optimized at two installation sites, namely the offshore Orchid Island and Wuchi in Taiwan. The optimization scheme is validated to optimize power capacities of a photovoltaic array, a battery and a wind turbine generator with a relative

Greece: Health system review.

Science.gov (United States)

Economou, Charalambos

2010-01-01

financing and equity in access to health care services. Efficiency is in question due to the lack of incentives to improve performance in the public sector. Mechanisms for needs assessment and priority-setting are underdeveloped and, as a consequence, the regional distribution of health resources is unequal. Centralization of the system is coupled with a lack of planning and coordination, and limited managerial and administrative capacity. In addition, the oversupply of physicians, the absence of a referral system, and irrational pricing and reimbursement policies are factors encouraging under-the-table payments and the black economy. These shortcomings result in low satisfaction with the health care system expressed by citizens. The landmark in the development of the Greek health care system was the creation of the national health system (ESY) in 1983. This report describes the development of the ESY at the structural level and generally, the process of implementing reforms. The strategic targets of health reform initiatives have been to structure a unified health care sector along the lines of the original ESY proposal and to cope with current inefficiencies. However, the three reforms attempted in the 1990s were never fully implemented, while the ambitious reform project of the period 2000–2004, which provided for the regionalization of the system, new management structures, prospective reimbursement, new employment conditions for hospital doctors, modernization of public health services and reorganization of primary health care, was abolished after the elections of 2004 and a change in government. While the new strategy, launched in 2005 with the stated aims of securing the financial viability of the health care system in the short term and its sustainability in the long term, addressed specific weaknesses, it has been rather controversial: the introduction of a centralized administrative public procurement system, the development of public–private partnerships

Inactivation of transferrin iron binding capacity by the neutrophil myeloperoxidase system

International Nuclear Information System (INIS)

Clark, R.A.; Pearson, D.W.

1989-01-01

Human serum apotransferrin was exposed to the isolated myeloperoxidase-H2O2-halide system or to phorbol ester-activated human neutrophils. Such treatment resulted in a marked loss in transferrin iron binding capacity as well as concomitant iodination of transferrin. Each component of the cell-free system (myeloperoxidase, H2O2, iodide) or neutrophil system (neutrophils, phorbol ester, iodide) was required in order to observe these changes. In the cell-free system, the H2O2 requirement was fulfilled by either reagent H2O2 or the peroxide-generating system glucose oxidase plus glucose. Both loss of iron binding capacity and transferrin iodination by either the myeloperoxidase system or activated neutrophils were blocked by azide or catalase. The isolated peroxidase system had an acidic pH optimum, whereas the intact cell system was more efficient at neutral pH. The kinetics of changes in iron binding capacity and iodination closely paralleled one another, exhibiting t1/2 values of less than 1 min for the myeloperoxidase-H2O2 system, 3-4 min for the myeloperoxidase-glucose oxidase system, and 8 min for the neutrophil system. That the occupied binding site is protected from the myeloperoxidase system was suggested by (1) a failure to mobilize iron from iron-loaded transferrin, (2) an inverse correlation between initial iron saturation and myeloperoxidase-mediated loss of iron binding capacity, and (3) decreased myeloperoxidase-mediated iodination of iron-loaded versus apotransferrin. Since as little as 1 atom of iodide bound per molecule of transferrin was associated with substantial losses in iron binding capacity, there appears to be a high specificity of myeloperoxidase-catalyzed iodination for residues at or near the iron binding sites. Amino acid analysis of iodinated transferrin (approximately 2 atoms/molecule) demonstrated that iodotyrosine was the predominant iodinated species

Health policies and federative gaps in Brazil: an analysis of regional capacity of services delivery.

Science.gov (United States)

Ribeiro, José Mendes; Moreira, Marcelo Rasga; Ouverney, Assis Mafort; Silva, Cosme Marcelo Furtado Passos da

2017-04-01

This paper analyzes Brazilian health regions according to their service delivery capacity from the debate on the crisis of cooperative federalism in the SUS that resulted from decentralizing process established in the 1988 Constitution. Service delivery capacity tracer indicators were selected by regions and statistical analyses evidenced greater regional capacity in hospital care and large asymmetries with regard to the availability of physicians, high complexity equipment and private insurance coverage. In conclusion,we argue that further solutions are required to strengthen governmental capacity to reduce regional inequalities throughincreased central coordination.

The Aviation System Analysis Capability Airport Capacity and Delay Models

Science.gov (United States)

Lee, David A.; Nelson, Caroline; Shapiro, Gerald

1998-01-01

The ASAC Airport Capacity Model and the ASAC Airport Delay Model support analyses of technologies addressing airport capacity. NASA's Aviation System Analysis Capability (ASAC) Airport Capacity Model estimates the capacity of an airport as a function of weather, Federal Aviation Administration (FAA) procedures, traffic characteristics, and the level of technology available. Airport capacity is presented as a Pareto frontier of arrivals per hour versus departures per hour. The ASAC Airport Delay Model allows the user to estimate the minutes of arrival delay for an airport, given its (weather dependent) capacity. Historical weather observations and demand patterns are provided by ASAC as inputs to the delay model. The ASAC economic models can translate a reduction in delay minutes into benefit dollars.

The creation in the French power system of a capacity mechanism and of a capacity market

International Nuclear Information System (INIS)

Meda, Maurice

2014-01-01

The key objective of the French capacity remuneration mechanism is to ensure long term security of supply and to promote peak load containment. The mechanism was set up by the NOME law of December 7, 2010 ('new organisation of the electricity market'), which has changed the organisation of the electricity market and explicitly requires a capacity obligation from suppliers, and by a decree published on December 14, 2012 'concerning the contribution of suppliers to the security of electricity supply and establishing a capacity obligation mechanism in the electricity sector'; further regulation will set up the rules for the capacity mechanism, probably during 2014. The mechanism is decentralized: every supplier has to contribute to supply security and to prove its ability to provide its clients with the capacity they need; all capacity owners in metropolitan France must have their production tools certified. Certificates can be sold and suppliers can buy them to adjust their positions. The transport System operator (TSO) calculates suppliers' obligation, checks if capacity owners fulfil their availability commitment and if suppliers have bought enough certificates. The contribution of interconnections to France's SOS is taken into account implicitly. The decree provides an additional safeguard mechanism, which is centralized: in case a critical situation is observed regarding the electricity supply and demand, the government can organize a call for tender to secure the necessary capacities; the conditions to trigger the call for tender are very restrictive, to ensure the capacity market remains the main investment provider. (author)

Capacity analysis of an automated kit transportation system

NARCIS (Netherlands)

Zijm, W.H.M.; Adan, I.J.B.F.; Buitenhek, R.; Houtum, van G.J.J.A.N.

2000-01-01

In this paper, we present a capacity analysis of an automated transportation system in a flexible assembly factory. The transportation system, together with the workstations, is modeled as a network of queues with multiple job classes. Due to its complex nature, the steadystate behavior of this

Capital investment strategies in health care systems.

Science.gov (United States)

Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

2000-01-01

Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

Mutual research capacity strengthening: a qualitative study of two-way partnerships in public health research

Directory of Open Access Journals (Sweden)

Redman-MacLaren Michelle

2012-12-01

Full Text Available Abstract Introduction Capacity building has been employed in international health and development sectors to describe the process of ‘experts’ from more resourced countries training people in less resourced countries. Hence the concept has an implicit power imbalance based on ‘expert’ knowledge. In 2011, a health research strengthening workshop was undertaken at Atoifi Adventist Hospital, Solomon Islands to further strengthen research skills of the Hospital and College of Nursing staff and East Kwaio community leaders through partnering in practical research projects. The workshop was based on participatory research frameworks underpinned by decolonising methodologies, which sought to challenge historical power imbalances and inequities. Our research question was, “Is research capacity strengthening a two-way process?” Methods In this qualitative study, five Solomon Islanders and five Australians each responded to four open-ended questions about their experience of the research capacity strengthening workshop and activities: five chose face to face interview, five chose to provide written responses. Written responses and interview transcripts were inductively analysed in NVivo 9. Results Six major themes emerged. These were: Respectful relationships; Increased knowledge and experience with research process; Participation at all stages in the research process; Contribution to public health action; Support and sustain research opportunities; and Managing challenges of capacity strengthening. All researchers identified benefits for themselves, their institution and/or community, regardless of their role or country of origin, indicating that the capacity strengthening had been a two-way process. Conclusions The flexible and responsive process we used to strengthen research capacity was identified as mutually beneficial. Using community-based participatory frameworks underpinned by decolonising methodologies is assisting to redress

Developing capacities of community health workers in sexual and reproductive, maternal, newborn, child, and adolescent health: a mapping and review of training resources.

Science.gov (United States)

Tran, Nguyen Toan; Portela, Anayda; de Bernis, Luc; Beek, Kristen

2014-01-01

Given country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs. A mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation. We identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems. There is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined

Research culture and capacity in community health services: results of a structured survey of staff.

Science.gov (United States)

Friesen, Emma L; Comino, Elizabeth J

2017-05-01

Developing research capacity is recognised as an important endeavour. However, little is known about the current research culture, capacity and supports for staff working in community-based health settings. A structured survey of Division of Community Health staff was conducted using the research capacity tool. The survey was disseminated by email and in paper format. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. In total, 109 usable responses were received, giving a response rate of 26%. Respondents were predominately nurses (n=71, 65.7%), with ~50% reporting post-graduate vocational qualifications. The highest levels of skills or organisational success were in using evidence to plan, promote and guide clinical practice. Most participants were unsure of organisational and team level skills and success at generating research. Few reported recent experience in research-generating activities. Barriers to undertaking research included lack of skills, time and access to external support and funding. Lack of skills and success in accessing external funding and resources to protect research time or to 'buy-in' technical expertise appeared to exacerbate these barriers. Community health staff have limited capacity to generate research with current levels of skill, funding and time. Strategies to increase research capacity should be informed by knowledge of clinicians' research experience and interests, and target development of skills to generate research. Resources and funding are needed at the organisational and team levels to overcome the significant barriers to research generation reported.

Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

Science.gov (United States)

Minja, Happiness; Nsanzabana, Christian; Maure, Christine; Hoffmann, Axel; Rumisha, Susan; Ogundahunsi, Olumide; Zicker, Fabio; Tanner, Marcel; Launois, Pascal

2011-10-01

Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities. A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants. The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening

Information Processing Capacity of Dynamical Systems

Science.gov (United States)

Dambre, Joni; Verstraeten, David; Schrauwen, Benjamin; Massar, Serge

2012-07-01

Many dynamical systems, both natural and artificial, are stimulated by time dependent external signals, somehow processing the information contained therein. We demonstrate how to quantify the different modes in which information can be processed by such systems and combine them to define the computational capacity of a dynamical system. This is bounded by the number of linearly independent state variables of the dynamical system, equaling it if the system obeys the fading memory condition. It can be interpreted as the total number of linearly independent functions of its stimuli the system can compute. Our theory combines concepts from machine learning (reservoir computing), system modeling, stochastic processes, and functional analysis. We illustrate our theory by numerical simulations for the logistic map, a recurrent neural network, and a two-dimensional reaction diffusion system, uncovering universal trade-offs between the non-linearity of the computation and the system's short-term memory.

Information Processing Capacity of Dynamical Systems

Science.gov (United States)

Dambre, Joni; Verstraeten, David; Schrauwen, Benjamin; Massar, Serge

2012-01-01

Many dynamical systems, both natural and artificial, are stimulated by time dependent external signals, somehow processing the information contained therein. We demonstrate how to quantify the different modes in which information can be processed by such systems and combine them to define the computational capacity of a dynamical system. This is bounded by the number of linearly independent state variables of the dynamical system, equaling it if the system obeys the fading memory condition. It can be interpreted as the total number of linearly independent functions of its stimuli the system can compute. Our theory combines concepts from machine learning (reservoir computing), system modeling, stochastic processes, and functional analysis. We illustrate our theory by numerical simulations for the logistic map, a recurrent neural network, and a two-dimensional reaction diffusion system, uncovering universal trade-offs between the non-linearity of the computation and the system's short-term memory. PMID:22816038

Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh.

Science.gov (United States)

Sarriot, Eric G; Kouletio, Michelle; Jahan, Dr Shamim; Rasul, Izaz; Musha, Akm

2014-08-26

Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project. Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan,, and repeated stakeholder engagement in analysis and decisions . Formal assessments took place up to 5 years post-project (2009). Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap

A survey of the governance capacity of national public health associations to enhance population health.

Science.gov (United States)

Chauvin, James; Shukla, Mahesh; Rice, James; Rispel, Laetitia

2016-03-11

National public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public's health. Governance and organizational capacity are among the key determinants of a PHA's effectiveness as an advocate for appropriate public health policies and practice. During 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA's leaders (77 %) and the competence of people serving on the PHA's governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders. National PHA have a responsibility to put into place

RETRACTED M-HEALTH SERVICES: CAN IT BE A POTENTIAL MECHANISM IN IMPROVING PUBLIC HEALTH SYSTEM OF INDIA?

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Sanjeev Davey

2013-09-01

Full Text Available Background: The role of mobile in health system is now important for us, to make use of this very fastly growing technology in improving the public health of Indian people. Objectives: To critically review the role of m-health in public health system of India. Methods: A systematic review of related studies and literature of last 10 years published in pubmed etc till 31st March 2013 on role of m-Health in public health was done. Results and discussion: A wide variety of m-health applications are available in mobile phone market, needing proper regulation from health care authorities and with a hope of better future results. Recommendations: We must use these applications weighing their benefits and utility in public health as well as capitalizing the better prospect of m-health worldwide in the field of public health. This can give a greater access to larger segments of a rural and underserved population in developing countries like India with a hope of improving the capacity of health system to provide quality healthcare to Indian people.

Leading toward value: the role of strategic human resource management in health system adaptability.

Science.gov (United States)

Garman, Andrew N; Polavarapu, Nandakishor; Grady, Jane C; Canar, W Jeffrey

2013-01-01

Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such become a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems. Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform. Significant correlations were found between strategic alignment of HR and HR's involvement in responses related to cost control (r = 0.46, p strategic alignment of organizational learning and HR involvement with these responses. Results suggest that HR structure may affect an organization's capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

Organizational capacity for service integration in community-based addiction health services.

Science.gov (United States)

Guerrero, Erick G; Aarons, Gregory A; Palinkas, Lawrence A

2014-04-01

We examined factors associated with readiness to coordinate mental health, public health, and HIV testing among community-based addiction health services programs. We analyzed client and program data collected in 2011 from publicly funded addiction health services treatment programs in Los Angeles County, California. We analyzed a sample of 14 379 clients nested in 104 programs by using logistic regressions examining odds of service coordination with mental health and public health providers. We conducted a separate analysis to examine the percentage of clients receiving HIV testing in each program. Motivational readiness and organizational climate for change were associated with higher odds of coordination with mental health and public health services. Programs with professional accreditation had higher odds of coordinating with mental health services, whereas programs receiving public funding and methadone and residential programs (compared with outpatient) had a higher percentage of clients receiving coordinated HIV testing. These findings provide an evidentiary base for the role of motivational readiness, organizational climate, and external regulation and funding in improving the capacity of addiction health services programs to develop integrated care.

A Case for Open Network Health Systems: Systems as Networks in Public Mental Health

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Michael Grant Rhodes

2017-03-01

Full Text Available Increases in incidents involving so-called confused persons have brought attention to the potential costs of recent changes to public mental health (PMH services in the Netherlands. Decentralized under the (Community Participation Act (2014, local governments must find resources to compensate for reduced central funding to such services or “innovate.” But innovation, even when pressure for change is intense, is difficult. This perspective paper describes experience during and after an investigation into a particularly violent incident and murder. The aim was to provide recommendations to improve the functioning of local PMH services. The investigation concluded that no specific failure by an individual professional or service provider facility led to the murder. Instead, also as a result of the Participation Act that severed communication lines between individuals and organizations, information sharing failures were likely to have reduced system level capacity to identify risks. The methods and analytical frameworks employed to reach this conclusion, also lead to discussion as to the plausibility of an unconventional solution. If improving communication is the primary problem, non-hierarchical information, and organizational networks arise as possible and innovative system solutions. The proposal for debate is that traditional “health system” definitions, literature and narratives, and operating assumptions in public (mental health are ‘locked in’ constraining technical and organization innovations. If we view a “health system” as an adaptive system of economic and social “networks,” it becomes clear that the current orthodox solution, the so-called integrated health system, typically results in a “centralized hierarchical” or “tree” network. An overlooked alternative that breaks out of the established policy narratives is the view of a ‘health systems’ as a non-hierarchical organizational structure or �

Dynamic Buffer Capacity in Acid-Base Systems.

Science.gov (United States)

Michałowska-Kaczmarczyk, Anna M; Michałowski, Tadeusz

The generalized concept of 'dynamic' buffer capacity β V is related to electrolytic systems of different complexity where acid-base equilibria are involved. The resulting formulas are presented in a uniform and consistent form. The detailed calculations are related to two Britton-Robinson buffers, taken as examples.

Dynamic Buffer Capacity in Acid?Base Systems

OpenAIRE

Micha?owska-Kaczmarczyk, Anna M.; Micha?owski, Tadeusz

2015-01-01

The generalized concept of ?dynamic? buffer capacity ? V is related to electrolytic systems of different complexity where acid?base equilibria are involved. The resulting formulas are presented in a uniform and consistent form. The detailed calculations are related to two Britton?Robinson buffers, taken as examples.

Liquid heat capacity of the solvent system (piperazine + n-methyldiethanolamine + water)

International Nuclear Information System (INIS)

Chen, Y.-R.; Caparanga, Alvin R.; Soriano, Allan N.; Li, M.-H.

2010-01-01

A new set of values for the heat capacity of aqueous mixtures of piperazine (PZ) and n-methyldiethanolamine (MDEA) at different concentrations and temperatures are reported in this paper. The differential scanning calorimetry technique was used to measure the property over the range T = 303.2 K to T = 353.2 K for mixtures containing 0.60 to 0.90 mole fraction water with 15 different concentrations of the system (PZ + MDEA + H 2 O). Heat capacity for four concentrations of the binary system (PZ + MDEA) was also measured. A Redlich-Kister-type equation was adopted to estimate the excess molar heat capacity, which was used to predict the value of the molar heat capacity at a particular concentration and temperature, which would then be compared against the measured value. A total of 165 data points fit into the model resulted in a low overall average absolute deviation of 4.6% and 0.3% for the excess molar heat capacity and molar heat capacity, respectively. Thus, the results presented here are of acceptable accuracy for use in engineering process design.

Smart Card Based Integrated Electronic Health Record System For Clinical Practice

OpenAIRE

N. Anju Latha; B. Rama Murthy; U. Sunitha

2012-01-01

Smart cards are used in information technologies as portable integrated devices with data storage and data processing capabilities. As in other fields, smart card use in health systems became popular due to their increased capacity and performance. Smart cards are used as a Electronic Health Record (EHR) Their efficient use with easy and fast data access facilities leads to implementation particularly widespread in hospitals. In this paper, a smart card based Integrated Electronic health Reco...

Accounting for the Assimilative Capacity of Water Systems in Scotland

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Paula Novo

2017-07-01

Full Text Available A key methodological challenge in understanding the relationship between the economy and the underlying ecosystem base resides in how to account for the ecosystem’s degradation and the decline of associated ecosystem services. In this study, we use information on nutrients and metals concentrations from the Environmental Change Network (ECN database and the Scottish Environment Protection Agency (SEPA for the period 2000–2010 in order to assess the assimilation capacity of water systems. The research covers five upstream sites and 17 downstream sites in northeast Scotland. Our results highlight the relevance of considering a number of pollutants, and suggest that elements such as arsenic, lead and mercury can pose a threat to ecosystems’ sustainability and health. However, little research has been done in terms of their assimilation capacity and their impact on grey water footprint assessments. In addition, the results indicate that background conditions might be relevant when performing sustainability analysis at different spatial scales. The study also poses relevant questions in relation to land management approaches versus traditional ‘end-of-pipe’ water treatment approaches, and the definition of maximum and background concentrations. In this regard, further studies will be required to understand the trade-offs between different ecosystem services depending on how these concentrations are defined.

Reverse Link CDMA System Capacity Evaluation for Stratospheric Platform Mobile Communications

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Iskandar Iskandar

2010-10-01

Full Text Available We propose an analysis of reverse link CDMA multispot beam stratospheric platforms (SPF in this paper. The SPF is currently proposed as a novel wireless technology for the development of the next generation fixed and mobile communications. The geometry of this technology is different from that of the terrestrial but rather similar to the satellite based cellular system. However, evaluation on the CDMA system capacity of this technology has not been much reported. This paper addresses all possible multiple access interference analyses including the effects of channel fading and shadowing in order to evaluate the system capacity. Single SPF and multiple SPF model are evaluated under perfect power control and imperfect power control. The results indicate that in SPF systems the reverse link CDMA capacity is significantly reduced because of the power control imperfections. Moreover, in multiple SPF model the interference caused by the users in overlapped region is not trivial. We found that because of this problem the capacity is reduced for both speech and real-time data applications compared with the single SPF model even though the assumption of perfect power control can be made. In order to improve the system capacity we proposed two methods, first is to increase the minimum elevation angle definition for each platform and the second is to employ an adaptive antenna.

Capacity analysis of spectrum sharing spatial multiplexing MIMO systems

KAUST Repository

Yang, Liang; Qaraqe, Khalid A.; Serpedin, Erchin; Alouini, Mohamed-Slim

2014-01-01

This paper considers a spectrum sharing (SS) multiple-input multiple-output (MIMO) system operating in a Rayleigh fading environment. First the capacity of a single-user SS spatial multiplexing system is investigated in two scenarios that assume

Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research [version 1; referees: 2 approved

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Ryan Li

2017-03-01

Full Text Available Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders – not only the technical capacity to “do” research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values; academics need to understand and respond to decision-makers’ needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England’s National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to

Comparative Health Risk Assessment of CdTe Solar PV System and Nuclear Power Plant

International Nuclear Information System (INIS)

Lee, Sang Hun; Kang, Hyun Gook

2014-01-01

In terms of national energy policy decision-making process, several key factors, including low production cost, negligible risk or impact to environment and population around the facility, must be considered. The purpose of this paper is to assess the public health risk in case of postulated nuclear power plant and CdTe solar PV system accident and compare the estimated public health risk. Both systems release toxic materials to the environment which adversely affect nearby population by exposure from the inhalation and ingestion of the toxic material transported via air. By simulating the airborne transport of released toxic material using Gaussian plume model and modeling exposure pathways to nearby population, average individual health risk is assessed and public health risk per power capacity of each system is compared. The result shows that the average public health risk per power capacity of NPP is less than the case of solar PV system. This implies that NPP has lower risk in terms of public health risk in case of severe accident while it can be used as more reliable energy source than renewable energy source so that NPP would take priority over other renewable energy sources in terms of national energy policy

Capacity on wireless quantum cellular communication system

Science.gov (United States)

Zhou, Xiang-Zhen; Yu, Xu-Tao; Zhang, Zai-Chen

2018-03-01

Quantum technology is making excellent prospects in future communication networks. Entanglement generation and purification are two major components in quantum networks. Combining these two techniques with classical cellular mobile communication, we proposed a novel wireless quantum cellular(WQC) communication system which is possible to realize commercial mobile quantum communication. In this paper, the architecture and network topology of WQC communication system are discussed, the mathematical model of WQC system is extracted and the serving capacity, indicating the ability to serve customers, is defined and calculated under certain circumstances.

Assessing fistula and obstetrical surgical capacity in South Kivu, DRC

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Stephen C. Morris

2013-01-01

Full Text Available The Democratic Republic of Congo has suffered from decades of conflict and poverty. The Eastern DRC, in particular, continues to be a region dominated by instability, resulting in a fragmented health system. Governments and agencies interested in working towards improving health in the region are often challenged by an absence of knowledge of health metrics, limited capacity for health care delivery and overwhelming needs. The Harvard Humanitarian Initiative and Engender Health needs assessment, outlined in this report, demonstrates an effort to better understand the current state of surgical capacity in the region with an emphasis on needs and opportunities related to fistula repair.

Capacity limits of spectrum-sharing systems over hyper-fading channels

KAUST Repository

Ekin, Sabit

2011-01-20

Cognitive radio (CR) with spectrum-sharing feature is a promising technique to address the spectrum under-utilization problem in dynamically changing environments. In this paper, the achievable capacity gain of spectrum-sharing systems over dynamic fading environments is studied. To perform a general analysis, a theoretical fading model called hyper-fading model that is suitable to the dynamic nature of CR channel is proposed. Closed-form expressions of probability density function (PDF) and cumulative density function (CDF) of the signal-to-noise ratio (SNR) for secondary users (SUs) in spectrum-sharing systems are derived. In addition, the capacity gains achievable with spectrum-sharing systems in high and low power regions are obtained. The effects of different fading figures, average fading powers, interference temperatures, peak powers of secondary transmitters, and numbers of SUs on the achievable capacity are investigated. The analytical and simulation results show that the fading figure of the channel between SUs and primary base-station (PBS), which describes the diversity of the channel, does not contribute significantly to the system performance gain. © 2011 John Wiley & Sons, Ltd.

Capacity limits of spectrum-sharing systems over hyper-fading channels

KAUST Repository

Ekin, Sabit; Yilmaz, Ferkan; Ç elebi, Hasari Burak; Qaraqe, Khalid A.; Alouini, Mohamed-Slim; Serpedin, Erchin

2011-01-01

Cognitive radio (CR) with spectrum-sharing feature is a promising technique to address the spectrum under-utilization problem in dynamically changing environments. In this paper, the achievable capacity gain of spectrum-sharing systems over dynamic fading environments is studied. To perform a general analysis, a theoretical fading model called hyper-fading model that is suitable to the dynamic nature of CR channel is proposed. Closed-form expressions of probability density function (PDF) and cumulative density function (CDF) of the signal-to-noise ratio (SNR) for secondary users (SUs) in spectrum-sharing systems are derived. In addition, the capacity gains achievable with spectrum-sharing systems in high and low power regions are obtained. The effects of different fading figures, average fading powers, interference temperatures, peak powers of secondary transmitters, and numbers of SUs on the achievable capacity are investigated. The analytical and simulation results show that the fading figure of the channel between SUs and primary base-station (PBS), which describes the diversity of the channel, does not contribute significantly to the system performance gain. © 2011 John Wiley & Sons, Ltd.

HIV communication capacity strengthening: a critical review.

Science.gov (United States)

Lettenmaier, Cheryl; Kraft, Joan Marie; Raisanen, Keris; Serlemitsos, Elizabeth

2014-08-15

HIV communication is most effective and sustainable when it is designed and implemented locally and tailored to the local context. This requires capacity strengthening at national, subnational, and community levels. Through a review of the published and selected "grey" literature, we examine HIV communication capacity strengthening: definitions, measurements, implementation, and effects. We found limited documentation of HIV communication capacity needs or systematic approaches to address them. Most HIV communication capacity strengthening to date has focused on building individual competencies to design and manage social and behavior change communication programs through training courses, often coupled with networking opportunities for participants, post-training mentoring, and technical assistance. A few of these efforts have been evaluated through pre- and post-training tests and qualitative interviews with participants and have shown potential for improvement in individual skills and knowledge. Health communication capacity assessment tools that measure individual and organizational competencies exist, but they have most often been used to identify capacity building needs, not for evaluating capacity strengthening efforts. A new definition of capacity strengthening, grown out of recent efforts to improve effectiveness of international health and development programs, focuses on improving organizational and societal systems that support performance and individual competencies. We propose a holistic model for HIV communication capacity strengthening and call for rigorous documentation and evaluation to determine and scale-up optimal capacity building interventions for strengthening social and behavior change communication for HIV prevention, care, and treatment in developing countries.

The Health Systems Funding Platform: Is this where we thought we were going?

Directory of Open Access Journals (Sweden)

Ooms Gorik

2011-05-01

Full Text Available Abstract Background In March 2009, the Task Force for Innovative International Financing for Health Systems recommended "a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies." Momentum to establish the Health Systems Funding Platform was swift, with the World Bank convening a Technical Workshop on Health Systems Strengthening (HSS, and serial meetings organized to progress the agenda. Despite its potential significance, there has been little comment in peer-reviewed literature, though some disquiet in the international development community around the scope of the Platform and the capacity of the partners, which appears disproportionate to the available information. Methods This case study uses documentary analysis, participant observation and 24 in-depth interviews to examine the processes of development and key issues raised by the Platform. Results The findings show a fluid and volatile process, with debate over whether ongoing engagement in HSS by Global Fund and GAVI represents a dilution of organizational focus, risking ongoing support, or a paradigm shift that facilitates the achievement of targeted objectives, builds systems capacity, and will attract additional resources. Uncertainty in the development of the Platform reflects the flexibility of the recently formed global health initiatives, and the instability of donor commitments, particularly in the current financial climate. But implicit in the conflict is tension between key global stakeholders over defining and ownership of the health systems agenda. Conclusions The tensions appear to have been resolved through a focus on national planning, applying International Health Partnership principles, though the global financial crisis and key personnel changes may yet alter outcomes. Despite its dynamic

Should fully autonomous artificial intelligence systems be granted legal capacity?

OpenAIRE

Naučius, Mindaugas

2018-01-01

The aim of this article is to address the issue of granting legal capacity to artificial inteligence systems. In order to approach the solution to the problem addressed, the article includes several aspects, relevant in order to achieve it. To begin with, the general concept of legal capacity is introduced. Following this aspect, the main features of both natural and juridical persons are addressed, in order to become familiar with the content of legal capacity, or in other words, to be aware...

A thematic analysis of the role of the organisation in building allied health research capacity: a senior managers' perspective.

Science.gov (United States)

Golenko, Xanthe; Pager, Susan; Holden, Libby

2012-08-27

Evidence-based practice aims to achieve better health outcomes in the community. It relies on high quality research to inform policy and practice; however research in primary health care continues to lag behind that of other medical professions. The literature suggests that research capacity building (RCB) functions across four levels; individual, team, organisation and external environment. Many RCB interventions are aimed at an individual or team level, yet evidence indicates that many barriers to RCB occur at an organisational or external environment level. This study asks senior managers from a large healthcare organisation to identify the barriers and enablers to RCB. The paper then describes strategies for building allied health (AH) research capacity at an organisational level from a senior managers' perspective. This qualitative study is part of a larger collaborative RCB project. Semi-structured in-depth interviews were conducted with nine allied health senior managers. Recorded interviews were transcribed and NVivo was used to analyse findings and emergent themes were defined. The dominant themes indicate that the organisation plays an integral role in building AH research capacity and is the critical link in creating synergy across the four levels of RCB. The organisation can achieve this by incorporating research into its core business with a whole of organisation approach including its mission, vision and strategic planning. Critical success factors include: developing a co-ordinated and multidisciplinary approach to attain critical mass of research-active AH and enhance learning and development; support from senior managers demonstrated through structures, processes and systems designed to facilitate research; forming partnerships to increase collaboration and sharing of resources and knowledge; and establishing in internal framework to promote recognition for research and career path opportunities. This study identifies four key themes: whole of

Contribution of the Japan International Cooperation Agency health-related projects to health system strengthening.

Science.gov (United States)

Yuasa, Motoyuki; Yamaguchi, Yoshie; Imada, Mihoko

2013-09-22

The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects' contributions to health system strengthening. The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas.

Farming System Evolution and Adaptive Capacity: Insights for Adaptation Support

Directory of Open Access Journals (Sweden)

Jami L. Dixon

2014-02-01

Full Text Available Studies of climate impacts on agriculture and adaptation often provide current or future assessments, ignoring the historical contexts farming systems are situated within. We investigate how historical trends have influenced farming system adaptive capacity in Uganda using data from household surveys, semi-structured interviews, focus-group discussions and observations. By comparing two farming systems, we note three major findings: (1 similar trends in farming system evolution have had differential impacts on the diversity of farming systems; (2 trends have contributed to the erosion of informal social and cultural institutions and an increasing dependence on formal institutions; and (3 trade-offs between components of adaptive capacity are made at the farm-scale, thus influencing farming system adaptive capacity. To identify the actual impacts of future climate change and variability, it is important to recognize the dynamic nature of adaptation. In practice, areas identified for further adaptation support include: shift away from one-size-fits-all approach the identification and integration of appropriate modern farming method; a greater focus on building inclusive formal and informal institutions; and a more nuanced understanding regarding the roles and decision-making processes of influential, but external, actors. More research is needed to understand farm-scale trade-offs and the resulting impacts across spatial and temporal scales.

Testing a Web-Based, Trained-Peer Model to Build Capacity for Evidence-Based Practices in Community Mental Health Systems.

Science.gov (United States)

German, Ramaris E; Adler, Abby; Frankel, Sarah A; Stirman, Shannon Wiltsey; Pinedo, Paola; Evans, Arthur C; Beck, Aaron T; Creed, Torrey A

2018-03-01

Use of expert-led workshops plus consultation has been established as an effective strategy for training community mental health (CMH) clinicians in evidence-based practices (EBPs). Because of high rates of staff turnover, this strategy inadequately addresses the need to maintain capacity to deliver EBPs. This study examined knowledge, competency, and retention outcomes of a two-phase model developed to build capacity for an EBP in CMH programs. In the first phase, an initial training cohort in each CMH program participated in in-person workshops followed by expert-led consultation (in-person, expert-led [IPEL] phase) (N=214 clinicians). After this cohort completed training, new staff members participated in Web-based training (in place of in-person workshops), followed by peer-led consultation with the initial cohort (Web-based, trained-peer [WBTP] phase) (N=148). Tests of noninferiority assessed whether WBTP was not inferior to IPEL at increasing clinician cognitive-behavioral therapy (CBT) competency, as measured by the Cognitive Therapy Rating Scale. WBTP was not inferior to IPEL at developing clinician competency. Hierarchical linear models showed no significant differences in CBT knowledge acquisition between the two phases. Survival analyses indicated that WBTP trainees were less likely than IPEL trainees to complete training. In terms of time required from experts, WBTP required 8% of the resources of IPEL. After an initial investment to build in-house CBT expertise, CMH programs were able to use a WBTP model to broaden their own capacity for high-fidelity CBT. IPEL followed by WBTP offers an effective alternative to build EBP capacity in CMH programs, rather than reliance on external experts.

Reverse innovation: an opportunity for strengthening health systems.

Science.gov (United States)

Snowdon, Anne W; Bassi, Harpreet; Scarffe, Andrew D; Smith, Alexander D

2015-02-07

Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada. An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team. The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women's health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize. The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the

Factors influencing resource allocation decisions and equity in the health system of Ghana.

Science.gov (United States)

Asante, A D; Zwi, A B

2009-05-01

Allocation of financial resources in the health sector is often seen as a formula-driven activity. However, the decision to allocate a certain amount of resources to a particular health jurisdiction or facility may be based on a broader range of factors, sometimes not reflected in the existing resource allocation formula. This study explores the 'other' factors that influence the equity of resource allocation in the health system of Ghana. The extent to which these factors are, or can be, accounted for in the resource allocation process is analysed. An exploratory design focusing on different levels of the health system and diverse stakeholders. Data were gathered through semi-structured qualitative interviews with health authorities at national, regional and district levels, and with donor representatives and local government officials in 2003 and 2004. The availability of human resources for health, local capacity to utilize funds, donor involvement in the health sector, and commitment to promote equity have considerable influence on resource allocation decisions and affect the equity of funding allocations. However, these factors are not accounted for adequately in the resource allocation process. This study highlights the need for a more transparent resource allocation system in Ghana based on needs, and takes into account key issues such as capacity constraints, the inequitable human resource distribution and donor-earmarked funding.

Achievable capacity of a spectrum sharing system over hyper fading channels

KAUST Repository

Ekin, Sabit

2009-11-01

Cognitive radio with spectrum sharing feature is a promising technique to address the spectrum under-utilization problem in dynamically changing environments. In this paper, achievable capacity gain of spectrum sharing systems over dynamic fading environments is studied. For the analysis, a theoretical fading model called hyper fading model that is suitable to the dynamic nature of cognitive radio channel is proposed. Closed-form expression of probability density function (PDF) and cumulative density function (CDF) of the signal-to-noise ratio (SNR) for secondary users in spectrum sharing systems are derived. In addition, the capacity gains achievable with spectrum sharing systems in high and low power regions are obtained. Numerical simulations are performed to study the effects of different fading figures, average powers, interference temperature, and number of secondary users on the achievable capacity.

A survey of the governance capacity of national public health associations to enhance population health

Directory of Open Access Journals (Sweden)

James Chauvin

2016-03-01

Full Text Available Abstract Background National public health associations (PHAs are key partners with governments and communities to improve, protect and promote the public’s health. Governance and organizational capacity are among the key determinants of a PHA’s effectiveness as an advocate for appropriate public health policies and practice. Methods During 2014, the World Federation of Public Health Associations (WFPHA conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis Results Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77 % and the competence of people serving on the PHA’s governing body (76 %. The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %. The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health

Building allied health workforce capacity: a strategic approach to workforce innovation.

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Somerville, Lisa; Davis, Annette; Elliott, Andrea L; Terrill, Desiree; Austin, Nicole; Philip, Kathleen

2015-06-01

The aim of the present study was to identify areas where allied health assistants (AHAs) are not working to their full scope of practice in order to improve the effectiveness of the allied health workforce. Qualitative data collected via focus groups identified suitable AHA tasks and a quantitative survey with allied health professionals (AHPs) measured the magnitude of work the current AHP workforce spends undertaking these tasks. Quantification survey results indicate that Victoria's AHP workforce spends up to 17% of time undertaking tasks that could be delegated to an AHA who has relevant training and adequate supervision. Over half this time is spent on clinical tasks. The skills of AHAs are not being optimally utilised. Significant opportunity exists to reform the current allied health workforce. Such reform should result in increased capacity of the workforce to meet future demands.

Influence of genotype, cultivation system and irrigation regime on antioxidant capacity and selected phenolics of blueberries (Vaccinium corymbosum L.).

Science.gov (United States)

Cardeñosa, Vanessa; Girones-Vilaplana, Amadeo; Muriel, José Luis; Moreno, Diego A; Moreno-Rojas, José M

2016-07-01

Demand for and availability of blueberries has increased substantially over recent years, driven in part by their health-promoting properties. Three blueberry varieties ('Rocío', V2, and V3) were grown under two cultivation systems (open-field and plastic tunnels) and subjected to two irrigations regimes (100% and 80% of crop evapotranspiration) in two consecutive years (2011-2012). They were evaluated for their phytochemical composition and antioxidant capacity. Genotype influenced the antioxidant capacity and the content of the three groups of phenolics in the blueberries. The antioxidant activity and total flavonols content increased when the blueberries were grown under open-field conditions. Deficit irrigation conditions led to additional positive effects on their phenolics (delphinidn-3-acetilhexoside content was increased under plastic tunnel with deficit irrigation). In conclusion, the amount of phenolic compounds and the antioxidant capacity of blueberries were not negatively affected by water restriction; Moreover, several changes were recorded due to growing system and genotype. Copyright © 2016 Elsevier Ltd. All rights reserved.

One health? What about plant health?

DEFF Research Database (Denmark)

Danielsen, Solveig

2012-01-01

One Health has been defined around zoonotic diseases and the sharing of infrastructure and capacities of human and animal health systems in the health triad, people-animals-environment. Plant health needs to be part of the One Health concept....

Smoking and Early COPD as Independent Predictors of Body Composition, Exercise Capacity, and Health Status.

Science.gov (United States)

Caram, Laura Miranda de Oliveira; Ferrari, Renata; Bertani, André Luís; Garcia, Thaís; Mesquita, Carolina Bonfanti; Knaut, Caroline; Tanni, Suzana Erico; Godoy, Irma

2016-01-01

The effects of tobacco smoke, mild/moderate COPD disease and their combined effect on health status (HS), body composition (BC), and exercise capacity (EC) impairment are still unclear. We hypothesized that smoking and early COPD have a joint negative influence on these outcomes. We evaluated 32 smokers (smoking history >10 pack/years), 32 mild/moderate COPD (current smokers or former smokers), and 32 never smokers. All individuals underwent medical and smoking status evaluations, pre and post-bronchodilator spirometry, BC [fat-free mass (FFM) and FFM index (FFMI)], EC [six-minute walk distance (6MWD)] and HS [Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)]. FFM (p = 0.02) and FFMI (p = 0.008) were lower in COPD than never smokers. 6MWT, as a percentage of reference values for the Brazilian population, was lower in COPD and smokers than never smokers (p = 0.01). Smokers showed worse SF-36 score for functional capacity than never smokers (psmoking were inversely associated with FFMI, 6MWD and HS. Smoking and early COPD have a joint negative influence on body composition, exercise capacity and health status.

Self-Assessment of Physical Activity and Health Capacity of Students

OpenAIRE

Plavina Liana; Dulevska Ilva; Karklina Helena

2017-01-01

The compulsory part of the individual life is physical activity. The physical activity is important for maintenance health capacity. Physical activity includes various kinds of components: physical activity during the leisure time (during the week days and weekend days), physical activity at home and in working place and physical activity during the transference from home to other place. Intensity of the physical activity could also be various from low to moderate and till high. Respondent of...

[A health system's neoliberal reform: evidence from the Mexican case].

Science.gov (United States)

López-Arellano, Oliva; Jarillo-Soto, Edgar C

2017-07-27

This study addressed the shaping of Mexico's health system in recent years, with an analysis of the social determination conditioning the system's current formulation, the consequences for the population's living and working conditions, and the technical and legal reform measures that shaped the system's transformation. The article then analyzes the survival of social security institutions and the introduction of an individual insurance model and its current implications and consequences. From the perspective of the right to health, the article compares the measures, resources, and interventions in both health care models and highlights the relevance of the social security system for Popular Insurance. The article concludes that the measures implemented to reform the Mexican health system have failed to achieve the intended results; on the contrary, they have led to a reduction in interventions, rising costs, and a decrease in the installed capacity and professional personnel for the system's operation, thus falling far short of solving the problem, rather aggravating the inequities without solving the system's structural contradictions. Health systems face new challenges, inevitably requiring that the analyses be situated in a broader framework rather than merely focusing on the functional, administrative, and financial operation of the systems in the respective countries.

The Healthy Aging Research Network: Resources for Building Capacity for Public Health and Aging Practice

Science.gov (United States)

Wilcox, Sara; Altpeter, Mary; Anderson, Lynda A.; Belza, Basia; Bryant, Lucinda; Jones, Dina L.; Leith, Katherine H.; Phelan, Elizabeth A.; Satariano, William A.

2015-01-01

There is an urgent need to translate science into practice and help enhance the capacity of professionals to deliver evidence-based programming. We describe contributions of the Healthy Aging Research Network in building professional capacity through online modules, issue briefs, monographs, and tools focused on health promotion practice, physical activity, mental health, and environment and policy. We also describe practice partnerships and research activities that helped inform product development and ways these products have been incorporated into real-world practice to illustrate possibilities for future applications. Our work aims to bridge the research-to-practice gap to meet the demands of an aging population. PMID:24000962

Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes.

Directory of Open Access Journals (Sweden)

Happiness Minja

2011-10-01

capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.

Achieving Health SDG 3 in Africa through NGO Capacity Building - Insights from the Gates Foundation Investment in Partnership in Advocacy for Child and Family Health (PACFaH) Project.

Science.gov (United States)

Walker, Judith-Ann

2016-09-01

As global impact investors gear up to support roll out of the Sustainable Development Goals in the developing world, African CSOs are urged to ensure that governments shift health funding sources away from aid and loans to innovative domestic funding sources which prioritize health. To do so, African CSOs require support to build their capacity for policy and budget advocacy. Governments and development partners have failed to invest in long term capacity building projects for indigenous NGOs and instead support INGOs to push the health advocacy agenda forward. In Nigeria, the Gates foundation has risen to the challenge of building capacity of indigenous NGOs for social accountability in child and family health. The 3 year pilot project - Partnership for Advocacy in Child and Family Health Project (PACFaH) mainstreams capacity building as an effective implementation strategy for 8 indigenous NGOs to deliver on - policy; budgetary; legislative; and administrative advocacy in four issue areas: 1) family planning; 2) nutrition; 3) routine immunization; and 4) reduction of under-5 deaths from diarrhea and pneumonia. This paper documents the achievements of the eight advocacy NGOs in PACFaH, at midterm and notes that while there have been challenges, working through capacity building as an implementation strategy has enabled the local groups in the delivery of evidence based advocacy.

Driving improvements in emerging disease surveillance through locally relevant capacity strengthening.

Science.gov (United States)

Halliday, Jo E B; Hampson, Katie; Hanley, Nick; Lembo, Tiziana; Sharp, Joanne P; Haydon, Daniel T; Cleaveland, Sarah

2017-07-14

Emerging infectious diseases (EIDs) threaten the health of people, animals, and crops globally, but our ability to predict their occurrence is limited. Current public health capacity and ability to detect and respond to EIDs is typically weakest in low- and middle-income countries (LMICs). Many known drivers of EID emergence also converge in LMICs. Strengthening capacity for surveillance of diseases of relevance to local populations can provide a mechanism for building the cross-cutting and flexible capacities needed to tackle both the burden of existing diseases and EID threats. A focus on locally relevant diseases in LMICs and the economic, social, and cultural contexts of surveillance can help address existing inequalities in health systems, improve the capacity to detect and contain EIDs, and contribute to broader global goals for development. Copyright © 2017, American Association for the Advancement of Science.

Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique.

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Sweetland, Annika C; Oquendo, Maria A; Sidat, Mohsin; Santos, Palmira F; Vermund, Sten H; Duarte, Cristiane S; Arbuckle, Melissa; Wainberg, Milton L

2014-01-01

Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and

Capacity Estimation and Near-Capacity Achieving Techniques for Digitally Modulated Communication Systems

DEFF Research Database (Denmark)

Yankov, Metodi Plamenov

investigation will include linear interference channels of high dimensionality (such as multiple-input multiple-output), and the non-linear optical fiber channel, which has been gathering more and more attention from the information theory community in recent years. In both cases novel CCC estimates and lower......This thesis studies potential improvements that can be made to the current data rates of digital communication systems. The physical layer of the system will be investigated in band-limited scenarios, where high spectral efficiency is necessary in order to meet the ever-growing data rate demand....... Several issues are tackled, both with theoretical and more practical aspects. The theoretical part is mainly concerned with estimating the constellation constrained capacity (CCC) of channels with discrete input, which is an inherent property of digital communication systems. The channels under...

Influence of health systems in malaria case management as part of malaria control in Tanzania

OpenAIRE

Masanja, Irene M.

2013-01-01

The World Health Organization report in 2007, declared that, it will not be possible to achieve national and international health goals without greater investments in health systems. It is a known fact that today, the advancement in science has led to a better understanding of aetiologies and risk factors of most diseases burden in the world. However, the capacity to deliver these innovations to the population that needs them the most is severely handicapped by fragile and poor health systems...

The Development and Implementation of a Public Health Strategy:Cost and Health System Analysis of Intermittent Preventive Treatment in Infants

OpenAIRE

Manzi, Fatuma

2010-01-01

The achievements of the health Millennium Development Goal of reducing child mortality (MDG 4) depend on the massive scaling-up of new and available health interventions. Evidence shows that effective interventions to attain MDG 4 are available; however coverage rates are currently low. The health systems in developing countries lack the necessary capacity to deliver the interventions to those in need. These factors among others are the cause of millions of preventable child...

Parasite-based malaria diagnosis: are health systems in Uganda equipped enough to implement the policy?

Science.gov (United States)

Kyabayinze, Daniel J; Achan, Jane; Nakanjako, Damalie; Mpeka, Betty; Mawejje, Henry; Mugizi, Rukaaka; Kalyango, Joan N; D'Alessandro, Umberto; Talisuna, Ambrose; Jean-Pierre, Van geertruyden

2012-08-24

Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda. In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD. Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months' long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs. Primary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems.

Strengthening and expanding the capacity of health worker education in Zambia.

Science.gov (United States)

Michelo, Charles; Zulu, Joseph Mumba; Simuyemba, Moses; Andrews, Benjamin; Katubulushi, Max; Chi, Benjamin; Njelesani, Evariste; Vwalika, Bellington; Bowa, Kasonde; Maimbolwa, Margaret; Chipeta, James; Goma, Fastone; Nzala, Selestine; Banda, Sekelani; Mudenda, John; Ahmed, Yusuf; Hachambwa, Lotti; Wilson, Craig; Vermund, Sten; Mulla, Yakub

2017-01-01

Zambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia. Data generated through documentary review, key informant interviews and observations were analyzed using a thematic approach. The MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turn around of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle. Expansion and improvement in training processes for health care workers requires targeted investment within medical institutions and strengthening local and international partnerships.

Building knowledge development and exchange capacity in Canada: lessons from Youth Excel.

Science.gov (United States)

Riley, B; Wong, K; Manske, S

2014-07-01

Youth Excel was a 3-year pan-Canadian initiative to advance youth health through improving knowledge development and exchange (KDE) capacity. KDE capacity refers to an improvement cycle linking evidence and action. Capacities include local surveillance of youth behaviours; knowledge exchange; skills, resources and a supportive environment to use knowledge; and evaluation. Interviews were conducted with Youth Excel members, including 7 provincial teams and 2 national organizations. Interviews explored participant experiences with building KDE capacity. Local surveillance systems were considered the backbone to KDE capacity, strengthened by co-ordinating surveys within and across jurisdictions and using common indicators and measures. The most effective knowledge exchange included tailored products and opportunities for dialogue and action planning. Evaluation is the least developed KDE component. Building KDE capacity requires frequent dialogue, mutually beneficial partnerships and trust. It also requires attention to language, vision, strategic leadership and funding. Youth Excel reinforces the need for a KDE system to improve youth health that will require new perspectives and sustained commitment from individual champions and relevant organizations.

What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

Science.gov (United States)

Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

2017-01-01

Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

Conservation of resources theory and research use in health systems.

Science.gov (United States)

Alvaro, Celeste; Lyons, Renée F; Warner, Grace; Hobfoll, Stevan E; Martens, Patricia J; Labonté, Ronald; Brown, Richard E

2010-10-20

Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally) with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT) research. What resources, broadly defined, are required for KT and how does their presence or absence influence research use?In this paper, we consider conservation of resources (COR) theory as a theoretical basis for understanding the capacity to use research evidence in health systems. Three components of COR theory are examined in the context of KT. First, resources are required for research uptake. Second, threat of resource loss fosters resistance to research use. Third, resources can be optimized, even in resource-challenged environments, to build capacity for KT. A scan of the KT literature examined organizational resources needed for research use. A multiple case study approach examined the three components of COR theory outlined above. The multiple case study consisted of a document review and key informant interviews with research team members, including government decision-makers and health practitioners through a retrospective analysis of four previously conducted applied health research studies in a resource-challenged region. The literature scan identified organizational resources that influence research use. The multiple case study supported these findings, contributed to the development of a taxonomy of organizational resources, and revealed how fears concerning resource loss can affect research use. Some resources were found to compensate for other resource deficits. Resource needs differed at various stages in the research use process. COR theory contributes to understanding the role of resources in research use, resistance to

Health systems as defences against the consequences of poverty: equity in health as social justice.

Science.gov (United States)

Mburu, F M

1983-01-01

The main development problems in the Third World are known to be gross socioeconomic inequality, widespread poor health status accompanied by high fertility and infant mortality rates, low life expectancy, mass illiteracy and mass poverty. In most of these countries governments invest a great deal of scarce resources toward the consequences of poverty rather than it causes. The paucity of resources for such social services is exacerbated by continuously increasing demands and needs which have to be satisfied. Unmet needs tend to cause apathy in the population. For purposes of controlling poverty and its consequences, these must be clearly formulated and relevant policies, a commitment to implement such policies, adequate administrative capacity and reasonably adequate resources. In the case of the health services system, the same requirements apply. Above all, the health system has to be directed toward the greatest needs of the population. This must involve policy makers, implementors and the consumer community. This paper argues that health systems cannot be an effective weapon against the consequences of poverty unless the above kinds of policy exist and are implemented.

Capacity and coverage of power controlled CDMA cellular systems ...

African Journals Online (AJOL)

Coverage and capacity are among the ambitious challenges to be met by the third generation (3G) systems for successful deployment of its services to both residential and commercial subscribers. This paper reports on the performance study of CDMA systems in relation to an optimum step-regulated SNR-based ...

Strengthening capacity for local evidence to inform local responders to HIV in a remote Solomon Island health service

Directory of Open Access Journals (Sweden)

David MacLaren

2015-04-01

Full Text Available Background: Documenting specific knowledge and attitudes about HIV in the culturally diverse nation of Solomon Islands is essential to inform locally targeted public health responses. As part of a large capacity-strengthening project at Atoifi Adventist Hospital in East Kwaio, Solomon Islands, researchers, using a ‘learn-by-doing’ process, worked with participants in public health research methods. Methods: Overall, 43 people attended research capacity building workshops in 2011; eight joined the HIV study group. A cross-sectional survey including semi-structured interviews on HIV was conducted by the group. In February 2014, a hospital administrator was interviewed about how the 2011 study informed local HIV responses. Results: Of the 53 survey participants, 64% self-assessed as having little or no HIV knowledge, but 90% knew HIV could be transmitted between men and women during sex. Less than 50% knew HIV could be transmitted between two men having sex, 45% thought HIV could be transmitted by mosquitoes and 55% agreed condoms help protect from HIV. Most participants reported negative attitudes towards people with HIV. Three years later the health administrator reported ad hoc responses to HIV because of low HIV prevalence, increasing noncommunicable diseases, staff turnover and resource shortages. Discussion: This HIV study was used to strengthen research skills in local health professionals and community members in Solomon Islands. It showed that community members require accurate information about HIV transmission and that entrenched stigma is an issue. Although results provided local evidence for local response, ongoing health system challenges and little local HIV transmission meant HIV services remain rudimentary.

RedeAmericas: building research capacity in young leaders for sustainable growth in community mental health services in Latin America.

Science.gov (United States)

Yang, L; Pratt, C; Valencia, E; Conover, S; Fernández, R; Burrone, M S; Cavalcanti, M T; Lovisi, G; Rojas, G; Alvarado, R; Galea, S; Price, L N; Susser, E

2017-01-01

The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional 'Hubs' funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities - Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina - working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future capacity-building efforts, and also comment on future prospects for maintaining this type of effort.

Improving Power System Modeling. A Tool to Link Capacity Expansion and Production Cost Models

Energy Technology Data Exchange (ETDEWEB)

Diakov, Victor [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sullivan, Patrick [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brinkman, Gregory [National Renewable Energy Lab. (NREL), Golden, CO (United States); Margolis, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2015-11-01

Capacity expansion models (CEM) provide a high-level long-term view at the prospects of the evolving power system. In simulating the possibilities of long-term capacity expansion, it is important to maintain the viability of power system operation in the short-term (daily, hourly and sub-hourly) scales. Production-cost models (PCM) simulate routine power system operation on these shorter time scales using detailed load, transmission and generation fleet data by minimizing production costs and following reliability requirements. When based on CEM 'predictions' about generating unit retirements and buildup, PCM provide more detailed simulation for the short-term system operation and, consequently, may confirm the validity of capacity expansion predictions. Further, production cost model simulations of a system that is based on capacity expansion model solution are 'evolutionary' sound: the generator mix is the result of logical sequence of unit retirement and buildup resulting from policy and incentives. The above has motivated us to bridge CEM with PCM by building a capacity expansion - to - production cost model Linking Tool (CEPCoLT). The Linking Tool is built to onset capacity expansion model prescriptions onto production cost model inputs. NREL's ReEDS and Energy Examplar's PLEXOS are the capacity expansion and the production cost models, respectively. Via the Linking Tool, PLEXOS provides details of operation for the regionally-defined ReEDS scenarios.

Hydrophobic interaction chromatography in dual salt system increases protein binding capacity.

Science.gov (United States)

Senczuk, Anna M; Klinke, Ralph; Arakawa, Tsutomu; Vedantham, Ganesh; Yigzaw, Yinges

2009-08-01

Hydrophobic interaction chromatography (HIC) uses weakly hydrophobic resins and requires a salting-out salt to promote protein-resin interaction. The salting-out effects increase with protein and salt concentration. Dynamic binding capacity (DBC) is dependent on the binding constant, as well as on the flow characteristics during sample loading. DBC increases with the salt concentration but decreases with increasing flow rate. Dynamic and operational binding capacity have a major raw material cost/processing time impact on commercial scale production of monoclonal antibodies. In order to maximize DBC the highest salt concentration without causing precipitation is used. We report here a novel method to maintain protein solubility while increasing the DBC by using a combination of two salting-out salts (referred to as dual salt). In a series of experiments, we explored the dynamic capacity of a HIC resin (TosoBioscience Butyl 650M) with combinations of salts. Using a model antibody, we developed a system allowing us to increase the dynamic capacity up to twofold using the dual salt system over traditional, single salt system. We also investigated the application of this novel approach to several other proteins and salt combinations, and noted a similar protein solubility and DBC increase. The observed increase in DBC in the dual salt system was maintained at different linear flow rates and did not impact selectivity.

Classification of reserve capacity in future power systems

NARCIS (Netherlands)

Frunt, J.; Kling, W.L.; Myrzik, J.M.A.

2009-01-01

In electrical power systems must always be a balance between supply and demand. Any imbalance will result in a frequency deviation. To reduce the imbalance to zero, ancillary services for balancing are in use. Ancillary services are characterised by their deployment time and their capacity. By using

Improvement of fungal disease identification and management: combined health systems and public health approaches.

Science.gov (United States)

Cole, Donald C; Govender, Nelesh P; Chakrabarti, Arunaloke; Sacarlal, Jahit; Denning, David W

2017-12-01

More than 1·6 million people are estimated to die of fungal diseases each year, and about a billion people have cutaneous fungal infections. Fungal disease diagnosis requires a high level of clinical suspicion and specialised laboratory testing, in addition to culture, histopathology, and imaging expertise. Physicians with varied specialist training might see patients with fungal disease, yet it might remain unrecognised. Antifungal treatment is more complex than treatment for bacterial or most viral infections, and drug interactions are particularly problematic. Health systems linking diagnostic facilities with therapeutic expertise are typically fragmented, with major elements missing in thousands of secondary care and hospital settings globally. In this paper, the last in a Series of eight papers, we describe these limitations and share responses involving a combined health systems and public health framework illustrated through country examples from Mozambique, Kenya, India, and South Africa. We suggest a mainstreaming approach including greater integration of fungal diseases into existing HIV infection, tuberculosis infection, diabetes, chronic respiratory disease, and blindness health programmes; provision of enhanced laboratory capacity to detect fungal diseases with associated surveillance systems; procurement and distribution of low-cost, high-quality antifungal medicines; and concomitant integration of fungal disease into training of the health workforce. Copyright © 2017 Elsevier Ltd. All rights reserved.

Building Capacity for Conducting HIV Prevention Trials in the Health ...

International Development Research Centre (IDRC) Digital Library (Canada)

Journal supplement features 10 years of West African health systems research. In the wake of the devastating Ebola virus outbreak in 2014, increased attention has been paid to West Africa's poorly functioning health systems. View moreJournal supplement features 10 years of West African health systems research ...

Understanding the organization of public health delivery systems: an empirical typology.

Science.gov (United States)

Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

2010-03-01

Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

Leveraging finances for public health system improvement: results from the Turning Point initiative.

Science.gov (United States)

Bekemeier, Betty; Riley, Catharine M; Berkowitz, Bobbie

2007-01-01

Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

Leadership in Nigerian health system for cancer prevention and control.

Science.gov (United States)

Ogbimi, R I

2009-06-01

Unacceptable health system outcomes are often related to problems with leadership because the ultimate responsibility for assigned work rests on leadership. In this paper, proper leadership at micro and macro-levels can have positive impact on the health and well being of citizens. While this may be readily obvious in other spheres, it has not been addressed adequately in the context of health care systems and its impact on health outcomes. In this paper, I discuss types of work and leadership systems in order to highlight the importance of leadership and leadership training in collaborative training and research for cancer management. The complexity of health systems highlight the expanded role of leadership in terms of capacity and capability to control the environmental risk factors for cancer, deploy adequate resources for the management of cancers, and ensure fruitful and productive post treatment life for citizens. Improved community awareness, better training of health care workers, improved working environment based on better interpersonal relationships between all cadres of health care workers, environmental health and safety initiatives and research on cancer are some of the areas where improved leadership can lead to better health outcomes. Effective leadership requires a set of skills that can be acquired with requisite operating environment, political will and adequate funding in order to generate the expected improvements in outcome.

Empowerment and the ecological determinants of health: three critical capacities for practitioners.

Science.gov (United States)

Williams, Lewis

2017-08-01

Human agency or the expression of intentionality towards some form of betterment has long occupied human imagination and creativity. The ways in which we express such aspirations are fundamentally informed by our beliefs about the nature of reality, meanings of human well-being and progress, and the ways in which our social locations shape our interests. Within Western health-promoting discourse and practice, such processes have largely been expressed through the construct of empowerment. To date, like health, much empowerment practice has been implicitly rooted in Cartesianism, has tended towards anthropocentrism and in cases where it has engaged with environmental issues, has mirrored environmentalism's focus on externalities and objectivity. These tendencies coupled with the increasing complexity of global, ecological, human well-being issues call empowerment practitioners to integrate new kinds of capacities more suited to addressing the ecological determinants of health. Drawing in part on the author's empowerment research over more than a decade, this article distinguishes between a range of epistemological perspectives underlying contemporary empowerment practices while fore-grounding the concepts of place-based agency and social-ecological resilience. These constructs in turn form the basis for three capacities considered critical for practitioners addressing human-ecological well-being. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An assessment of Makerere University College of Health Sciences: optimizing health research capacity to meet Uganda’s priorities

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Groves Sara

2011-03-01

Full Text Available Abstract Background Health research is critical to the institutional mission of the Makerere College of Health Sciences (MakCHS. Optimizing the alignment of health research capacity at MakCHS with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP, is a deliberate priority, a responsibility, and a significant opportunity for research. To guide this strategic direction, an assessment of MakCHS’s research grants and publication portfolio was conducted. Methods A survey of all new and ongoing grants, as well as all publications, between January 2005 and December 2009 was conducted. Research, training, and education grants awarded to MakCHS’ constituent faculties and departments, were looked for through financial records at the college or by contact with funding organizations. Published manuscripts registered with PubMed, that included MakCHS faculty authors, were also analyzed. Results A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV/AIDS (44%, malaria (19%, maternal and child health (14%, tuberculosis (11%, mental health (3%, and others (8%. MakCHS faculty were identified as Principal Investigators (PIs in only 22 (38% active grants. Grant funding details were only available for one third of the active grants at MakCHS. A total of 837 publications were identified, with an average of 167 publications per year, most of which (66% addressed the country’s priority health areas, and 58% had MakCHS faculty or students as first authors. Conclusions The research grants and publications at MakCHS are generally well-aligned with the Ugandan Health Ministry priorities. Greater efforts to establish centralized and efficient grants management procedures are needed. In addition, greater efforts are needed to expand

Integrating ICTs within health systems | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

2016-06-10

Jun 10, 2016 ... ... to help improve service delivery, build local capacity for primary health care, and address the ... There is limited evidence on how electronic health (eHealth) technologies can be ... The world is now home to the greatest num.

Evaluation of a health system strengthening initiative in the Zambian prison system

Science.gov (United States)

Sharma, Anjali; Moonga, Clement N; Chileshe, Chisele; Magwende, George; Henostroza, German

2018-01-01

Introduction In 2013, the Zambian Correctional Service (ZCS) partnered with the Centre for Infectious Disease Research in Zambia on the Zambian Prisons Health System Strengthening project, seeking to tackle structural, organisational and cultural weaknesses within the prison health system. We present findings from a nested evaluation of the project impact on high, mid-level and facility-level health governance and health service arrangements in the Zambian Correctional Service. Methods Mixed methods were used, including document review, indepth interviews with ministry (11) and prison facility (6) officials, focus group discussions (12) with male and female inmates in six of the eleven intervention prisons, and participant observation during project workshops and meetings. Ethical clearance and verbal informed consent were obtained for all activities. Analysis incorporated deductive and iterative inductive coding. Results Outcomes: Improved knowledge of the prison health system strengthened political and bureaucratic will to materially address prison health needs. This found expression in a tripartite Memorandum of Understanding between the Ministry of Home Affairs, Ministry of Health (MOH) and Ministry of Community Development, and in the appointment of a permanent liaison between MOH and ZCS. Capacity-building workshops for ZCS Command resulted in strengthened health planning and management outcomes, including doubling ZCS health professional workforce (from 37 to78 between 2014 and 2016), new preservice basic health training for incoming ZCS officers and formation of facility-based prison health committees with a mandate for health promotion and protection. Mechanisms: continuous and facilitated communication among major stakeholders and the emergence of interorganisational trust were critical. Enabling contextual factors included a permissive political environment, a shift within ZCS from a ‘punitive’ to ‘correctional’ organisational culture, and

Dynamic simulation of variable capacity refrigeration systems under abnormal conditions

International Nuclear Information System (INIS)

Liang Nan; Shao Shuangquan; Tian Changqing; Yan Yuying

2010-01-01

There are often abnormal working conditions at evaporator outlet of a refrigeration system, such as two-phase state in transient process, and it is essential to investigate such transient behaviours for system design and control strategy. In this paper, a dynamic lumped parameter model is developed to simulate the transient behaviours of refrigeration system with variable capacity in both normal and abnormal working conditions. The appropriate discriminant method is adopted to switch the normal and abnormal conditions smoothly and to eliminate the simulated data oscillation. In order to verify the dynamic model, we built a test system with variable frequency compressor, water-cooling condenser, evaporator and electronic expansion valve. Calculated values from the mathematical model show reasonable agreement with the experimental data. The simulation results show that the transient behaviours of the variable capacity refrigeration system in the abnormal working conditions can be calculated reliably with the dynamic model when the compressor rotary speed or the opening of electronic expansion valve changes abruptly.

Developing Institutional Capacity for Reproductive Health in Humanitarian Settings: A Descriptive Study.

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Nguyen-Toan Tran

Full Text Available Institutions play a central role in advancing the field of reproductive health in humanitarian settings (RHHS, yet little is known about organizational capacity to deliver RHHS and how this has developed over the past decade. This study aimed to document the current institutional experiences and capacities related to RHHS.Descriptive study using an online questionnaire tool.Respondents represented 82 institutions from 48 countries, of which two-thirds originated from low-and middle-income countries. RHHS work was found not to be restricted to humanitarian agencies (25%, but was also embraced by development organizations (25% and institutions with dual humanitarian and development mandates (50%. Agencies reported working with refugees (81%, internally-displaced (87% and stateless persons (20%, in camp-based settings (78%, and in urban (83% and rural settings (78%. Sixty-eight percent of represented institutions indicated having an RHHS-related policy, 79% an accountability mechanism including humanitarian work, and 90% formal partnerships with other institutions. Seventy-three percent reported routinely appointing RH focal points to ensure coordination of RHHS implementation. There was reported progress in RHHS-related disaster risk reduction (DRR, emergency management and coordination, delivery of the Minimum Initial Services Package (MISP for RH, comprehensive RH services in post-crisis/recovery situations, gender mainstreaming, and community-based programming. Other reported institutional areas of work included capacity development, program delivery, advocacy/policy work, followed by research and donor activities. Except for abortion-related services, respondents cited improved efforts in advocacy, capacity development and technical support in their institutions for RHHS to address clinical services, including maternal and newborn health, sexual violence prevention and response, HIV prevention, management of sexually-transmitted infections

Capacity building to improve the Malaysian inspection and monitoring systems for aquaculture and fisheries products

NARCIS (Netherlands)

Berendsen, B.; Wegh, R.S.; Zaaijer, S.; Dijk, van J.P.; Gevers, G.J.M.

2013-01-01

This report describes the content, the approach used and lessons learned during the implementation of a capacity development programme to build the analytical capacity of laboratory staff of the Department of Fisheries (DoF) and the Ministry of Health (MoH) who are directly involved in the analysis

Impact of Operating Rules on Planning Capacity Expansion of Urban Water Supply Systems

Science.gov (United States)

de Neufville, R.; Galelli, S.; Tian, X.

2017-12-01

This study addresses the impact of operating rules on capacity planning of urban water supply systems. The continuous growth of metropolitan areas represents a major challenge for water utilities, which often rely on industrial water supply (e.g., desalination, reclaimed water) to complement natural resources (e.g., reservoirs). These additional sources increase the reliability of supply, equipping operators with additional means to hedge against droughts. How do their rules for using industrial water supply impact the performance of water supply system? How might it affect long-term plans for capacity expansion? Possibly significantly, as demonstrated by the analysis of the operations and planning of a water supply system inspired by Singapore. Our analysis explores the system dynamics under multiple inflow and management scenarios to understand the extent to which alternative operating rules for the use of industrial water supply affect system performance. Results first show that these operating rules can have significant impact on the variability in system performance (e.g., reliability, energy use) comparable to that of hydro-climatological conditions. Further analyses of several capacity expansion exercises—based on our original hydrological and management scenarios—show that operating rules significantly affect the timing and magnitude of critical decisions, such as the construction of new desalination plants. These results have two implications: Capacity expansion analysis should consider the effect of a priori uncertainty about operating rules; and operators should consider how their flexibility in operating rules can affect their perceived need for capacity.

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

Science.gov (United States)

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and

Croatia: health system review.

Science.gov (United States)

Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

2014-01-01

of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity; psychiatric care in the community is not well developed; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to assess it properly. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Air conditioning system with supplemental ice storing and cooling capacity

Science.gov (United States)

Weng, Kuo-Lianq; Weng, Kuo-Liang

1998-01-01

The present air conditioning system with ice storing and cooling capacity can generate and store ice in its pipe assembly or in an ice storage tank particularly equipped for the system, depending on the type of the air conditioning system. The system is characterized in particular in that ice can be produced and stored in the air conditioning system whereby the time of supplying cooled air can be effectively extended with the merit that the operation cycle of the on and off of the compressor can be prolonged, extending the operation lifespan of the compressor in one aspect. In another aspect, ice production and storage in great amount can be performed in an off-peak period of the electrical power consumption and the stored ice can be utilized in the peak period of the power consumption so as to provide supplemental cooling capacity for the compressor of the air conditioning system whereby the shift of peak and off-peak power consumption can be effected with ease. The present air conditioning system can lower the installation expense for an ice-storing air conditioning system and can also be applied to an old conventional air conditioning system.

Entanglement Capacity of Two-Qubit Unitary Operator with the Help of Auxiliary System

International Nuclear Information System (INIS)

Hu Baolin; Di Yaomin

2007-01-01

The entanglement capacity of general two-qubit unitary operators is studied when auxiliary systems are allowed, and the analytical results based on linear entropy when input states are disentangled are given. From the results the condition for perfect entangler, α 1 = α 2 = π/4, is obtained. Contrary to the case without auxiliary system, the parameter α 3 may play active role to the entanglement capacity when auxiliary systems are allowed.

Bursaries, writing grants and fellowships: a strategy to develop research capacity in primary health care

Directory of Open Access Journals (Sweden)

Farmer Elizabeth A

2007-04-01

Full Text Available Abstract Background General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity. Methods Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities. Results The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47% of all grant recipients were allied health professionals, followed by general practitioners (21%. The majority (70% were novice and early career researchers. Eighty-nine percent of the grant recipients were

The Analysis and the Performance Simulation of the Capacity of Bit-interleaved Coded Modulation System

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Hongwei ZHAO

2014-09-01

Full Text Available In this paper, the capacity of the BICM system over AWGN channels is first analyzed; the curves of BICM capacity versus SNR are also got by the Monte-Carlo simulations===?=== and compared with the curves of the CM capacity. Based on the analysis results, we simulate the error performances of BICM system with LDPC codes. Simulation results show that the capacity of BICM system with LDPC codes is enormously influenced by the mapping methods. Given a certain modulation method, the BICM system can obtain about 2-3 dB gain with Gray mapping compared with Non-Gray mapping. Meanwhile, the simulation results also demonstrate the correctness of the theory analysis.

SE Capstone Project: Building Systems Engineering Education and Workforce Capacity

Science.gov (United States)

2012-04-01

This project developed a system to improve fuel efficiency by means of regenerative braking . The team designed a simple system that allows "bolt-on...air traffic control, social networking, credit/debit cards, and anti-lock brakes are only a few functions enabled by complex systems of systems . We...Building Systems Engineering Education and Workforce Capacity SE Capstone Project APRIL 2012 Report Documentation Page Form ApprovedOMB No. 0704

Capacity analysis of automatic transport systems in an assembly factory

NARCIS (Netherlands)

Zijm, W.H.M.; Lenstra, J.K.; Tijms, H.C.; Volgenant, A.

1989-01-01

We describe a case study concerning the capacity analysis of a completely automated transport system in a flexible assembly environment. Basically, the system is modelled as a network of queues, however, due to its complex nature, product-form network theory is not applicable. Instead, we present an

Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems.

Science.gov (United States)

Pratt, Bridget; Hyder, Adnan A

2017-02-01

Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder's policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Disability and Health Institutional Research Capacity Building and Infrastructure Model Evaluation: A Tribal College-Based Case Study

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Moore, Corey L.; Manyibe, Edward O.; Sanders, Perry; Aref, Fariborz; Washington, Andre L.; Robertson, Cherjuan Y.

2017-01-01

Purpose: The purpose of this multimethod study was to evaluate the institutional research capacity building and infrastructure model (IRCBIM), an emerging innovative and integrated approach designed to build, strengthen, and sustain adequate disability and health research capacity (i.e., research infrastructure and investigators' research skills)…

Assessing Performance of Botswana’s Public Hospital System: The Use of the World Health Organization Health System Performance Assessment Framework

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Onalenna Seitio-Kgokgwe

2014-09-01

Full Text Available Background Very few studies have assessed performance of Botswana public hospitals. We draw from a large research study assessing performance of the Botswana Ministry of Health (MoH to evaluate the performance of public hospital system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF. We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing performance of hospital systems in a developing country. Methods This article is based on data collected from document analysis, 54 key informants comprising senior managers and staff of the MoH (N= 40 and senior officers from stakeholder organizations (N= 14, and surveys of 42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and thematic analysis while data analysis for surveys was descriptive determining proportions and percentages. Results The organizational structure of the Botswana’s public hospital system, authority and decision-making are highly centralized. Overall physical access to health services is high. However, challenges in the distribution of facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited by inadequate resources. There are significant challenges with the quality of care. Conclusion While Botswana invested considerably in building hospitals around the country resulting in high physical access to services, the organization and governance of the hospital system, and inadequate resources limit service delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively new, this approach proved

Putting Chronic Disease on the Map: Building GIS Capacity in State and Local Health Departments

Science.gov (United States)

Casper, Michele; Tootoo, Joshua; Schieb, Linda

2013-01-01

Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants’ experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments. PMID:23786907

Putting chronic disease on the map: building GIS capacity in state and local health departments.

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Miranda, Marie Lynn; Casper, Michele; Tootoo, Joshua; Schieb, Linda

2013-06-20

Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants' experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments.

The opportunity and strategy for quality and health-system improvement now and in the future.

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Sherar, Michael; Maley, Oonagh

2015-01-01

Since 2004, Cancer Care Ontario (CCO) has played a leadership role in linking funding to quality of care, and in using evidence and administrative and clinical data to drive performance and quality improvement. This article describes how CCO has used its cancer and renal health system strategies to establish an environment of continuous health system improvement. The article also describes how CCO's Corporate Strategy is driving organizational improvement: evolving CCO's capacity and capability to drive quality and value across healthcare settings, and its ability to advance broader health system transformation in support of cancer and renal patients. Copyright © 2014 Longwoods Publishing.

Lasting change – strengthening capacity to improve health systems

International Development Research Centre (IDRC) Digital Library (Canada)

Health workers from Bauchi and Cross River states ponder how best to respond to findings they ... these skills over the long term. An integrated ... social audits. Learning in interdiscipli- nary teams, they share their practical challenges through frequent presenta- tions and discussions. The program, which is offered at both a ...

Conservation of resources theory and research use in health systems

Directory of Open Access Journals (Sweden)

Hobfoll Stevan E

2010-10-01

Full Text Available Abstract Background Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT research. What resources, broadly defined, are required for KT and how does their presence or absence influence research use? In this paper, we consider conservation of resources (COR theory as a theoretical basis for understanding the capacity to use research evidence in health systems. Three components of COR theory are examined in the context of KT. First, resources are required for research uptake. Second, threat of resource loss fosters resistance to research use. Third, resources can be optimized, even in resource-challenged environments, to build capacity for KT. Methods A scan of the KT literature examined organizational resources needed for research use. A multiple case study approach examined the three components of COR theory outlined above. The multiple case study consisted of a document review and key informant interviews with research team members, including government decision-makers and health practitioners through a retrospective analysis of four previously conducted applied health research studies in a resource-challenged region. Results The literature scan identified organizational resources that influence research use. The multiple case study supported these findings, contributed to the development of a taxonomy of organizational resources, and revealed how fears concerning resource loss can affect research use. Some resources were found to compensate for other resource deficits. Resource needs differed at various stages in the research use process. Conclusions COR theory contributes to

A national survey on health department capacity for community engagement in emergency preparedness.

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Schoch-Spana, Monica; Selck, Frederic W; Goldberg, Lisa A

2015-01-01

Limited systematic knowledge exists about how public health practitioners and policy makers can best strengthen community engagement in public health emergency preparedness ("CE-PHEP"), a top priority for US national health security. To investigate local health department (LHD) adoption of federally recommended participatory approaches to PHEP and to identify LHD organizational characteristics associated with more intense CE-PHEP. National survey in 2012 of LHDs using a self-administered Web-based questionnaire regarding LHD practices and resources for CE-PHEP ("The Community Engagement for Public Health Emergency Preparedness Survey"). Differences in survey responses were examined, and a multivariate analysis was used to test whether LHD organizational characteristics were associated with differences in CE-PHEP intensity. A randomized sample of 754 LHDs drawn from the 2565 LHDs that had been invited to participate in the 2010 National Profile of LHDs. Sample selection was stratified by the size of population served and geographic location. Emergency preparedness coordinators reporting on their respective LHDs. CE-PHEP intensity as measured with a scoring system that rated specific CE-PHEP practices by LHD according to the relative degrees of public participation and community capacity they represented. Survey response rate was 61%. The most common reported CE-PHEP activity was disseminating personal preparedness materials (90%); the least common was convening public forums on PHEP planning (22%). LHD characteristics most strongly associated with more intense CE-PHEP were having a formal CE-PHEP policy, allocating funds for CE-PHEP, having strong support from community-based organizations, and employing a coordinator with prior CE experience. Promising ways to engage community partners more fully in the PHEP enterprise are institutionalizing CE-PHEP objectives, employing sufficient and skilled staff, leveraging current community-based organization support, and

Psychological first-aid training for paraprofessionals: a systems-based model for enhancing capacity of rural emergency responses.

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