Health reform in post conflict Kosovo

The international community undertakes complex interventions in states emerging from war. These interventions include broad efforts to reform the political and institutional structures of the state. After the United Nations took political control of Kosovo in June 1999, it embarked on such a reform program, extremely ambitious in nature. This thesis examines the efforts to rehabilitate and reform the health sector. The immediate post-conflict environment in Kosovo was extremely chaotic. Hundreds of millions of dollars poured into the province, funding the operations of several hundred non-governmental organisations. The initial efforts of the international community in the health sector were focused on coordinating resources and the activities of these organisations. However, Kosovo' s health system was in clear need of widespread reform. The system had been devastated by years of neglect and months of conflict. A reform program was undertaken, with the objectives of establishing a primary care based system, increasing the quality of secondary and tertiary care, modernizing the public health system, and ensuring a cost-effective, equitable health system. By 2004, the reform program had largely failed to meet these objectives. This study examines the reasons that health reform was so difficult utilizing a combination of methods, i.e. a review of literature on peacebuilding, health and conflict, and health reform; analysis of the implementation of reform utilizing primary evidence such as policy documents and health data; and interviews with key stakeholders. Results show two important lessons for other post-conflict interventions. First, the reform program neglected building the capacity of government institutions. If the state does not have the capacity to implement reforms, the sustainability of the health reform process will be undermined. And second, the Kosovo reform program failed to build the foundation for reform before initiating ambitious projects to modernize the health sector.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Health systems and gender in post-conflict contexts: building back better?

The post-conflict or post-crisis period provides the opportunity for wide-ranging public sector reforms: donors fund rebuilding and reform efforts, social norms are in a state of flux, and the political climate may be conducive to change. This reform period presents favourable circumstances for the promotion of gender equity in multiple social arenas, including the health system. As part of a larger research project that explores whether and how gender equity considerations are taken into account in the reconstruction and reform of health systems in conflict-affected and post conflict countries, we undertook a narrative literature review based on the questions “How gender sensitive is the reconstruction and reform of health systems in post conflict countries, and what factors need to be taken into consideration to build a gender equitable health system?” We used the World Health Organisation’s (WHO) six building blocks as a framework for our analysis; these six building blocks are: 1) health service delivery/provision, 2) human resources, 3) health information systems, 4) health system financing, 5) medical products and technologies, and 6) leadership and governance

A case study of health sector reform in Kosovo

The impact of conflict on population health and health infrastructure has been well documented; however the efforts of the international community to rebuild health systems in post-conflict periods have not been systematically examined. Based on a review of relevant literature, this paper develops a framework for analyzing health reform in post-conflict settings, and applies this framework to the case study of health system reform in post-conflict Kosovo. The paper examines two questions: first, the selection of health reform measures; and second, the outcome of the reform process. It measures the success of reforms by the extent to which reform achieved its objectives. Through an examination of primary documents and interviews with key stakeholders, the paper demonstrates that the external nature of the reform process, the compressed time period for reform, and weak state capacity undermined the ability of the success of the reform program

Comprehensive compartmental model and calibration algorithm for the study of clinical implications of the population-level spread of COVID-19 : a study protocol

Introduction: The complex dynamics of the coronavirus disease 2019 (COVID-19) pandemic has made obtaining reliable long-term forecasts of the disease progression difficult. Simple mechanistic models with deterministic parameters are useful for short-term predictions but have ultimately been unsuccessful in extrapolating the trajectory of the pandemic because of unmodelled dynamics and the unrealistic level of certainty that is assumed in the predictions. Methods and analysis: We propose a 22-compartment epidemiological model that includes compartments not previously considered concurrently, to account for the effects of vaccination, asymptomatic individuals, inadequate access to hospital care, post-acute COVID-19 and recovery with long-term health complications. Additionally, new connections between compartments introduce new dynamics to the system and provide a framework to study the sensitivity of model outputs to several concurrent effects, including temporary immunity, vaccination rate and vaccine effectiveness. Subject to data availability for a given region, we discuss a means by which population demographics (age, comorbidity, socioeconomic status, sex and geographical location) and clinically relevant information (different variants, different vaccines) can be incorporated within the 22-compartment framework. Considering a probabilistic interpretation of the parameters allows the model’s predictions to reflect the current state of uncertainty about the model parameters and model states. We propose the use of a sparse Bayesian learning algorithm for parameter calibration and model selection. This methodology considers a combination of prescribed parameter prior distributions for parameters that are known to be essential to the modelled dynamics and automatic relevance determination priors for parameters whose relevance is questionable. This is useful as it helps prevent overfitting the available epidemiological data when calibrating the parameters of the proposed model. Population-level administrative health data will serve as partial observations of the model states. Ethics and dissemination: Approved by Carleton University's Research Ethics Board-B (clearance ID: 114596). Results will be made available through future publication

A call for an immediate ceasefire and peaceful end to the Russian aggression against Ukraine

The Lancet–SIGHT Commission condemns the Russian Government's aggression against Ukraine and its attacks on civilians and civilian infrastructure, including health workers and hospitals. We support the March 2, 2022 UN General Assembly (UNGA) resolution ES-11/1 that “deplores in the strongest terms the aggression by the Russian Federation”. The indiscriminate use of weaponry violates international humanitarian law and has caused catastrophic health impacts, especially on children, older people, and disabled persons, and social and economic disruptions that will be long lasting. There are nuclear risks, both from Russian attacks on Ukrainian nuclear facilities and the potential for nuclear weapons use. There is a further risk that Russia might use chemical or biological weapons. We call for an immediate ceasefire and the appointment of a mediator to facilitate negotiations for a sustainable and peaceful settlement on the basis of international law to end the conflict. We urge the global health community to deliver humanitarian assistance impartially to all those affected by and fleeing the war; document atrocities committed against civilians and the devastating impacts of the war; counter disinformation about the conflict; and advocate for a peaceful settlement. We also call for an end to the repression of those in Russia protesting the war.http://www.thelancet.comhj2023Economic

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

Background Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. Methods This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. Findings Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. Conclusion The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies

Health Reform in Post Conflict Kosovo

The international community undertakes complex interventions in states emerging from war. These interventions include broad efforts to reform the political and institutional structures of the state. After the United Nations took political control of Kosovo in June 1999, it embarked on such a reform program, extremely ambitious in nature. This thesis examines the efforts to rehabilitate and reform the health sector. The immediate post-conflict environment in Kosovo was extremely chaotic. Hundreds of millions of dollars poured into the province, funding the operations of several hundred non-governmental organisations. The initial efforts of the international community in the health sector were focused on coordinating resources and the activities of these organisations. However, Kosovo' s health system was in clear need of widespread reform. The system had been devastated by years of neglect and months of conflict. A reform program was undertaken, with the objectives of establishing a primary care based system, increasing the quality of secondary and tertiary care, modernizing the public health system, and ensuring a cost-effective, equitable health system. By 2004, the reform program had largely failed to meet these objectives. This study examines the reasons that health reform was so difficult utilizing a combination of methods, i.e. a review of literature on peacebuilding, health and conflict, and health reform; analysis of the implementation of reform utilizing primary evidence such as policy documents and health data; and interviews with key stakeholders. Results show two important lessons for other post-conflict interventions. First, the reform program neglected building the capacity of government institutions. If the state does not have the capacity to implement reforms, the sustainability of the health reform process will be undermined. And second, the Kosovo reform program failed to build the foundation for reform before initiating ambitious projects to modernize the health sector