33 research outputs found
Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India.
BackgroundIn 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal and neonatal health indicators remain poor in India. The objective of this study is to highlight the experiences of women, their husbands, and mothers-in-law related to maternal health services and delivery experiences.MethodsIn total, we conducted 80 in-depth interviews, including 40 with recent mothers, 20 with their husbands, and 20 with their mothers-in-law. Purposeful sampling was conducted in order to obtain differences across delivery experiences (facility vs. home), followed by their family members.ResultsMajor factors that influence decision-making about where to seek care included household dynamics and joint-decision-making with families, financial barriers, and perceived quality of care. Women perceived that private facilities were higher quality compared to public facilities, but also more expensive. Disrespectful care, bribes in the facility, and payment challenges were common in this population.ConclusionsA number of programmatic and policy recommendations are highlighted from this study. Future endeavors should include a greater focus on health education and public programs, including educating women on how to access programs, who is eligible, and how to obtain public funds. Families need to be educated on their rights and expectations in facilities. Future programs should consider the role of husbands and mothers-in-law in reproductive decision-making and support during deliveries. Triangulating information from multiple sources is important for future research efforts
Achieving a âGrand Convergenceâ in Global Health by 2035: Rwanda Shows the Way Comment on âImproving the Worldâs Health Through the Post-2015 Development Agenda: Perspectives From Rwandaâ
lobal Health 2035
, the report of The Lancet Commission on Investing in Health, laid out a bold, highly ambitious
framework for making rapid progress in improving global public health outcomes. It showed that with the right
health investments, the international community could achieve a âgrand convergenceâ in global healthâa reduction
in avertable infectious, maternal, and child deaths down to universally low levelsâwithin a generation. Rwandaâs
success in rapidly reducing such deaths over the last 20 years shows that convergence is feasible. Binagwaho and Scott
have argued that 5 lessons from this success are the importance of equity, quality health services, evidence-informed
policy, intersectoral collaboration, and effective collaboration between countries and multilateral agencies. This
article re-examines these lessons through the lens of the
Global Health 2035
report to analyze how the experience
in Rwanda might be generalized for other countries to making progress towards achieving a grand convergenc
Mexicoâs path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030
Background The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for
signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of
the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we
analysed Mexicoâs mortality to assess the feasibility of reducing premature (0â69 years) mortality and propose a path
to meet SDG3.
Methods We developed a baseline scenario applying 2010 age-specifi c and cause-specifi c mortality rates from the
Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD)
population projections. In a second scenario, INEGI age-specifi c and cause-specifi c trends in death rates from 2000 to
2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a
40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantifi ed shortfalls
in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to
better performing countries.
Findings UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated
reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all
age groups mask uneven gains across health disorders. Injuries, particularly road traffi c accidents and homicides, are
the main health challenge for young adults (aged 20â49 years) whereas unabated diabetes mortality is the single most
important health concern for older adults (aged 50â69 years).
Interpretation Urgent action is now required to control non-communicable diseases and reduce fatal injuries in
Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of
substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting
national health priorities. Further analysis of the equity implications of following the suggested pathway remains a
subject of future research
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Expanded roles of community health workers to sustain malaria services in the Asia-Pacific: A landscaping survey
Malaria Community Health Workers (CHWs) in the Greater Mekong Subregion (GMS) are an important component of malaria elimination efforts. As malaria declines with intensified efforts to eliminate by 2030, expanding their roles beyond malaria could help to sustain funding and provision of malaria services at the community level. Evidence of how programmes have implemented and managed CHWs performing both malaria and non-malaria roles across the Asia-Pacific region can provide insight into the viability of this strategy. A short survey was distributed to national malaria programmes and implementing organizations in the Asia-Pacific region in 2021â2022. The survey identified CHW programmes in the region, and collected information on malaria and non-malarial services provided by CHWs, characteristics of each identified programme, and the impact of COVID-19 on these programmes. 35 survey responses identified 28 programmes in 14 countries. The most frequently reported services provided by malaria CHWs were health promotion and education for malaria (13/14 countries) and other diseases (11/14); and COVID-19 related activities (10/14). Most programmes were financed wholly through donor funding (18/28 programmes), or donor plus government funding (6/28). Of 21 programmes which performed programme evaluation, only 2 evaluated their impacts on diseases beyond malaria. Declining donor funding, and COVID-19 related travel and activity restrictions were identified as implementation challenges. CHWs across the Asia Pacific provide a range of health services with malaria and are resilient under changing public health landscapes such as the COVID-19 pandemic. Further investigation into the impact of additional roles on malaria CHW performance and targeted health outcomes is needed to verify the benefits and feasibility of role expansion. As the GMS approaches elimination, and funding declines, verifying the cost effectiveness of malaria CHW programmes will be vital to persuade donors and countries to invest in malaria CHWs to sustain malaria services, and strengthen community-based health care
Salud global 2035: implicaciones para MĂ©xico
En noviembre de 2014, la SecretarĂa de Salud de MĂ©xico fue sede de una mesa redonda con miembros de la ComisiĂłn de The Lancet para la InversiĂłn en Salud (CIS) para analizar el informe de esta misma comisiĂłn titulado Salud global 2035 y sus posibles implicaciones para el mejoramiento de la salud pĂșblica..
Building a tuberculosis-free world: The Lancet Commission on tuberculosis
___Key messages___
The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer
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Advancing a Social Determinants Approach to Climate Change and Health
Climate change is a global crisis harming the health of communities around the world. We have known about the causes and risks of climate change since at least the 1960s, and about the health harms of climate change since the 1990s. Yet our collective inability to envision and enact alternative energy and economic systems has locked in a level of global temperature rise with devastating consequences. At current levels of warming, communities around the world are already experiencing a wide range of harmful impacts to mental and physical health and wellbeing; impacts which will grow as climate change continues unabated. As a result of systemic forms of social injustice â including those of economics, race, and gender â climate change is deepening health inequities within and between countries. Gaps in the literature hinder our ability to comprehend and effectively communicate the scale of the challenge, to identify and implement effective programs and policies to protect health in the face of climate change, and to overcome deeply entrenched political barriers to action. In this dissertation, I focus on one gap in particular: the paucity of research at the global level exploring the intersection of climate change and the social determinants of health. Using Nancy Kriegerâs Ecosocial Theory of Disease Distribution as a conceptual guide, I develop three empirical case studies, each of which focuses on a distinct pathway though which climate change and the social determinants of health intersect to drive adverse health outcomes.
Chapter One offers a brief overview of the current state of climate change and health and describes how a social determinants approach can respond to existing research gaps. Chapter Two utilizes a historical case study to document the engagement of the fossil fuel industry in the science of climate change and health, newly emergent in the 1990s. It identifies how the industry sought to influence the public health narrative on climate change and opens a critical new area of research for understanding and navigating political barriers to climate action. Chapter Three quantitatively assesses the relationship between drought â an environmental phenomenon becoming increasingly common and severe because of climate change â and womenâs empowerment â a social determinant of womenâs and childrenâs health. Drawing on analysis of household surveys in twenty-four countries in sub-Saharan Africa, this paper finds that drought is associated with small but significant decline in womenâs empowerment, thus expanding a currently understudied area in the literature on climate change and womenâs health. Chapter Four presents qualitative analysis of how climate change impacts mental health in a uniquely vulnerable population of smallholder farmers living with HIV in western Kenya. This chapter finds that mental health is predominantly mediated by profound changes in economic and social systems, and thus proposes a new conceptual framework for understanding the social determinants pathways through which climate change shapes emotional health.
Finally, Chapter Five draws conclusions from these three studies, proposing directions for future research, and highlighting how a social determinants approach to global health sciences research on climate change can inform more effective community and policy interventions to reduce climate changeâs health harms