Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050.

Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings: In 2019, health spending globally reached$8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this,$13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and$1·4 billion was repurposed from existing health projects. $3·1 billion (22·4$2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all.S

The Challenges facing midwifery educators in sustaining a future education workforce

Background national and international trends have identified concerns over the ability of health and social care workforces in meeting the needs of service users. Attention has increasingly been drawn to problems of recruiting and retaining professionals within higher education; however data in relation to the midwifery profession is scant. Aim to examine the perceptions and experiences of midwifery educators, in south-west England, about the challenges facing them sustaining the education workforce of the future. Design a mixed methodology approach was adopted involving heads of midwifery education and midwife educators. Methodology midwifery participants were recruited from three higher education institutions in south west England. Data collection comprised of self-administered questionnaires plus individual qualitative interviews with heads of midwifery education (n=3), and tape recorded focus groups with midwife academics (n=19). Numerical data were analysed using descriptive statistics. Textual data were analysed for themes that represented the experiences and perspectives of participants. Ethics approval was granted by one University Ethics committee. Findings demographic data suggests that within south-west England, there is a clear ageing population and few in possession of a doctorate within midwifery. The six identified sub-themes represented in the data describe challenges and tensions that midwifery academics experienced in their efforts to attract new recruits and retain those in post in a highly changing educational environment which demands more from a contracting workforce. Conclusion and implications for practice there remain some serious challenges facing midwifery educators in sustaining the future education workforce, which if unresolved may jeopardise standards of education and quality of care women receive. Active succession planning and more radical approaches that embrace flexible careers will enable educational workforce to be sustained and by a clinically credible and scholarly orientated midwifery workforce

The burden of low back pain in Malta at a population level

Background: Low back pain (LBP) is a leading global cause of all-age years lived with disability (YLD). Studies conducted in Malta reported that musculoskeletal complaints were the commonest in primary care. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) studypeer-reviewe

Completing Baseline Mapping of Trachoma in Uganda: Results of 14 Population-Based Prevalence Surveys Conducted in 2014 and 2018.

PURPOSE: We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. METHODS: Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1-9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1-9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. RESULTS: A total of 11,796 households were surveyed; 22,465 children aged 1-9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1-0.7) to 3.9% (95% CI 2.1-5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0-0.11) to 0.81% (95% CI 0.35-1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. CONCLUSION: TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda

Narrowing the gap between eye care needs and service provision: the service-training nexus

<p>Abstract</p> <p>Background</p> <p>The provision of eye care in the developing world has been constrained by the limited number of trained personnel and by professional cultures. The use of personnel with specific but limited training as members of multidisciplinary teams has become increasingly important as health systems seek to extract better value from their investments in personnel. Greater positive action is required to secure more efficient allocation of roles and resources. The supply of professional health workers is a factor of the training system, so it stands to reason that more cost-effective, flexible and available education methods are needed. This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit.</p> <p>Methods</p> <p>Literature surveys and interviews in five continents were carried out. Based on this and the author's own experience, a encies-based multiple entry and exit scheme for eye care in a developing country was derived, modeled and critically reviewed by interested parties in one country.</p> <p>Results</p> <p>The scheme was shown to be highly cost-effective and readily adaptable to the anticipated eye care needs of the population. Eye care players in one selected country have commented favourably on the scheme.</p> <p>Conclusion</p> <p>The underlying principles used to derive this model can be applied to many eye care systems in many developing countries. The model can be used in other disciplines with similar constructs to eye care.</p

Flexible working and work-life balance: Midwives’ experiences and views

This article presents midwives’ views and experiences of flexible working and work–life balance. Both flexible working and work–life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work–life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work–life balance is marginalized and this is fuelling discontent and resentment among midwives and leading to divisions between full- and part-time staff that reinforce flexibility stigma. Although flexible working and work–life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession

Validation of the person-centred coordinated care experience questionnaire (P3CEQ)

Abstract Background Measuring patient experiences of healthcare is increasingly emphasized as a mechanism to measure, benchmark and drive quality improvement, clinical effectiveness and patient safety at both national and local NHS level. Person-centred coordinated care (P3C) is the conjunction of two constructs; person-centred care and care coordination. It is a complex intervention requiring support for changes to organizational structure and the behaviour of professionals and patients. P3C can be defined as: ‘care and support that is guided by and organized effectively around the needs and preferences of individuals’. Despite the vast array of PRMS available, remarkably few tools have been designed that efficiently probe the core domains of P3C. This paper presents the psychometric properties of a newly developed PREM to evaluate P3C from a patient perspective. Methods A customized EMIS search was conducted at 72 GP practices across the South West (Somerset, Devon and Cornwall) to identify 100 patients with 1 or more LTCs, and are frequent users of primary healthcare services. Partial Credit Rasch Modelling was conducted to identify dimensionality and internal consistency. Ecological validity and sensitivity to change were assessed as part of intervention designed to improve P3C in adults with multiple long-term conditions; comparisons were drawn between the P3CEQ and qualitative data. Results Response rate for the P3CEQ was 32.82%. A two-factor model was identified. Rasch analysis confirmed unidimensionality of each factor (using infit MSQ values between 0.5 and 1.5). High internal consistency was established for both factors; For the Person-centred scale Cronbach’s Alpha = 0.829, Person separation = 0.756 and for the coordination scale Cronbach’s alpha = 0.783, person separation = 0.672. Conclusions The P3CEQ is a valid and reliable measure of P3C. The P3C is considered to have strong face, construct and ecological validity, with demonstrable sensitivity to change in a primary healthcare intervention.Abstract Background Measuring patient experiences of healthcare is increasingly emphasized as a mechanism to measure, benchmark and drive quality improvement, clinical effectiveness and patient safety at both national and local NHS level. Person-centred coordinated care (P3C) is the conjunction of two constructs; person-centred care and care coordination. It is a complex intervention requiring support for changes to organizational structure and the behaviour of professionals and patients. P3C can be defined as: ‘care and support that is guided by and organized effectively around the needs and preferences of individuals’. Despite the vast array of PRMS available, remarkably few tools have been designed that efficiently probe the core domains of P3C. This paper presents the psychometric properties of a newly developed PREM to evaluate P3C from a patient perspective. Methods A customized EMIS search was conducted at 72 GP practices across the South West (Somerset, Devon and Cornwall) to identify 100 patients with 1 or more LTCs, and are frequent users of primary healthcare services. Partial Credit Rasch Modelling was conducted to identify dimensionality and internal consistency. Ecological validity and sensitivity to change were assessed as part of intervention designed to improve P3C in adults with multiple long-term conditions; comparisons were drawn between the P3CEQ and qualitative data. Results Response rate for the P3CEQ was 32.82%. A two-factor model was identified. Rasch analysis confirmed unidimensionality of each factor (using infit MSQ values between 0.5 and 1.5). High internal consistency was established for both factors; For the Person-centred scale Cronbach’s Alpha = 0.829, Person separation = 0.756 and for the coordination scale Cronbach’s alpha = 0.783, person separation = 0.672. Conclusions The P3CEQ is a valid and reliable measure of P3C. The P3C is considered to have strong face, construct and ecological validity, with demonstrable sensitivity to change in a primary healthcare intervention

Meeting the health and social needs of pregnant asylum seekers; midwifery students’ perspectives. Part 2; Dominant discourses and approaches to care

YesPregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with “midwifery discourse” being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge