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BMC Public Health Nov 2023Nearly all countries have ratified the United Nations Convention on the Rights of the Child and, therefore, support children having access to their rights. However, only...
BACKGROUND
Nearly all countries have ratified the United Nations Convention on the Rights of the Child and, therefore, support children having access to their rights. However, only a small minority of children worldwide have access to their environmental, economic, and social rights. The most recent global effort to address these deficits came in 2015, when the United Nations General Assembly agreed to a plan for a fairer and more sustainable future by 2030 and outlined the Sustainable Development Goals (SDGs). One remediable cause is the lack of revenue in many countries, which affects all SDGs. However, illicit financial flows from low-income to high-income countries, including international tax abuse, continue unabated.
METHODS
Using the most recent estimates of tax abuse perpetuated by multinational companies and tax evasion through offshore wealth, and precise econometric modelling, we illustrate the potential regarding child rights (or progress towards the SDGs) if there was an increase in revenue equivalent to tax abuse in Malawi, a low-income country particularly vulnerable to climate change. The Government Revenue and Development Estimations model provides realistic estimates of government revenue changes in developmental outcomes. Using panel data on government revenue per capita, it models the impact of increased revenue on governance and SDG progress.
RESULTS
If cross-border tax abuse and tax evasion were curtailed, the equivalent increase in government revenue in one country, Malawi, would be associated with 12,000 and 20,000 people having access to basic water and sanitation respectively each year. Each year, an additional 5000 children would attend school, 150 additional children would survive, and 10 mothers would survive childbirth.
CONCLUSIONS
More children would access their economic and social rights if actions were taken to close the gap in global governance regarding taxation. We discuss the responsibility of duty bearers, the need for a global body to arbitrate and monitor international tax matters, and how the Government of Malawi could take further domestic action to mitigate the gaps in global governance and protect itself against illicit financial flows, including tax abuse.
Topics: Humans; Child; Malawi; Income; Poverty; United Nations; Government; Taxes
PubMed: 37974100
DOI: 10.1186/s12889-023-16319-x -
Frontiers in Public Health 2023In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before... (Review)
Review
INTRODUCTION
In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.
METHODS
We reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia's IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.
RESULTS
Between 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.
DISCUSSION
From 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.
Topics: Humans; Somalia; COVID-19; World Health Organization; Government
PubMed: 37780418
DOI: 10.3389/fpubh.2023.1204165 -
Health Research Policy and Systems Apr 2024There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here,... (Review)
Review
BACKGROUND
There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience.
METHODS
We follow Schwarz-Barcott and Kim's hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form.
RESULTS
Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises.
CONCLUSION
A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country's health system resilience performance.
Topics: Humans; Resilience, Psychological; Epidemics; COVID-19; Learning; Health Expenditures
PubMed: 38576011
DOI: 10.1186/s12961-024-01114-w -
PloS One 2023Improving the efficiency of converting natural resources into social benefits is an important issue for sustainable development in today's world. Based on this...
Improving the efficiency of converting natural resources into social benefits is an important issue for sustainable development in today's world. Based on this background this paper applies the super-efficient SBM model with non-expected output to measure the ecological welfare performance (EWP) of Chinese provinces from 2005-2019, and explores the relationship between government competition and EWP under different assessment systems. The research results show that government competition under economic performance assessment is self-interested and short-sighted, which can negatively affect ecological welfare performance in the current period as well as in the next four years. In contrast, government competition under the environmental assessment system promotes EWP in both the current and long term, balancing short-term and long-term benefits. The results of the spatial GMM found that government competition under economic performance appraisal can deteriorate EWP in local as well as surrounding areas, but government competition under the environmental assessment system can achieve an increase in local ecological welfare performance and the spillover effect is not significant. To alleviate the limitations of a single appraisal system, this paper incorporates both economic and ecological appraisals into the multidimensional appraisal system. When the weights of both are between 1:9 and 3:7, the government competition under multidimensional performance appraisal can promote both current and longer-term EWP, and achieve its own ecological welfare performance without affecting the surrounding areas.
Topics: Sustainable Development; Government; China; Economic Development
PubMed: 37561688
DOI: 10.1371/journal.pone.0289837 -
The Lancet. Digital Health Sep 2023The international response to the COVID-19 pandemic provided opportunities for countries to use digital technologies for vaccine deployment and associated activities,... (Review)
Review
The international response to the COVID-19 pandemic provided opportunities for countries to use digital technologies for vaccine deployment and associated activities, but misaligned digital investments could weaken or fragment national systems. In this review of 311 funding applications from 120 country governments to four donor agencies (UNICEF; Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Bank) up to May 1, 2022, we found that 272 (87%) of the applications included at least one digital aspect and that substantial funding has been dedicated towards digital aspects from donors. The majority of digital aspects concerned immunisation information systems, vaccine acceptance and uptake, and COVID-19 surveillance. As the global community sets its sights on a COVID-19-free world, continued coordinated investments in digital health and health information systems for pandemic preparedness and response will be key to strengthening the resilience of health systems.
Topics: Humans; COVID-19 Vaccines; COVID-19; Pandemics; Digital Technology; Government
PubMed: 37625897
DOI: 10.1016/S2589-7500(23)00134-6 -
Iranian Journal of Public Health Nov 2023The implementation of health interventions requires the collaboration of various sectors outside health due to the multidimensional nature of healthcare. Building... (Review)
Review
BACKGROUND
The implementation of health interventions requires the collaboration of various sectors outside health due to the multidimensional nature of healthcare. Building effective partnerships demands the use of intersectoral mechanisms that facilitate the leadership and implementation of these programs. In this review, the mechanisms of intersectoral collaboration (ISC) and their results were identified.
METHODS
This scoping review was conducted in 2020. Using relevant keywords, all documents related to ISC in the health system were identified by searching four databases (PubMed, Scopus, Science Direct, and Web of Science), Google, and Google scholar search engines. In the initial search, 2911 documents were extracted. Based on the selection criteria 52 documents were selected for content analysis.
RESULTS
Five areas of ISC were identified, including funding (collection, pooling, and distribution of funds), governance and leadership (political commitment, rules and regulations, control and evaluation, and stakeholder engagement), structural mechanisms (interorganizational, government-based, and program-based structures), process tools (information tools, support tools, and resource and service sharing), and models and frameworks (general, national, and program-specific models).
CONCLUSION
An intersectoral framework or model be developed that considers the financial, structural, and leadership aspects as well as the necessary process tools required for each program. Moreover, it should be considered communication and human resources empowerment in each intervention.
PubMed: 38106823
DOI: 10.18502/ijph.v52i11.14030 -
BMC Health Services Research Nov 2023This study raises two key arguments: First, government health expenditure (GHE) and per capita out-of-pocket expenditures on healthcare (OPEH) are sensitive to...
BACKGROUND
This study raises two key arguments: First, government health expenditure (GHE) and per capita out-of-pocket expenditures on healthcare (OPEH) are sensitive to contemporary good governance practices, giving policy importance to the exogeneity of healthcare determinants, i.e., governance for health rather than health governance. Second, it is the income level of countries that reflects the volatility of the governance spillovers on the subject.
METHODS
The present study constructs a composite governance index (CGI) and employs a set of panel data for 144 countries over the period from 2002 to 2020. To allow comparability and extract specific policy implications, the countries are classified as full, high-, middle-, and low-income panels. Meanwhile to delve into the short- and long-run effects of CGI on GHE and OPEH, the study employs the cross-sectionally augmented autoregressive distributed lags (CS-ARDL) model. Further, to establish a causal link between the variables, it uses the Dumitrescu-Hurlin panel causality technique.
RESULTS
The results indicate that CGI is significantly cointegrated with GHE and OPEH in all recipient panels. It indicates that while CGI has significantly positive impacts on GHE and OPEH, its effects vary according to the income level of the underlying economies. The findings support the idea of governance for health and show that CGI drives the stabilization and enhancement of GHE and OPEH in the long run. Furthermore, the findings reveal that economic growth, the age dependency ratio, and tax revenue have positive effects, while the crude death rate and the child mortality rate exert negative impacts on the subject. Finally, the results highlight a unidirectional causality running from CGI to GHE and OPEH, while no feedback response is evident.
CONCLUSIONS
Although an increase in GHE and OPEH is associated with the improvement of the population's healthcare, the results suggest the recognition of the importance and institutionalization of good governance to streamline this improvement through effective channelization, outreach, and social environment development for extensive health inclusion.
Topics: Child; Humans; Government; Child Mortality; Health Expenditures; Economic Development; Poverty
PubMed: 37950257
DOI: 10.1186/s12913-023-10261-9 -
Health Policy and Planning Jan 2024Development assistance is a major source of financing for health in least developed countries. However, persistent aid fragmentation has led to inefficiencies and health... (Review)
Review
Development assistance is a major source of financing for health in least developed countries. However, persistent aid fragmentation has led to inefficiencies and health inequities and constrained progress towards Universal Health Coverage (UHC). Malawi is a case study for this global challenge, with 55% of total health expenditure funded by donors and fragmentation across 166 financing sources and 265 implementing partners. This often leads to poor coordination and misalignment between government priorities and donor projects. To address these challenges, the Malawi Ministry of Health (MoH) has developed and implemented an architecture of aid coordination tools and processes. Using a case study approach, we documented the iterative development, implementation and institutionalization of these tools, which was led by the MoH with technical assistance from the Clinton Health Access Initiative. We reviewed the grey literature, including relevant policy documents, planning tools and databases of government/partner funding commitments, and drew upon the authors' experiences in designing, implementing and scaling up these tools. Overall, the iterative use and revision of these tools by the Government of Malawi across the national and subnational levels, including integration with the government's public financial management system, was critical to successful uptake. The tools are used to inform government and partner resource allocation decisions, assess financing and gaps for national and district plans and inform donor grant applications. As Malawi has launched the Health Sector Strategic Plan 2023-2030, these tools are being adapted for the 'One Plan, One Budget and One Report' approach. However, while the tools are an incremental mechanism to strengthen aid alignment, success has been constrained by the larger context of power imbalances and misaligned incentives between the donor community and the Government of Malawi. Reform of the aid architecture is therefore critical to ensure that these tools achieve maximum impact in Malawi's journey towards UHC.
Topics: Humans; Malawi; Universal Health Insurance; Budgets; Databases, Factual; Developing Countries
PubMed: 38253443
DOI: 10.1093/heapol/czad102 -
Journal of Infusion Nursing : the...Biologic drugs are large, complex molecules produced through biotechnology. A biosimilar is a biologic product that is highly similar to an already approved biologic...
Biologic drugs are large, complex molecules produced through biotechnology. A biosimilar is a biologic product that is highly similar to an already approved biologic (reference product), with no clinically meaningful differences in purity, safety, or efficacy; as such, a biosimilar does not need to undergo the same level of study in a clinical trial program as the original reference product. Due to the potential impact of biosimilars on patient access and health care systems, the US Food and Drug Administration introduced an abbreviated pathway for approving biosimilars (351[k]) in 2009. There is strong evidence that switching from a reference product to a biosimilar does not reduce treatment effectiveness or increase the risk of adverse events. Biosimilars may reduce costs and increase patient access to biologic therapies. Biosimilar use in the United States has increased, as have the associated biosimilar cost savings, which are expected to reach $104 billion between 2020 and 2024. Yet, a need remains for increased knowledge among health care professionals and patients. Prescriber confidence is key to patient acceptance of biosimilars and minimizing the incidence of the nocebo effect. Infusion nurses are well positioned to help educate patients and to improve clinical outcomes across a range of diseases.
Topics: Humans; United States; Biosimilar Pharmaceuticals; Drug Approval; United States Food and Drug Administration; Health Personnel; Cost Savings
PubMed: 38211611
DOI: 10.1097/NAN.0000000000000528 -
PloS One 2023The coronavirus pandemic has revived interest in the effects of fiscal policy. This paper studies the effects of government spending on default risk in emerging...
The coronavirus pandemic has revived interest in the effects of fiscal policy. This paper studies the effects of government spending on default risk in emerging economies. We first build a general equilibrium small open economy model where government spending shocks influence external debt and sovereign bond spreads. We show that external debt piles up and sovereign bond spreads increase following a government spending shock. We then develop VAR evidence based on a panel of 18 countries. We find that in response to a 10% government spending increase, (1) the real effective exchange rate appreciates by 1.0% and the current account to GDP ratio deteriorates by 0.0025 on impact; (2) external debt increases by an average of 3.5% in the year following the shock; and (3) the EMBI Global spread rises by an average of 25 basis points within two years and peaks at 132 basis points 14 quarters after the shock, suggesting a higher sovereign default risk. The empirical results confirm the theoretical predictions from the general equilibrium model.
Topics: Health Expenditures; Government; Financing, Government
PubMed: 37471355
DOI: 10.1371/journal.pone.0288802