Redefining global health-care delivery

Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To ...

Prevention and control of non-communicable diseases: report of the Secretary-General

Non-communicable diseases represent a new frontier in the fight to improve global health. Worldwide, the increase in such diseases means that they are now responsible for more deaths than all other causes combined. Commonly known as chronic or lifestyle-related diseases, the main non-communicable diseases are cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. While the international community has focused on communicable diseases such as HIV/AIDS, malaria and tuberculosis, the four main non-communicable diseases have emerged relatively unnoticed in the developing world and are now becoming a global epidemic. However, such diseases could be significantly reduced and prevented, with millions of lives saved and untold suffering avoided, through proven and affordable measures, many of which are complementary to global health efforts already under way. The knowledge and technology to fight the onset and effects of non-communicable diseases already exist. It’s time to act to save future generations from the ...

People-centered tuberculosis care versus standard directly observed therapy: study protocol for a cluster randomized controlled trial

Background: Tuberculosis is a major public health concern resulting in high rates of morbidity and mortality worldwide, particularly in low-and middle-income countries. Tuberculosis requires a long and intensive course of treatment. Thus, various approaches, including patient empowerment, education and counselling sessions, and involvement of family members and community workers, have been suggested for improving treatment adherence and outcome. The current randomized controlled trial aims to evaluate the effectiveness over usual care of an innovative multicomponent people-centered tuberculosis-care strategy in Armenia.

Methods/design: Innovative Approach to Tuberculosis care in Armenia is an open-label, stratified cluster randomized controlled trial with two parallel arms. Tuberculosis outpatient centers are the clusters assigned to intervention and control arms. Drug-sensitive tuberculosis patients in the continuation phase of treatment in the intervention arm and their family members participate in a short educational and counselling session to raise their knowledge, decrease tuberculosis-related stigma, and enhance treatment adherence ...

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.

FINDINGS AND CONCLUSIONS:

A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local ...

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.

FINDINGS AND CONCLUSIONS:

A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local ...

Integrating delivery of TB services in primary care in Tajikistan

Following on from previous national efforts to address high TB incidence rates, the third National TB Programme 2010–2015 was approved by the government to systematically address service delivery gaps and continue to develop TB services in primary care; building on previous actions taken to reduce TB and learning from these experiences enabled a stronger approach moving forward; cross-ministry partnerships ensured united government support and greater stability for the initiative; partnerships between the government and international organizations provided an infusion of technical expertise and resources; adjusting resource allocation was used as a mechanism to drive organizational shifts in service delivery.

Establishing ambulatory care for patients with tuberculosis in Uzbekistan

Médecins Sans Frontières (MSF), in partnership with the Government of the Republic of Karakalpakstan, introduced ambulatory care from day one (ACD1) as an alternative model for TB care; a strong understanding of service delivery challenges led to a solution that met patients’ needs; a supportive political and legal framework, developed prior to implementation, helped to sustainably embed reforms within the health system; strong relationships between key actors who had a history of working together aided the initiative.

Tuberculosis, HIV, and viral hepatitis diagnostics in eastern Europe and central Asia: high time for integrated and people-centred services

The international medical journal, The Lancet, has published an article demonstrating the benefits of integrated and people-centred services in responding to the rise of HIV, tuberculosis (TB) and viral hepatitis in eastern European and central Asian countries of the WHO European Region.

Policy framework for building integrated care for TB patients in Romania: setting up the scene

Ending tuberculosis in a post-COVID-19 world: a person-centred, equity-oriented approach

The COVID-19 pandemic has disrupted systems of care for infectious diseases—including tuberculosis—and has exposed pervasive inequities that have long marred efforts to combat these diseases. The resulting health disparities often intersect at the individual and community levels in ways that heighten vulnerability to tuberculosis. Effective responses to tuberculosis (and other infectious diseases) must respond to these realities. Unfortunately, current tuberculosis programmes are generally not designed from the perspectives of affected individuals and fail to address structural determinants of health disparities. We describe a person-centred, equity-oriented response that would identify and focus on communities affected by disparities, tailor interventions to the mechanisms by which disparities worsen tuberculosis, and address upstream determinants of those disparities. 

UN General Assembly High-Level Meetings on health 2023: Universal Health Coverage