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 decolonised Commission agenda : the missing ingredients – Author's reply

No abstract available.https://www.thelancet.com/journals/lanhiv/home2024-04-18hj2024EconomicsSDG-03:Good heatlh and well-beingSDG-05:Gender equalitySDG-16:Peace,justice and strong institution

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

The Lancet Commission on peaceful societies through health equity and gender equality

The multiple and overlapping crises faced by countries, regions, and the world appear unprecedented in their magnitude and complexity. Protracted conflicts continue and new ones emerge, fuelled by geopolitics and social, political, and economic pressures. The legacy of the COVID-19 pandemic, economic uncertainty, climatic events ranging from droughts to fires to cyclones, and rising food insecurity add to these pressures. These crises have exposed the inadequacy of national and global leadership and governance structures. The world is experiencing a polycrisis—ie, an interaction of multiple crises that dramatically intensifies suffering, harm, and turmoil, and overwhelms societies' ability to develop effective policy responses. Bold approaches are needed to enable communities and countries to transition out of harmful cycles of inequity and violence into beneficial cycles of equity and peace. The Lancet Commission on peaceful societies through health equity and gender equality provides such an approach. The Commission, which had its inaugural meeting in May, 2019, examines the interlinkages between Sustainable Development Goal 3 (SDG3) on health; SDG5 on gender equality; and SDG16 on peace, justice, and strong institutions. Our research suggests that improvements to health equity and gender equality are transformative, placing societies on pathways towards peace and wellbeing. Four key messages emerge from our research. First, health equity and gender equality have a unique and powerful ability to contribute to more peaceful societies. This Commission recognises the complex web of factors that contribute to conflict. Moreover, health equity and gender equality are themselves shaped by social and economic processes that are complex, contextually specific, and unfold over long timescales. Even accounting for this complexity, our Commission provides evidence that improvements in health equity and gender equality can place societies on pathways to peace. Health equity and gender equality are powerful agents of transformation because they require definitive actions, namely tangible and sustained policies that improve health and gender equality outcomes. We refer to these definitive actions as the mechanisms of health equity and gender equality. Health equity requires countries to embrace the right to health, acknowledge disparities, and recognise that universal access to health-care services is crucial for human potential and dignity. Gender equality requires laws to protect the rights of women and sexual and gender minorities. All individuals need equal access to education, resources, technology, infrastructure, and safety and security to enable participation in the economy, civil society, and politics. Processes to advance health equity and gender equality are more powerful when they operate together, through access to comprehensive sexual and reproductive health services. Advocacy is also an essential component as it builds a social consensus that the principles of health equity and gender equality apply to all individuals, regardless of their gender or other forms of identity. These tangible actions or mechanisms transform capabilities, a term that we define here as what people are able to do and to be. With improved health equity and gender equality, individuals can access economic resources and assets, live in safety and security, and exercise greater agency. Through these changes, human capital improves and economic growth becomes more inclusive. Social capital is strengthened and social norms are altered to inhibit violence and aggression. Although political processes are characterised by short-term dynamics, the institutionalisation of gender equality and health equity improves the quality of governance and can strengthen the social contract between the government and the citizenry. These processes interact with each other in self-reinforcing feedback loops creating beneficial cycles that influence the dynamics of economic, social, and political systems. For countries locked in harmful cycles of inequity, conflict, and instability, our research suggests that improvements in gender equality and health equity help nudge them onto pathways towards peace. Second, to deliver the promise of the Commission's research, health equity and gender equality principles and processes must be led by communities and tailored to their context. Local and national actors must drive improvements in health equity and gender equality, a process we refer to as change from the inside out. Although communities benefit from evidence from other contexts, we highlight the danger of importing policy models from other contexts. Health and gender systems are social systems, deeply intertwined in culture, contexts, and politics. Tangible and sustained improvements require gender equality and health equity mechanisms to be led by national actors, rooted in the local context, shaped by data, sustained through national systems, and accountable to communities. Efforts to improve gender equality are always contentious, but are transformative, enabling the recognition of the equal rights of women, girls, and sexual and gender minorities within the private and public spheres. Our Commission supports the call from decolonisation advocates for structural reform of global development processes to enable locally driven, context-specific change. However, we also stress that these local and national efforts should leverage and build upon the global scaffolding or architecture of norms, initiatives, funding, and institutions designed to advance health equity and gender equality. Third, within the health sector and beyond, the Commission calls on policy makers to embrace, advocate for, and advance health equity and gender equality. In the health sector, services and systems must adopt, implement, and be accountable to benchmarks for gender equal health responses. The health sector is a key social, economic, and political institution. Individuals engage with health services throughout their lifespan. Health professionals are respected leaders within their communities. Given their reproductive and caregiving roles, women are a majority of users as well as providers of health care. Yet health services and systems can reflect and reinforce implicit biases that undermine access to and delivery of services and the effectiveness of health policy decisions. The gender-blind response to the COVID-19 pandemic and the tolerance of sexual exploitation within humanitarian contexts are examples of the failure to integrate gender equality principles within health sector strategies and responses. Our Commission provides definitive benchmarks for gender equal health services and humanitarian action. If policy makers advance these benchmarks, health outcomes as well as the level of gender equality would improve. Finally, given the evidence we present in this Commission, health equity and gender equality must form an integral part of national and global processes to promote peace and wellbeing. The beneficial cycles of health equity and gender equality unfold over long time scales. Conflict management and humanitarian efforts understandably prioritise short-term interventions to reduce human suffering and stop violence. However, given the path dependencies established by such engagement, gender equality and health equity must be built into these short-term interventions. When integrating health equity and gender equality into humanitarian and conflict management interventions, we need to better analyse conflict dynamics and understand what conditions foster backlash, including when and how best to confront, counter, navigate, and minimise backlash. Gender equality and health equity processes must also recognise how gender norms impact men and boys, and not assume women and girls have the power to single-handedly transform their environments. Policy processes from the UN Sustainable Development Goals to the Group of Seven and Group of 20 Agendas present an important opportunity to advance this agenda. Although global initiatives can provide financial and technical support, gender or health outcomes cannot be instrumentalised or pursued for the interests of external actors rather than for the benefit of communities. The Lancet Commission provides an agenda for a path forward, rooted in a vision of our shared human dignity and collective responsibility to build a more equitable world. This agenda takes communities, governments, and international agencies on a challenging and sometimes contentious journey forward. We can accept the challenge and leverage this moment of opportunity to advance this agenda, or our politics and policies can entrench inequities and create the conditions for a more conflictual world. The choice is ours.The Swedish MFA, the Ministry of Social Affairs and Health in Finland, Canada's International Development Research Centre, and a donor whose organisation's policy is to remain anonymous but is known to The Lancet.https://www.thelancet.com/journals/lanhiv/home2024-05-04hj2024EconomicsSDG-03:Good heatlh and well-beingSDG-05:Gender equalitySDG-16:Peace,justice and strong institution

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