Advancing Global Health - The Need for (Better) Social Science Comment on "Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health".

In his perspective "Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health," Ooms argues that actions taken in the field of global health are dependent not only on available resources, but on the normative premise that guides how these resources are spent. This comment sets out how the application of a predominately biomedical positivist research tradition in global health, has potentially limited understanding of the value judgements underlying decisions in the field. To redress this critical social science, including health policy analysis has much to offer, to the field of global health including on questions of governance

Exploring how women use the Alexander Technique: psycho-physical re-education in the postpartum

Background The postpartum phase is a transitional period of heightened vulnerability for women with potentially compromised self-care. Fatigue and musculo-skeletal tension can impact well-being. While postnatal depression (PND) has received much research attention, a systematic literature review on lumbo-pelvic pain (LPP) in the postpartum for the years 2008-2018 revealed only ten randomised controlled treatment trials. This suggests that some aspects of the postpartum are under-researched. The Alexander Technique (AT) is a long- established holistic self-management approach shown to be effective in managing psycho- physical tension issues and heightening self-efficacy and self-care.Research studies An interpretative phenomenological analysis explored how eight women with different amounts of AT-experience with babies under a year used the method in the postpartum. Findings suggest that participants used a variety of self-care strategies and skills to consciously modify their self-management via awareness. Using the AT led to a range of well-being benefits through a sense of agency regarding their self-care. Applying the AT while lying in semi-supine was important to their lives. In a second study, a small-scale mixed- methods feasibility study, 15 women without prior experience and with babies under a year were given access to an online self-care package based on AT principles. Eleven women completed the study. Participants were able to draw on aspects of the AT which positively impacted their self-care. This benefitted their well-being and changed their postpartum experience. Prioritising time for themselves to practice the AT while lying down in semi- supine was challenging. Implications/conclusions These studies are the first (known) studies exploring how women use the AT in the postpartum. The AT has significance for self- management, self-care and prioritising maternal needs for rest and addressing tension issues. Further research into the AT as an approach to supporting perinatal well-being is warranted

A first city-wide early defibrillation project in a German city: 5-year results of the Bochum against sudden cardiac arrest study

<p>Abstract</p> <p>Background</p> <p>Immediate defibrillation is the decisive determinant of prognosis in patients suffering from cardiac/circulatory arrest caused by ventricular fibrillation (VF). Therefore, various national and international associations recommend that first responders use defibrillators as soon as possible and also recommend public access to early defibrillation programmes. Here we report the results of the first city-wide early defibrillation project in a large German urban area.</p> <p>Methods</p> <p>There were 155 automated external defibrillators (AEDs) put into operation in the Bochum municipal area, and 6,294 people took part in cardiopulmonary resuscitation (CPR) and AED training. Free, accessible AEDs were installed in places with large volumes of people. Additionally, emergency forces were progressively equipped with AEDs.</p> <p>Results</p> <p>Twelve AED administrations prior to the arrival of an emergency physician were recorded and analysed over a period of 5 years (08/2004-08/2009). Rhythm analysis via AED demonstrated VF in seven cases, non-malignant dysrhythmias in four cases and asystole in one case. Two of the seven patients with VF were successfully defibrillated and survived cardiac/circulatory arrest without any neurological sequelae. Eight of the 12 AED applications were performed by laymen. The mean time between switching the unit on and applying the electrodes to the patient was 39 seconds (SD +/-20 sec). On average, another 20 seconds elapsed before the AED recommendation of "shock delivery" was displayed, and a total of 96 seconds elapsed before shock administration (± 56 sec).</p> <p>Conclusion</p> <p>Consistent with other reports, our findings show that the organisation of a city-wide initiative by a project office combining public access and first-responder defibrillation programmes can be safe, feasible and successful. Our experiences confirm that strategic planning of AED placement is a prerequisite for successful, cost-effective resuscitation.</p

Debate: can we achieve universal health coverage without a focus on disability?

BACKGROUND: The achievement of Universal Health Coverage (UHC) is a key aim of the global health agenda, and an important target of the Sustainable Development Goals. There is increasing recognition that some groups may fall behind in efforts to achieve UHC, including the 1 billion people globally living with disabilities. A fundamental question for debate is - can UHC be achieved without the inclusion of people with disabilities? MAIN TEXT: People with disabilities are more likely to experience poor health. They will therefore have greater need for general healthcare services, as well as rehabilitation and specialist services, related to their underlying impairment. People with disabilities also frequently face additional difficulties in accessing healthcare, incur greater costs when seeking healthcare and often report experiencing worse quality services than others. As a consequence of these different challenges, people with disabilities face specific and added difficulties across three dimensions of UHC: coverage, access to services needed, and at reasonable cost. A focus on people with disabilities is therefore essential to achieving UHC, particularly since they constitute 15% of the global population. To ensure the realisation of UHC is inclusive of and addresses the needs of people with disabilities, health systems need to adapt. A twin-tracked approach is recommended, which means that there is a focus on including people with disabilities in mainstream services, as well as targeting them with specific services needed. There also must be efforts to improve the quality of services (e.g. through healthcare staff training) and enhance cost protection for people with disabilities (e.g. through social protection). A key challenge to changing UHC strategies to be more inclusive is the lack of evidence on what is needed and works, and more research is needed urgently on this topic. CONCLUSIONS: It will be difficult to achieve UHC without a focus on people with disabilities. Changes made to improve coverage for people with disabilities will likely benefit a wider group, including older people, ethnic minorities, and people with short-term functional difficulties. Disability-inclusive strategies will therefore improve health system equity and ensure that we "Leave no one behind" as we move towards UHC

We need a better understanding of the effects of ‘medical tourism’ on health systems to have an informed debate about fairness and regulation

Medical tourism is not a one-way street. Research shows the number of patients travelling from the UK for treatment abroad is greater than the number coming to the UK. Johanna Hanefeld, Neil Lunt and Richard Smith looked at effects of health tourists on the NHS and uncovered a nuanced picture which has implications for debates around medical tourism, migration and health

What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia

BACKGROUND: Since the beginning of the 21st century, development assistance for HIV/AIDS has increasingly been provided through Global Health Initiatives, specifically the United States Presidential Emergency Plan for AIDS Relief, the Global Fund to Fight HIV, TB and Malaria and the World Bank Multi-country AIDS Programme. Zambia, like many of the countries heavily affected by HIV/AIDS in southern Africa, also faces a shortage of human resources for health. The country receives significant amounts of funding from GHIs for the large-scale provision of antiretroviral treatment through the public and private sector. This paper examines the impact of GHIs on human resources for ART roll-out in Zambia, at national level, in one province and two districts. METHODS: It is a qualitative policy analysis relying on in-depth interviews with more than 90 policy-makers and implementers at all levels. RESULTS: Findings show that while GHIs do not provide significant funding for additional human resources, their interventions have significant impact on human resources for health at all levels. While GHIs successfully retrain a large number of health workers, evidence suggests that GHIs actively deplete the pool of skilled human resources for health by recruiting public sector staff to work for GHI-funded nongovernmental implementing agencies. The secondment of GHI staff into public sector facilities may help alleviate immediate staff shortages, but this practice risks undermining sustainability of programmes. GHI-supported programmes and initiatives add significantly to the workload of existing public sector staff at all levels, while incentives including salary top-ups and overtime payments mean that ART programmes are more popular among staff than services for non-focal diseases. CONCLUSION: Research findings suggest that GHIs need to actively mediate against the potentially negative consequences of their funding on human resources for health. Evidence presented highlights the need for new strategies that integrate retraining of existing staff with longer-term staff development to ensure staff retention. The study results show that GHIs must provide significant new and longer-term funding for additional human resources to avoid negative consequences on the overall provision of health care services and to ensure sustainability and quality of programmes they support