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Community Engagement in Support of Moving Toward Universal Health Coverage

Allotey P, Tan DT, Kirby T, Tan LH

Health Syst Reform, 2019;5(1):66-77.
PMID: 30924744 DOI: 10.1080/23288604.2018.1541497

Community engagement describes a complex political process with dynamic negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. Though examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic, and sustained component of health systems. Through a series of case studies, this article explores the factors that enable community engagement particularly with a direct impact on health systems.

Matched MeSH terms: Health Plan Implementation/methods*
Fulltext Compliance of the Gulf Cooperation Council airlines with COVID-19 mitigation measures

Alshahrani NZ, Alshahrani SM, Alshahrani AM, Leggat PA, Rashid H

J Travel Med, 2021 02 23;28(2).
PMID: 33146380 DOI: 10.1093/jtm/taaa205
Matched MeSH terms: Health Plan Implementation/methods*
Fulltext Health system strengthening: Integration of breast cancer care for improved outcomes

Horton S, Camacho Rodriguez R, Anderson BO, Aung S, Awuah B, Delgado Pebé L, et al.

Cancer, 2020 05 15;126 Suppl 10:2353-2364.
PMID: 32348567 DOI: 10.1002/cncr.32871

The adoption of the goal of universal health coverage and the growing burden of cancer in low- and middle-income countries makes it important to consider how to provide cancer care. Specific interventions can strengthen health systems while providing cancer care within a resource-stratified perspective (similar to the World Health Organization-tiered approach). Four specific topics are discussed: essential medicines/essential diagnostics lists; national cancer plans; provision of affordable essential public services (either at no cost to users or through national health insurance); and finally, how a nascent breast cancer program can build on existing programs. A case study of Zambia (a country with a core level of resources for cancer care, using the Breast Health Global Initiative typology) shows how a breast cancer program was built on a cervical cancer program, which in turn had evolved from the HIV/AIDS program. A case study of Brazil (which has enhanced resources for cancer care) describes how access to breast cancer care evolved as universal health coverage expanded. A case study of Uruguay shows how breast cancer outcomes improved as the country shifted from a largely private system to a single-payer national health insurance system in the transition to becoming a country with maximal resources for cancer care. The final case study describes an exciting initiative, the City Cancer Challenge, and how that may lead to improved cancer services.

Matched MeSH terms: Health Plan Implementation/methods*
Multidimensional model to assess the readiness of Kuwait to implement evidence-based child maltreatment prevention programs at a national level

Alkhawari M, Ali K, Al-Abdul Razzaq F, Saleheen HN, Almuneef M, Al-Eissa MA

Public Health, 2020 Apr;181:182-188.
PMID: 32088599 DOI: 10.1016/j.puhe.2020.01.005

OBJECTIVE: To assess the readiness to implement child maltreatment (CM) prevention programs at a national level.
STUDY DESIGN: This is a cross-sectional study.
METHODS: This study was completed alongside similar studies undertaken by the rest of the Gulf Cooperation Council (GCC) countries and led by Kingdom of Saudi Arabia (KSA). The study will allow further understanding of possible obstacles that may be encountered while implementing a nationwide prevention program. The 10-dimensional model of readiness had been developed by the World Health Organization (WHO) in collaboration with five countries (Brazil, The Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa) through a five-stage process. Stakeholders and decision makers were invited to participate. Scores for each dimension were compared with those for the rest of the GCC countries.
RESULTS: The overall score of Kuwait was 39.17 out of 100. This was below the mean average score for the GCC countries (47.83). Out of the 10 dimensions, key informants scored the highest on legislation, mandates and policies (6.61). The lowest score was reported on attitudes towards CM prevention (1.94). Informal social resources (5.72) ranked the highest as compared to the rest of the GCC countries.
CONCLUSIONS: The readiness of Kuwait is weak on several dimensions and needs to be strengthened. Despite that, the country is moderately ready to implement large-scale evidence-based CM prevention programs because it is strong in the infrastructure of knowledge, legislation, mandates, and policies and informal social resources.

Matched MeSH terms: Health Plan Implementation/methods*
Fulltext Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement

Salem A, Elamir H, Alfoudri H, Shamsah M, Abdelraheem S, Abdo I, et al.

BMJ Open Qual, 2020 Nov;9(4).
PMID: 33199287 DOI: 10.1136/bmjoq-2020-001130

BACKGROUND: The COVID-19 pandemic represents an unprecedented challenge to healthcare systems and nations across the world. Particularly challenging are the lack of agreed-upon management guidelines and variations in practice. Our hospital is a large, secondary-care government hospital in Kuwait, which has increased its capacity by approximately 28% to manage the care of patients with COVID-19. The surge in capacity has necessitated the redeployment of staff who are not well-trained to manage such conditions. There was a great need to develop a tool to help redeployed staff in decision-making for patients with COVID-19, a tool which could also be used for training.
METHODS: Based on the best available clinical knowledge and best practices, an eight member multidisciplinary group of clinical and quality experts undertook the development of a clinical algorithm-based toolkit to guide training and practice for the management of patients with COVID-19. The team followed Horabin and Lewis' seven-step approach in developing the algorithms and a five-step method in writing them. Moreover, we applied Rosenfeld et al's five points to each algorithm.
RESULTS: A set of seven clinical algorithms and one illustrative layout diagram were developed. The algorithms were augmented with documentation forms, data-collection online forms and spreadsheets and an indicators' reference sheet to guide implementation and performance measurement. The final version underwent several revisions and amendments prior to approval.
CONCLUSIONS: A large volume of published literature on the topic of COVID-19 pandemic was translated into a user-friendly, algorithm-based toolkit for the management of patients with COVID-19. This toolkit can be used for training and decision-making to improve the quality of care provided to patients with COVID-19.

Matched MeSH terms: Health Plan Implementation/methods*
Fulltext Breast cancer early detection: A phased approach to implementation

Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Yataco JA, et al.

Cancer, 2020 May 15;126 Suppl 10(Suppl 10):2379-2393.
PMID: 32348566 DOI: 10.1002/cncr.32887

When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.

Matched MeSH terms: Health Plan Implementation/methods*
Fulltext Factors influencing implementation of a patient decision aid in a developing country: an exploratory study

Tong WT, Lee YK, Ng CJ, Lee PY

Implement Sci, 2017 03 21;12(1):40.
PMID: 28327157 DOI: 10.1186/s13012-017-0569-9

BACKGROUND: Most studies on barriers and facilitators to implementation of patient decision aids (PDAs) are conducted in the west; hence, the findings may not be transferable to developing countries. This study aims to use a locally developed insulin PDA as an exemplar to explore the barriers and facilitators to implementing PDAs in Malaysia, an upper middle-income country in Asia.
METHODS: Qualitative methodology was adopted. Nine in-depth interviews (IDIs) and three focus group discussions (FGDs) were conducted with policymakers (n = 6), medical officers (n = 13), diabetes educators (n = 5) and a nurse, who were involved in insulin initiation management at an academic primary care clinic. The interviews were conducted with the aid of a semi-structured interview guide based on the Theoretical Domains Framework. The interviews were audio-recorded, transcribed verbatim and analyzed using a thematic approach.
RESULTS: Five themes emerged, and they were lack of shared decision-making (SDM) culture, role boundary, lack of continuity of care, impact on consultation time and reminder network. Healthcare providers' (HCPs) paternalistic attitude, patients' passivity and patient trust in physicians rendered SDM challenging which affected the implementation of the PDA. Clear role boundaries between the doctors and nurses made collaborative implementation of the PDA challenging, as nurses may not view the use of insulin PDA to be part of their job scope. The lack of continuity of care might cause difficulties for doctors to follow up on insulin PDA use with their patient. While time was the most commonly cited barrier for PDA implementation, use of the PDA might reduce consultation time. A reminder network was suggested to address the issue of forgetfulness as well as to trigger interest in using the PDA. The suggested reminders were peer reminders (i.e. HCPs reminding one another to use the PDA) and system reminders (e.g. incorporating electronic medical record prompts, displaying posters/notices, making the insulin PDA available and visible in the consultation rooms).
CONCLUSIONS: When implementing PDAs, it is crucial to consider the healthcare culture and system, particularly in developing countries such as Malaysia where concepts of SDM and PDAs are still novel.
Study site: primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Health Plan Implementation/methods*
The assessment of the readiness of five countries to implement child maltreatment prevention programs on a large scale

Mikton C, Power M, Raleva M, Makoae M, Al Eissa M, Cheah I, et al.

Child Abuse Negl, 2013 Dec;37(12):1237-51.
PMID: 23962585 DOI: 10.1016/j.chiabu.2013.07.009

This study aimed to systematically assess the readiness of five countries - Brazil, the Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa - to implement evidence-based child maltreatment prevention programs on a large scale. To this end, it applied a recently developed method called Readiness Assessment for the Prevention of Child Maltreatment based on two parallel 100-item instruments. The first measures the knowledge, attitudes, and beliefs concerning child maltreatment prevention of key informants; the second, completed by child maltreatment prevention experts using all available data in the country, produces a more objective assessment readiness. The instruments cover all of the main aspects of readiness including, for instance, availability of scientific data on the problem, legislation and policies, will to address the problem, and material resources. Key informant scores ranged from 31.2 (Brazil) to 45.8/100 (the Former Yugoslav Republic of Macedonia) and expert scores, from 35.2 (Brazil) to 56/100 (Malaysia). Major gaps identified in almost all countries included a lack of professionals with the skills, knowledge, and expertise to implement evidence-based child maltreatment programs and of institutions to train them; inadequate funding, infrastructure, and equipment; extreme rarity of outcome evaluations of prevention programs; and lack of national prevalence surveys of child maltreatment. In sum, the five countries are in a low to moderate state of readiness to implement evidence-based child maltreatment prevention programs on a large scale. Such an assessment of readiness - the first of its kind - allows gaps to be identified and then addressed to increase the likelihood of program success.

Matched MeSH terms: Health Plan Implementation/methods*