Digital health and universal health coverage: opportunities and policy considerations for Pacific Island health authorities

The emergence of digital health tools offer opportunities to complement and support the health system in the delivery of health services, especially in resource-constrained settings. Low- and middle-income countries have implemented various digital health interventions to support a range of health functions including patient information collection, diagnostics, supply-chain management, and remote clinical monitoring. The use of digital health in Pacific Island countries and territories (PICTs) is increasing. Effective implementation is hampered by misalignment between system design and contextual realities among other factors. Health service delivery in PICTs are highly resource sensitive, digital health must add demonstrable benefit to justify the expenditure of resources that could otherwise be allocated to facilities, equipment, staff, medicines and other commodities. This policy brief aims to identify health system challenges in the region which digital health interventions may address for decision-makers. It aims to identify policy and implementation factors to increase the likelihood of sustainable and scalable adoption of DHIs, and identify health resources to best capitalize on opportunities that digital health solutions offer. Recommendations suggest the need for each country or territory in the region to assess and determine their own priorities and opportunities, and devise digital health strategies in response. Recommendations outlined in the brief suggest the need to develop national-level digital health strategies to identify timelines and priorities, support mechanisms to strengthen digital health governance, human resource and institutional capacity. The brief aims to provide recommendations to aid relevant stakeholders to strengthen and support the use of ICTs to deliver equitable and integrated person-centered health care in the region

Multiplex primer prediction software for divergent targets

We describe a Multiplex Primer Prediction (MPP) algorithm to build multiplex compatible primer sets to amplify all members of large, diverse and unalignable sets of target sequences. The MPP algorithm is scalable to larger target sets than other available software, and it does not require a multiple sequence alignment. We applied it to questions in viral detection, and demonstrated that there are no universally conserved priming sequences among viruses and that it could require an unfeasibly large number of primers (∼3700 18-mers or ∼2000 10-mers) to generate amplicons from all sequenced viruses. We then designed primer sets separately for each viral family, and for several diverse species such as foot-and-mouth disease virus (FMDV), hemagglutinin (HA) and neuraminidase (NA) segments of influenza A virus, Norwalk virus, and HIV-1. We empirically demonstrated the application of the software with a multiplex set of 16 short (10 nt) primers designed to amplify the Poxviridae family to produce a specific amplicon from vaccinia virus

Une caisse d'allocations familiales en progrès : la gestion moderne de la misère

This article presents a monographic approach to a now classical process of modernisation, in a particular institution: the French family allowance fund (Caisse d'Allocation Familiale) based in Nanterre near Paris. The authors first show how the reorganisation undertaken - including restructuring, introduction of new forms of work and employee mobilisation, introduction of advanced technologies with the implementation of the new system of real time information, etc. - resembles that of companies confronted with a market and with " classical " - meaning solvent - customers. They then examine the effects of this form of modernisation on this organisation and its employees, whose job is basically to deal with other people's problems and to ensure that they receive everything they are entitled to. How do the employees cope with this new approach? How does the service relationship which they establish with beneficiaries develop, both objectively and subjectively? How do they deal with a situation which confronts them with people in difficulty, and which highlights the inequalities spawned by our society? All these questions are situated in the context of modernistic transformation where objectives are defined in terms of user - even customer - satisfaction, efficiency and comparative productivity between agencies.Cet article présente l'approche monographique d'un processus de modernisation désormais classique mené dans un établissement particulier : la Caisse d'Allocations Familiales de Nanterre. Nous montrons d'abord comment les réorganisations entreprises rejoignent celles qui sont appliquées dans les entreprises confrontées à un marché et des clients classiques, c'est- à-dire solvables : modifications de structures, introduction de nouvelles formes de travail et de mobilisation des salariés, implantation de technologies avancées avec la mise en oeuvre du nouveau système d'information en temps réel, etc. Nous nous interrogeons ensuite sur les effets d'une telle modernisation sur cette organisation particulière et sur ses salariés dont la tâche bien précise est au fond de gérer la plupart du temps la misère des autres et de leur garantir au mieux leurs droits. Comment les salariés gèrent-ils cette évolution, comment évolue objectivement et subjectivement la relation de service qu'ils établissent avec les allocataires ? Comment font-ils avec une situation qui les met face à des populations en difficulté, qui mettent en avant et rendent manifeste, concret et totalement visible tout ce que notre société produit comme inégalités ? Et ce, dans le cadre d'une transformation moderniste où l'on parle satisfaction de l'usager sinon parfois du client, efficacité et comparaison de productivité des agences entre elles ? Telles sont les questions qui seront abordées.Jaeger Christine, Linhart Danièle. Une caisse d'allocations familiales en progrès : la gestion moderne de la misère. In: Réseaux, volume 16, n°91, 1998. Les relations clients-fournisseurs à l'épreuve des réseaux. pp. 31-66

Investing in our future: building strong and resilient health systems in the Indo-Pacific region

The COVID-19 pandemic has prompted a global rethink on the importance of strong and resilient health systems, capable of responding to health emergencies while maintaining continuous access to essential health services and addressing ongoing population health needs. The pandemic has caused severe and likely long-term ramifications for health system strengthening and population health outcomes in the Indo-Pacific region, with concerns that progress that has been made in improving equitable access to quality health services may stagnate or reverse. Significant disruptive effects have occurred across all aspects of health systems, including the capacity to raise budget allocations for health, together with uncertainty around the implementation of the medium- to long-term health and development agenda. Building strong and resilient health systems across the Indo-Pacific region will require the sustained support of development partners and donors for the foreseeable future. And although determining the most useful contributions that external agencies can make will be context specific, the focus must be on strengthening integration across the health system, with an emphasis on increasing equity in access, quality of care and resource optimisation.This report presents the findings and recommendations from a rapid desk-based review of the current status of health system strengthening in seven Indo-Pacific countries: Cambodia, Fiji, Indonesia, Lao People’s Democratic Republic, Papua New Guinea, Solomon Islands and Vietnam. The framework used to undertake the review was an adapted version of the World Health Organization (WHO) Building Blocks framework, with the incorporation of three cross-cutting key elements: equity in access, quality of care and resource optimisation. This framework was used as it acknowledges the interconnectedness and value of the WHO building blocks as a foundation for efforts to strengthen health systems, while also recognising three key cross-cutting elements considered essential for a well-performing health system. The review primarily focused on the community and primary health care level of the health system. However, pertinent activities that facilitate health system strengthening at all levels were also documented (e.g. governance structures from the national to the community level, and the continuum of care from the primary to the tertiary level).The most prominent health system strengths and weaknesses identified in the information reviewed for the seven countries were then used to construct a series of recommendations on what, where and how to prioritise future investments (financial and other) in health system strengthening in each country. The prominent commonalities across these country-specific recommendations were used to construct recommendations for the Indo-Pacific region more broadly. A high-level summary of the regional recommendations for the Indo-Pacific includes:• Governance: strengthening the capacity at all levels of government for health planning, budgeting and management, particularly in countries that have a decentralised system of government; strengthening regulation of private health facilities and private practitioners.• Financing: increasing focus on reducing out-of-pocket expenditure and the risk of catastrophic health expenditure, particularly through implementation, strengthening and/or expansion of government-funded health insurance schemes.• Physical resources for health: strengthening health infrastructure, and the processes and systems for procurement and distribution of medicines and medical supplies.• Human resources for health: improving the quantity and quality of the health workforce, particularly at the primary health care level; strengthening community health worker programs.• Health service delivery: improving the quality of service delivery at community health facilities; increasing preventive and promotive population health interventions.• Health information systems: increasing long-term investment in health information system infrastructure and workforce; strengthening data quality and data culture; increasing private sector health information reporting compliance.Although the challenges faced in creating strong and resilient health systems within each country are highly contextual and require local, tailored solutions, the country-specific and regional recommendations presented in this report provide an important starting point to highlight key areas of focus. The recommendations can be used for consultation with key stakeholders to prioritise activities and strategies over the immediate and medium-to-long term

Measuring progress towards achieving Millennium Development Goals in small populations: is under‐five mortality in Tuvalu declining?

Abstract Objectives: Infant mortality rates (IMR) and under‐five mortality rates (U5MR) in Tuvalu (2010 population 11,149) for 1990–2011 were evaluated to determine best estimates of levels and trends. Methods: Estimates were graphed over time to identify trends/inconsistencies, and censored for reliability/plausibility. Where possible, 95% confidence intervals (CIs) and tests for linear trend were calculated. Results: Ministry of Health (MoH) data indicates IMR and U5MR (per 1,000 live births) declined over 1990–2008: IMR 62 (95%CI 46–81) for 1991–93 (51 deaths) to 19 (95%CI 10–33) for 2006–08 (12 deaths); U5MR 67 (95%CI 50–87) for 1991–93 (55 deaths) to 19 (95%CI 10–33) for 2006–08 (12 deaths). The 2007 Demographic and Health Survey (DHS) suggests recent trends are increasing: IMR 24 for 1998–2002 to 31 (95%CI 20–42) for 2003–07; U5MR 29 for 1998–2002 to 36 (95%CI 30–43) for 2003–07 (deaths not provided). Tests for linear trend and 95%CIs indicate MoH declines are statistically significant, but recent increased estimates from DHS are not, and could be affected by recall bias. Conclusions: Small populations provide challenges in interpretation of IMR/U5MR trends. To ensure the correct interpretation of rates, CIs (95%) and tests for trend should be calculated. Tuvalu has experienced steady decline in IMR/U5MR over the past 20 years

La précarisation du travail

info:eu-repo/semantics/nonPublishe

Maternal mortality in Sierra Leone: from civil war to Ebola and the sustainable development goals

More than 1 year has passed since Sierra Leone marked the end of the largest Ebola virus epidemic ever recorded. However, maternal mortality remains a major challenge. The country’s maternal mortality ratio (MMR) is the highest in the world, estimated by the UN Maternal Mortality Estimation Inter-Agency Group to be 1360 [80% uncertainty interval (UI), 999–1980] deaths per 100,000 live births (WHO et al. 2015). This is higher than what the Demographic and Health Survey reports (1165 per 100,000 live births), given incomplete civil registration and vital statistics (CRVS) (Statistics Sierra Leone and ICF International 2014). In contrast, the Millennium Development Goal (MDG) 5A target the country needed to achieve by 2015 was 450 maternal deaths per 100,000 live births

Sexual Intercourse and Its Correlates Among School-aged Adolescents in Indonesia: Analysis of the 2015 Global School-based Health Survey

OBJECTIVES: This study aimed to determine the prevalence and correlates of sexual intercourse among junior secondary and high school students in Indonesia from the 2015 Global School-based Health Survey (GSHS). METHODS: The survey was conducted among 11 110 students from 75 schools in Indonesia using a self-administered questionnaire. Univariate and multivariate analyses were conducted to explore associations between sexual intercourse and socio-demographic variables, substance use, mental distress, and protective factors. RESULTS: Overall, 5.3% of students reported having ever had sex (6.9% of boys and 3.8% of girls). Of students who engaged in sexual intercourse, 72.7% of boys and 90.3% of girls had an early sexual debut (before reaching the age of 15) and around 60% had multiple sex partners. Sexual intercourse was associated with gender, school grade, smoking, alcohol consumption, drug use, suicidal ideation, truancy, peer support, and parental supervision. CONCLUSIONS: These findings indicate a pressing need to develop more comprehensive sexual health education in the national curriculum. An effective strategy should also address other risky behaviours.</p

Trends in cardiovascular disease risk factors in Pacific Island populations - Fiji, Samoa and Wallis Island

Since the mid-twentieth century many Pacific Island countries and territories have experienced the demographic and epidemiological transition, with cardiovascular disease (CVD) now the leading cause of morbidity and mortality in the region. The evolution of risk factor prevalence underpinning the epidemiological transition however, has not been well described. This PhD thesis relates to trends over three-four decades in risk factors for CVD in Pacific Island populations, and the contribution of obesity to selected risk factors. These long term trends have not previously been documented.Wallis Island, Fiji and Samoa are included in this research because they are Pacific Island populations in which the major health problems are related to CVD; and because of availability of long term CVD risk factor data from cross-sectional surveys. Nationally representative long term trends in hypertension, tobacco smoking, obesity and type 2 diabetes mellitus (T2DM), in particular, were derived from unit record data from Wallis Island (2 surveys 1980-2009; n=711), Fiji (5 surveys 1980-2011; n=14,191) and Samoa (7 surveys 1978-2013; n=9,223). Statistical methods were used to determine the contribution of changes in obesity to changes in hypertension (Wallis Island, Fiji and Samoa) and T2DM (Wallis Island) over time.This research has identified that in Wallis Island, Fiji and Samoa and there have been sustained increases in mean blood pressure and hypertension over the last three-four decades. These increases have been concurrent with increasing obesity and T2DM over the same period. This research also shows confirmatory evidence of the effect of increases in obesity on the increases in mean blood pressure and hypertension in Wallis Island, Fiji and Samoa; and on the increases in T2DM in Wallis Island. Trends in tobacco smoking in Fiji and Samoa showed periods of substantial long term decline commencing in the 20th century. This is the first evidence of decline in a CVD risk factor over several decades in Pacific Island populations; although in Fiji a plateau in male smoking is evident in the most recent decade