Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda

Health Policy and Planning
Volume 32, Issue 7   September 2017

Original Articles
Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda
Fiona Samuels; Ana B Amaya; Dina Balabanova
There is a growing understanding that strong health systems are crucial to sustain progress. Health systems, however, are complex and much of their success depends on factors operating at different levels and outside the health system, including broader governance and political commitment to health and social development priorities. Recognizing these complexities, this article offers a pragmatic approach to exploring the drivers of progress in maternal and child health in Mozambique, Nepal and Rwanda. To do this, the article builds on a semi-systematic literature review and case study findings, designed and analysed using a multi-level framework. At the macro level, governance with effective and committed leaders was found to be vital for achieving positive health outcomes. This was underpinned by clear commitment from donors coupled by a significant increase in funding to the health sector. At the meso level, where policies are operationalized, inter-sectoral partnerships as well as decentralization and task-shifting emerged as critical. At micro (service interface) level, community-centred models and accessible and appropriately trained and incentivized local health providers play a central role in all study countries. The key drivers of progress are multiple, interrelated and transversal in terms of their operation; they are also in a constant state of flux as health systems and contexts develop. Without seeking to offer a blueprint, the study demonstrates that a ‘whole-system’ approach can help elicit the key drivers of change and potential pathways towards desirable outcomes. Furthermore, understanding the challenges and opportunities that are instrumental to progress at each particular level of a health system can help policy-makers and implementers to navigate this complexity and take action to strengthen health systems.

Increasing health policy and systems research capacity in low- and middle-income countries: results from a bibliometric analysis

Health Research Policy and Systems
[Accessed 29 July 2017]

Increasing health policy and systems research capacity in low- and middle-income countries: results from a bibliometric analysis
For 20 years, substantial effort has been devoted to catalyse health policy and systems research (HPSR) to support vulnerable populations and resource-constrained regions through increased funding, institutional capacity-building and knowledge production; yet, participation from low- and middle-income countries (LMICs) is underrepresented in HPSR knowledge production… While the absolute number of publications remains low, lead authors from an LMIC have participated exponentially in the life and biomedical sciences (PubMed) since the early 2000s. HPSR publications with a topic relevant to LMICs and an LMIC lead author continue to increase at a greater rate than the life and biomedical science topics in general. This correlation is likely due to increased capacity for research within LMICs and the support for publications surrounding large HPSR initiatives. These findings provide strong evidence that continued support is key to the longevity and enhancement of HPSR toward its mandate.
Krista M. English and Babak Pourbohloul
Health Research Policy and Systems 2017 15:64
Published on: 28 July 2017

Association of the Priority Review Voucher With Neglected Tropical Disease Drug and Vaccine Development

July 25, 2017, Vol 318, No. 4, Pages 313-400

Research Letter
Association of the Priority Review Voucher With Neglected Tropical Disease Drug and Vaccine Development
Nina Jain, MD, MSc; Thomas Hwang, AB; Jessica M. Franklin, PhD; et al.
JAMA. 2017;318(4):388-389. doi:10.1001/jama.2017.7467
Congress created the priority review voucher in 2007 to incentivize the development of treatments for neglected tropical diseases. Vouchers, which can be transferred or sold, are awarded when a company obtains US Food and Drug Administration (FDA) approval for a drug or vaccine indicated for a neglected tropical disease (Box). They allow sponsors to obtain faster FDA review of a product for any indication, not restricted to neglected tropical diseases, moving the application from the standard 10 months to the priority review timeline of 6 months. This provides valuable earlier access to the US market for those drugs that would have not otherwise qualified for priority review: vouchers have been sold for prices ranging from $67 million to $350 million.2

Return on investment of public health interventions: a systematic review

Journal of Epidemiology & Community Health
AUGUST 2017 – Volume 71 – 8

Return on investment of public health interventions: a systematic review
Rebecca Masters, Elspeth Anwar, Brendan Collins, Richard Cookson, Simon Capewell
Background Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.
Methods We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.
Results We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.
Conclusions This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring

Journal of Pediatrics
August 2017 Volume 187, p1-340

Original Articles
First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring
Elyse Olshen Kharbanda, Gabriela Vazquez-Benitez, Paul A. Romitti, Allison L. Naleway, T. Craig Cheetham, Heather S. Lipkind, Nicola P. Klein, Grace Lee, Michael L. Jackson, Simon J. Hambidge, Natalie McCarthy, Frank DeStefano, James D. Nordin for the Vaccine Safety Datalink
Published online: May 24, 2017
To examine risks for major structural birth defects in infants after first trimester inactivated influenza vaccine (IIV) exposures.
Study design
In this observational study, we used electronic health data from 7 Vaccine Safety Datalink sites to examine risks for selected major structural defects in infants after maternal IIV exposure. Vaccine exposures for women with continuous insurance enrollment through pregnancy who delivered singleton live births between 2004 and 2013 were identified from standardized files. Infants with continuous insurance enrollment were followed to 1 year of age. We excluded mother–infant pairs with other exposures that potentially increased their background risk for birth defects. Selected cardiac, orofacial or respiratory, neurologic, ophthalmologic or otologic, gastrointestinal, genitourinary and muscular or limb defects were identified from diagnostic codes in infant medical records using validated algorithms. Propensity score adjusted generalized estimating equations were used to estimate prevalence ratios (PRs).
We identified 52 856 infants with maternal first trimester IIV exposure and 373 088 infants whose mothers were unexposed to IIV during first trimester. Prevalence (per 100 live births) for selected major structural birth defects was 1.6 among first trimester IIV exposed versus 1.5 among unexposed mothers. The adjusted PR was 1.02 (95% CI 0.94-1.10). Organ system-specific PRs were similar to the overall PR.
First trimester maternal IIV exposure was not associated with an increased risk for selected major structural birth defects in this large cohort of singleton live births.

Evolutionary public health: introducing the concept

The Lancet
Jul 29, 2017 Volume 390 Number 10093 p429-530

Evolutionary public health
Evolutionary public health: introducing the concept
Jonathan C K Wells, Randolph M Nesse, Rebecca Sear, Rufus A Johnstone, Stephen C Stearns
The emerging discipline of evolutionary medicine is breaking new ground in understanding why people become ill. However, the value of evolutionary analyses of human physiology and behaviour is only beginning to be recognised in the field of public health. Core principles come from life history theory, which analyses the allocation of finite amounts of energy between four competing functions—maintenance, growth, reproduction, and defence. A central tenet of evolutionary theory is that organisms are selected to allocate energy and time to maximise reproductive success, rather than health or longevity. Ecological interactions that influence mortality risk, nutrient availability, and pathogen burden shape energy allocation strategies throughout the life course, thereby affecting diverse health outcomes. Public health interventions could improve their own effectiveness by incorporating an evolutionary perspective. In particular, evolutionary approaches offer new opportunities to address the complex challenges of global health, in which populations are differentially exposed to the metabolic consequences of poverty, high fertility, infectious diseases, and rapid changes in nutrition and lifestyle. The effect of specific interventions is predicted to depend on broader factors shaping life expectancy. Among the important tools in this approach are mathematical models, which can explore probable benefits and limitations of interventions in silico, before their implementation in human populations.

Collaborating to ease Africa’s data drought

Lancet Global Health
Aug 2017 Volume 5 Number 8 e727-e837

Collaborating to ease Africa’s data drought
The Lancet Global Health
At the High-Level Political Forum on Sustainable Development in New York this week, UN Member States have been taking a detailed look at progress on a selection of the Sustainable Development Goals (SDGs), including goal 3 on ensuring healthy lives. As part of this process, 44 countries from across the wealth spectrum have provided voluntary national reviews, including seven from Africa. These African reviews reveal a dedication to the SDG process, with incorporation of targets into national plans and efforts to engage all stakeholders via consultations and awareness campaigns. However, there is a recurring theme when it comes to challenges. Aside from the obvious financial limitations, almost all countries cite a dearth of reliable disaggregated data on which to base intervention programmes….