Global health security: where is the data to inform health system strengthening?

[Extract] The Ebola outbreak in West Africa (2013–2016) triggered a renewed interest and sense of urgency about global health security. A surge of reports and publications ensued, examining various aspects of emerging infectious disease outbreaks. In 2016, Olivero and colleagues published a biogeographical approach mapping favourable conditions that facilitated the Ebola outbreak, in terms of environmental factors and the presence of potential host animals.1 Constructing biological vulnerability maps has value to guide preparations for future emerging infectious disease outbreaks, especially in low-income and middle-income countries. But perhaps more important is the need to develop similar ‘vulnerability maps’ to capture the ability of health systems to prevent or respond to major infectious disease challenges. Without a health system vulnerability map, or the public availability of the data to generate it, efforts to achieve global health security in relation to emerging infectious disease outbreaks will likely be limited and post hoc, rather than pre-emptive and strategic. Unfortunately, the revived interest in global health security has not been matched with commensurate action. In 2014, the G7 (Group of Seven) endorsed the Global Health Security Agenda (GHSA), a partnership of governments and international organisations with the goal of accelerating the achievement of the core disease outbreak preparedness and response capacities as required by the International Health Regulations, but progress has been limited

Promoting evidence-based policies, programs and services for ageing and health in Fiji

Population ageing presents significant implications for economies, health systems and social protection globally. In Pacific Island countries, the once young populations are ageing rapidly, yet national health systems remain vastly unprepared to cope with the complex needs of a growing number of older persons. The ability of Pacific governments to ‘re-orient health systems to respond to the needs of older people’ (WHO, 2014), is hindered by a lack of knowledge of what’s needed and what works for the care of older persons in their context. Limited translatable epidemiological data to underpin predictions of demographic and disease trends, lack of knowledge and coordination of multi-sectoral policies and services for the older population, and poor understanding of the preferences of older persons themselves, present significant barriers to driving evidence-based health policies and programs to enhance healthy ageing. This report presents the findings of a 2019/2020 scoping study of policy, program and service priorities to guide an effective health system response to population ageing in one of the most rapidly ageing Pacific Island countries, Fiji

Understanding community health worker employment preferences in Malang district, Indonesia using a discrete choice experiment

BACKGROUND: Community health workers (CHWs) play a critical role in supporting health systems, and in improving accessibility to primary healthcare. In many settings CHW programmes do not have formalised employment models and face issues of high attrition and poor performance. This study aims to determine the employment preferences of CHWs in Malang district, Indonesia, to inform policy interventions. METHODS: A discrete choice experiment was conducted with 471 CHWs across 28 villages. Attributes relevant to CHW employment were identified through a multistage process including literature review, focus group discussions and expert consultation. Respondents’ choices were analysed with a mixed multinomial logit model and latent class analyses. RESULTS: Five attributes were identified: (1) supervision; (2) training; (3) monthly financial benefit; (4) recognition; and (5) employment structure. The most important influence on choice of job was a low monthly financial benefit (US$~2) (β=0.53, 95$~20) was most unappealing to respondents (β=−0.13, 95% CI=−0.23 to −0.03). Latent class analysis identified two groups of CHWs who differed in their willingness to accept either job presented and preferences over specific attributes. Preferences diverged based on respondent characteristics including experience, hours’ worked per week and income. CONCLUSION: CHWs in Malang district, Indonesia, favour a small monthly financial benefit which likely reflects the unique cultural values underpinning the programme and a desire for remuneration that is commensurate with the limited number of hours worked. CHWs also desire enhanced methods of performance feedback and greater structure around training and their rights and responsibilities. Fulfilling these conditions may become increasingly important should CHWs work longer hours

A study of the quality of cardiovascular and diabetes medicines in Malang District, Indonesia, using exposure-based sampling

BACKGROUND: The WHO has warned that substandard and falsified medicines threaten health, especially in low and middle-income countries (LMICs). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine quality recorded that 15.4% of cardiovascular and 6.8% of diabetes samples failed at least one quality test. Review authors warn that study quality was mixed. Because they did not record medicine volume, no study reflected the risk posed to patients. METHODS AND FINDINGS: We investigated the quality of five medicines for cardiovascular disease and diabetes in Malang district, East Java, Indonesia. Our sample frame, based on dispensing volumes by outlet and price category, included sampling from public and private providers and pharmacies and reflected the potential risk posed to patients. The content of active ingredient was determined by high-performance liquid chromatography and compared with the labelled content. Dissolution testing was also performed. We collected a total of 204 samples: amlodipine (88); captopril (22); furosemide (21); glibenclamide (21) and simvastatin (52), comprising 83 different brands/products. All were manufactured in Indonesia, and all samples met specifications for both assay and dissolution. None was suspected of being falsified. CONCLUSIONS: While we cannot conclude that the prevalence of poor-quality medicines in Malang district is zero, our sampling method, which reflects likely exposure to specific brands and outlets, suggests that the risk to patients is very low; certainly nothing like the rates found in recent reviews of surveys in LMICs. Our study demonstrates the feasibility of sampling medicines based on likely exposure to specific products and underlines the dangers of extrapolating results across countries

A Scoping Review of National Policies for Healthy Ageing in Mainland China from 2016 to 2020

Abstract: There remains limited literature to facilitate understanding of healthy ageing-related policies in China over the last five-year policy planning cycle. This study aims to characterise all relevant policies and identifies the policy gaps from a health system perspective. A scoping review framework was used. A thorough search for healthy ageing-related policies was performed on the websites of all government ministries affiliated with the Chinese State Council. Essential information was extracted and mapped to an integrated framework of the World Health Organization’s Health System Building Blocks and the Chi- nese 13 th Five-Year Plan for Healthy Ageing. A total of 12471 policy documents were identified, while 99 policy documents were included. There were 14 ministries involved in the generation of policies, but mul- tisectoral collaboration between the ministries remained limited. National Health Commission and Min- istry of Civil Affairs were the leading ministries. Promoting the integration of medical services and older people care was most frequently addressed within these policies. Applying the health system perspective, governance and financing were often addressed, but there were limited policies on other components of the health system. The findings of this study support four policy recommendations: (1) to enhance mul- tisectoral collaboration in policy development; (2) to strengthen health system building blocks, including healthcare workforce, service delivery, health information, and medical products and technologies; (3) to establish a consolidated policy system centered on the national healthy ageing plan; (4) to formulate a national implementation work plan to promote an integrated health care model for older people

Beyond Vision Loss: Understanding the Impact of Cataract on Fall Risk and Health in Older Australians

Cataract is a leading cause of vision impairment in the older population. Although cataract surgery can restore sight, it is not uncommon for people in Australia to wait up to three years for first eye surgery; an initial two years for outpatient assessment and a further 12 months on the surgical wait list. The consequences of waiting for surgery encompass physical, mental and social domains, compromising an older person’s quality of life, and limiting active ageing. However data describing these effects in older Australians with cataract are scarce, hindering policy change to support timely care. Cataract also increases fall risk; a significant public health issue in the older population. The benefits of surgery for preventing falls is unclear, as visual mechanisms underlying fall risk in those with cataract are complex. While laboratory studies link blur, spectacle lens magnification, and lens type with impaired balance and mobility, up to now there were limited data from real-world settings. This thesis reports findings from a comprehensive prospective cohort study of fall risk and wellbeing in older adults with bilateral cataract referred to eight Australian public hospitals. It establishes cataract-related falls as an important public health concern and confirms the benefit of first eye cataract surgery for reducing fall risk. The determinants of falls during the wait for first eye surgery are assessed, highlighting greater risk for more active older adults and for those with a history of falls. Cautious refractive management after first eye cataract surgery may maximise the effect of surgery on fall prevention. The research shows a high prevalence of depressive symptoms, associated with greater visual disability and emerging at modest levels of vision loss. The interplay of physical function and visual disability in the presence of fear of falling is explored, reinforcing the importance of taking a holistic approach to the care of an older person with cataract. This thesis enriches the evidence base for policies underpinning the timely, effective management of cataract. By applying the World Health Organization’s policy framework for active ageing, it affirms need for a new policy direction to improve the ability of Australian public health services to support active ageing for those with cataract

Using the STROBE statement to assess reporting in blindness prevalence surveys in low and middle income countries.

OBJECTIVE: Cross-sectional blindness prevalence surveys are essential to plan and monitor eye care services. Incomplete or inaccurate reporting can prevent effective translation of research findings. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement is a 32 item checklist developed to improve reporting of observational studies. The aim of this study was to assess the completeness of reporting in blindness prevalence surveys in low and middle income countries (LMICs) using STROBE. METHODS: MEDLINE, EMBASE and Web of Science databases were searched on April 8 2016 to identify cross-sectional blindness prevalence surveys undertaken in LMICs and published after STROBE was published in December 2007. The STROBE tool was applied to all included studies, and each STROBE item was categorized as 'yes' (met criteria), 'no' (did not meet criteria) or 'not applicable'. The 'Completeness of reporting (COR) score' for each manuscript was calculated: COR score = yes / [yes + no]. In journals with included studies the instructions to authors and reviewers were checked for reference to STROBE. RESULTS: The 89 included studies were undertaken in 32 countries and published in 37 journals. The mean COR score was 60.9% (95% confidence interval [CI] 58.1-63.7%; range 30.8-88.9%). The mean COR score did not differ between surveys published in journals with author instructions referring to STROBE (10/37 journals; 61.1%, 95%CI 56.4-65.8%) or in journals where STROBE was not mentioned (60.9%, 95%CI 57.4-64.3%; p = 0.93). CONCLUSION: While reporting in blindness prevalence surveys is strong in some areas, others need improvement. We recommend that more journals adopt the STROBE checklist and ensure it is used by authors and reviewers