The state of health policy and systems research: Reflections from the 2018 5th global symposium

The latest version of this event, the 5th Global Symposium on Health Systems Research, took place in Liverpool, UK from 8 to 12 October 2018, and drew 2247 participants from >125 countries—the largest gathering to date of health systems researchers from across the globe.Organized by Health Systems Global (HSG), it took place 40 years after the Alma-Ata Conference on Primary Health Care and 70 years after the creation of the United Kingdom’s National Health Service. The conference theme, Advancing Health Systems for All in the Sustainable Development Goal (SDG) Era, was chosen to echo some of the themes that have shaped health system development since Alma-Ata, and to enable reflection on the achievements and challenges facing health systems in 2018; but also to draw attention to some of the important ways in which the struggle for ‘health for all’ and the context of health system development has changed in these past 40 years

Adolescent health in the sustainable development goal era: Are we aligned for multisectoral action?

Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multisectoral action for adolescent health, to understand the context of such change and to spark, sustain and steer it

Climate change, cash transfers and health

Abstract The forecast consequences of climate change on human health are profound, especially in low- and middle-income countries and among the most disadvantaged populations. Innovative policy tools are needed to address the adverse health effects of climate change. Cash transfers are established policy tools for protecting population health before, during and after climate-related disasters. For example, the Ethiopian Productive Safety Net Programme provides cash transfers to reduce food insecurity resulting from droughts. We propose extending cash transfer interventions to more proactive measures to improve health in the context of climate change. We identify promising cash transfer schemes that could be used to prevent the adverse health consequences of climatic hazards. Cash transfers for using emission-free, active modes of transport – e.g. cash for cycling to work – could prevent future adverse health consequences by contributing to climate change mitigation and, at the same time, improving current population health. Another example is cash transfers provided to communities that decide to move to areas in which their lives and health are not threatened by climatic disasters. More research on such interventions is needed to ensure that they are effective, ethical, equitable and cost–effective

Improving the resilience and workforce of health systems for women’s, children’s, and adolescents’ health

The United Nations’ first Every Woman Every Child strategy, Global Strategy for Women’s and Children’s Health, provided an impetus “to improve the health of hundreds of millions of women and children around the world and, in so doing, to improve the lives of all people.” The updated Global Strategy for Women’s, Children’s, and Adolescents’ Health calls for an even more ambitious agenda of expanding equitable coverage to a broader range of reproductive, maternal, newborn, child, and adolescent health services, as integral to the 2030 targets of the sustainable development goals.These goals cannot be realised by efforts that tackle only specific parts of the global strategy. Instead, an integrated approach is required, to include the complementary functions of stewardship, financing, workforce, supply chain, information systems, and service delivery.3 In this paper we highlight two core aspects that require urgent attention—building the resilience of health systems and ensuring sufficient human resources

Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the lives saved tool

Background: In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status.Methods: We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0–5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the full-text reports of relevant studies. We abstracted study characteristics and quantitative data, and assessed study quality. Meta-analyses were performed for similar intervention and outcome pairs.Results: Pooled analyses showed diarrhea risk reductions from the following interventions: point-of-use water filtration (pooled risk ratio (RR): 0.47, 95% confidence interval (CI): 0.36–0.62), point-of-use water disinfection (pooled RR: 0.69, 95% CI: 0.60–0.79), and hygiene education with soap provision (pooled RR: 0.73, 95% CI: 0.57–0.94). Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analyses. Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk, nor did the one eligible study examining the effect of latrine construction.Conclusions: Various WASH interventions show diarrhea risk reductions between 27% and 53% in children 0–5 years old, depending on intervention type, providing ample evidence to support the scale-up of WASH in low and middle-income countries (LMICs). Due to the overall low quality of the evidence and high heterogeneity, further research is required to accurately estimate the magnitude of the effects of these interventions in different contexts

Are rhetorical commitments to adolescents refected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children's and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health.We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda