Selection of sustainability indicators for health services in challenging environments: balancing scientific approach with political engagement.

Sustainability evaluation has become a key component of international health. However, evaluators have faced a number of challenges linked to the lack of consensus on the meaning of the concept of "sustainability". This paper aims to describe a methodology, the Sustainability Analysis Process, based on several conceptual frameworks and tested in five different countries in the physical rehabilitation sector. The methodology consists of five successive steps: (i) overview of the context; (ii) system boundary; (iii) consensus vision of sustainability, and derivation of stakeholder perspectives; (iv) selection of sustainability indicators and characterization and analysis of local system sustainability; and (v) verification and modification. The paper also discusses the place of the evaluator and researcher in the process: the methodology aims to help evaluators objectively measure the level of sustainability of a health system with the challenge of dealing with a subjective notion, the concept of sustainability, and a diversity of actors. The Sustainability Analysis Process also aims to capture the dynamics of systems by repeating the process on a regular basis. The methodology highlights the need for evaluators build consensus amongst stakeholders on a common vision of the future of a health system

Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on “Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries”

International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks

Systems thinking in public health: a bibliographic contribution to a meta-narrative review.

BACKGROUND: Research across the formal, natural and social sciences has greatly expanded our knowledge about complex systems in recent decades, informing a broadly inclusive, cross-disciplinary conceptual framework referred to as Systems Thinking (ST). Its use in public health is rapidly increasing, although there remains a poor understanding of how these ideas have been imported, adapted and elaborated by public health research networks worldwide. METHOD: This review employed a mixed methods approach to narrate the development of ST in public health. Tabulated results from a literature search of the Web of Science Core Collection database were used to perform a bibliometric analysis and literature review. Annual publication counts and citation scores were used to analyse trends and identify popular and potential 'landmark' publications. Citation network and co-authorship network diagrams were analysed to identify groups of articles and researchers in various network roles. RESULTS: Our search string related to 763 publications. Filtering excluded 208 publications while citation tracing identified 2 texts. The final 557 publications were analysed, revealing a near-exponential growth in literature over recent years. Half of all articles were published after 2010 with almost a fifth (17.8%) published in 2014. Bibliographic analysis identified five distinct citation and co-authorship groups homophilous by common geography, research focus, inspiration or institutional affiliation. As a loosely related set of sciences, many public health researchers have developed different aspects of ST based on their underlying perspective. Early studies were inspired by Management-related literature, while later groups adopted a broadly inclusive understanding which incorporated related Systems sciences and approaches. CONCLUSION: ST is an increasingly popular subject of discussion within public health although its understanding and approaches remain unclear. Briefly tracing the introduction and development of these ideas and author groups in public health literature may provide clarity and opportunities for further learning, research and development

Does the Humanitarian Sector Use Evidence-informed Standards? A Review of the 2011 Sphere Indicators for Wash, Food Security and Nutrition, and Health Action.

BACKGROUND: In 1997, the pursuit of greater accountability and effectiveness in humanitarian response prompted a multi-stakeholder collaboration to develop a set of indicators and standards to guide humanitarian practitioners, published later in the form of the Sphere Handbook. Twenty years after the first edition of the Handbook was developed, and in order to guide the 2018 revision, an assessment of the evidence base for current Water, Sanitation and Hygiene (WASH), Food Security and Nutrition, and Health Action indicators, as compared to evidence collated by the 2015 LSHTM Humanitarian Health Evidence Review (HHER), was conducted. METHODOLOGY: In order to assess the utility of the Sphere indicators as a tool with which to monitor and evaluate humanitarian activities, indicators from the WASH, Food Security and Nutrition, and Health Action chapters of the Sphere Handbook were analysed and classified according to the SMART criteria. Each indicator was then assessed based on existing evidence related to the effectiveness of humanitarian health interventions as compiled in the HHER. RESULTS: Of the 159 Sphere indicators intended to guide humanitarian response, only 2 met all of the SMART criteria. The remaining 157 did not provide any time indication for the measurement of the indicator. Furthermore, only 11 standards (23%) and 14 indicators (8%) are supported in part by 33 studies identified in the HHER. Less than one third of studies captured by HHER that explore interventions related to WASH, nutrition, or health could be linked to existing Sphere indicators. CONCLUSION: It is not possible to adequately link the 2011 Sphere indicators and standards to their sources in their current constitution, and they are not sufficiently evidence-informed. In the absence of clear measurement definitions, they do not provide necessarily detailed guidance. While recognising that a number of indicators have emerged as a combination of empirical evidence, expert experience, and "common sense", a focus on fewer indicators, each better defined, is likely to enhance the practical application of the Sphere Handbook in humanitarian settings

Towards systematic evaluation of epidemic responses during humanitarian crises: a scoping review of existing public health evaluation frameworks.

Epidemics continue to pose a significant public health threat to populations in low and middle-income countries. However, little is known about the appropriateness and performance of response interventions in such settings. We undertook a rapid scoping review of public health evaluation frameworks for emergency settings in order to judge their suitability for assessing epidemic response. Our search identified a large variety of frameworks. However, very few are suitable for framing the response to an epidemic, or its evaluation. We propose a generic epidemic framework that draws on elements of existing frameworks. We believe that this framework may potentially be of use in closing the gap between increasing global epidemic risk and the ability to respond effectively

Atlas comprenant le monde

Deux nouveaux ouvrages ont, cette année, enrichi  Atlas Monde, une collection lancée en 2005 par les éditions Autrement et désormais bien installée dans le paysage éditorial français. Après des ouvrages consacrés à l’Islam, au réchauffement climatique ou encore aux migrations, l’eau et la population mondiale sont les thèmes choisis pour les deux derniers volumes de cette collection ayant vocation à présenter les défis de nos sociétés contemporaines d’une manière attractive et pédagogique, non..

Défense civile

Hugo Slim, praticien d’expérience et chercheur britannique, se penche sur le sort des civils dans les conflits. Il tente d’expliquer les logiques de guerre et pourquoi les civils sont souvent pris comme cibles dans les conflits modernes. Et les exemples sont nombreux, bien trop nombreux. La question est d’autant plus actuelle que les formes modernes de guerre telles que le terrorisme s’attaquent directement aux civils plutôt que de se confronter aux armées. De nos jours, les affrontements int..

Plaidoyer étayé pour l’exemption des frais de santé

Valéry Ridde a mené durant les cinq dernières années des études dans les pays francophones d'Afrique de l'Ouest sur les thèmes de l'accès aux services de sante et de leur utilisation. Il publie régulièrement des articles scientifiques dans des revues de renom et, par son dernier ouvrage, met enfin à la disposition des gestionnaires de programmes de santé et des autorités sanitaires un ensemble de faits et preuves sur son champ d’études. Dans un effort certain de s'éloigner des idées reçues ci..