Health Systems Strengthening to Tackle the Global Burden of Pediatric and Congenital Heart Disease: A Diagonal Approach

1 Background Congenital heart disease(CHD)is the most common major congenital anomaly,affecting approximately one in every 100 live births[1].Among congenital anomalies,66%of preventable deaths are due to CHD,and 58%of the avertable morbidity and mortality due to congenital anomalies would result from scaling congenital heart surgery services[2].Every year,nearly 300,000 children and adults die from CHD,the majority of whom live in low-and middle-income countries(LMICs)[3].Approximately 49%of all individuals with CHD will require surgical or interventional care at some point in their lifetime[4];as a result of advances in access to and the delivery of such services,over 95%of children born with CHD in high-income countries now live into adulthood[3].Here,adults have surpassed children in the number of CHD cases at a ratio of 2:1[5].

Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Evaluation of the Effects of Sugary Beverages on the Health of Adolescent Students in Guangxi Based on Health System Function Scores

Objective:To evaluate the health effects of sugary beverage consumption among adolescent students in Guangxi.Methods:In three cities of Guangxi(Nanning,Liuzhou,and Guilin),we investigated the consumption of sugary beverages by distributing a self-administered Functional Assessment Questionnaire of Life Health System and a Dietary Behavior Questionnaire(this paper analyzes only the part of sugary beverage consumption)to adolescent students in four schools,aiming to find out the general health status of the students and also to assess the effects of sugary beverages on the functional system health of adolescent students.Results:A total of 953 adolescent students between the ages of 14 and 24 were surveyed.Among them,46.17%consumed sugary beverages once a week;37.46%consumed them 2-3 times;11.52%consumed them more than 3 times;and 4.83%consumed them every day.The mean score of Functional Assessment Questionnaire of Life Health System was 32.There was a positive correlation between the frequency of consumption of sugary beverages and the overall systemic function assessment score(P<0.05),and the rank of the total score elevated by 0.314 times for each increase in the level of consumption.Compared to those who drink sugary beverages at least once a day,drinking them once a week showed a statistically significant difference(P<0.05).However,there was no statistically significant difference between drinking 2-3 times a week and more than 3 times a week(P>0.05).The correlation between consuming sugary beverages once a week and 2-3 times a week and endocrine system scores was also statistically significant(P<0.05).Conclusion:More than half of the students in the surveyed areas consumed sugary beverages two or more times a week,and the higher the frequency of consumption,the higher the scores of systemic function assessment.Health education on sugar reduction among adolescents should be strengthened.

Difficulties Faced by Physicians in the Diagnosis of Endometriosis in the Brazilian Public Health System

Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.

Reacting to Epidemics:The Innovative Imperial Public Health System during the Late Northern Song Dynasty

Song China was a period in which China experienced a great increase in its population.Concurrently,the Song dynasty also experienced a rise in the frequency of epidemics and two major wars with the Western Xia and Liao dynasties during the 1000s and 1040s.The consequences of these changes were exacerbated by the increased geographical mobility of certain social groups such as traders and examinees attending civil service examinations.Thus,casualties of wars,epidemics,or disease,especially of people whose families were far away and could not care for them were left without care and“their corpses often lay bare along the roads.”This new social environment created a need for general relief.The Northern Song government(960-1127 CE),especially during the reign of Emperor Huizong,established an innovative public health system to address this issue.The public health system included poorhouses,public hospitals,and pauper’s cemeteries.The first were more of charity organizations,whereas the latter two promoted public health by providing medical services for the poor and burial for those that nobody cared for.In terms of rationale behind these institutions,on the one hand,they constituted an attempt to get the poor and homeless off the streets while providing them relief or burial.On the other hand,it seems that Huizong’s deep concern with medicine propelled him to design and implement a comprehensive public health system oriented to prevent contagion and outbreak of epidemics.This article depicts the background,the organization,and the functions of the system.The article also discusses the conditions and reasons that gave rise to such a unique undertaking by the Northern Song government.

To scan or not to scan:Use of transient elastography in an integrated health system

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for NAFLD.AIM To analyze how this CDST impacted health care utilization and patient outcomes.METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and mortality.RESULTS We identified 958 patients who had FibroScan,115 before and 843 after the CDST was implemented.The percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was implemented.Though there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more referrals.Very few patients were hospitalized or died.CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

Coronavirus disease 2019 (COVID-19) pandemic: how countries shouldbuild more resilient health systems for preparedness and response

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.

Patient and Health System Factors Associated with First Line Tuberculosis Treatment Adherence, 2009-2014

Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.

Healthcare Levels Cooperation, Action in Local Health System to Better Coordinate the Delivery of Healthcare

The healthcare system＇s approach considers the complexity and interactions between organized elements. In continuous processing, healthcare systems are affected by their constituent elements, themselves modified with each system change. To secure and optimize the system of care, collaboration between levels is necessary. Almost no documented experience to better coordination of levels of care in the Belgian system is available. To improve the quality of care, the system needs collaborative coordination between stakeholders. Good coordination improves the quality of patient care, it makes quality more efficient and optimal care. This coordination between care lines must be collaborative. Interactional communication is the founding element of inter-professional collaboration. A good self-esteem improves the relationship between actors in the health system and supports the initiatives and adaptability. It contributes therefore to an increase of the quality of care. The interactional Local Health System promotes cooperation in the relevant health network. Consultation and coordination between the actors involved and motivated bring care quality and operational solutions. This dynamic modality of exchanges appears fruitful as participants continue to meet and coordinate care, even after the official end of the action-research. The climate became conducive to solving real problems through the skills developed in the LHS.

Financial Sustainability of a Public or Private Health System,a Condition for a Romania With a Healthy Population

Can Romania have a sustainable health system,so that the population can choose medical services at a state hospital or at a private hospital?A healthy state,with a healthy population,can ensure a viable balance with a secure future.Each country ensures its health system through levers,policies,and well-defined sources of funding,determined by demographics,geographical position,culture,nationality,has the necessary sources to implement its own health system,whether it is public or private.The programs that can be implemented in the health system start from the quality of medical services,which must be provided so that each patient can be sure that medical needs are achievable.We have a people with diverse traditions,a beautiful culture,specialized doctors and yet the medical system is still fragile.Funding programs must help us start this health system,build many private hospitals,so from prevention to services specialized,surgical,to be able to bring in the country specialized medical staff to us but gone to many states of the world.Any change can lead us to what we want,the health of our population in the village,the city,the majority of the population,the identification of possibilities to revive the health system.The market of private health systems,diversified by international players,bank brokers,manages to bring important changes in the health system.From a technical point of view,health insurance has its originality in the impossibility of being able to predict the insured’s illness and the costs necessary for recovery.Any risk related to personal injury,illness,temporary incapacity for work,can be identified,assessed in the form of medical expenses,loss of income,as a result,disability,borne by both the individual and the family,due to the inability to insure a normal activity,daily existence.Insurance can be considered as a method of controlling the health risk.The current situation regarding the disease of the population whit COVID often makes us understand that we must be prepared at all times.The situation of the pandemic SARS-COV 19 found a timely solution through the private health system.

The Performance of a Health System in Romania Ensures a Present for a Stable Healthy Population,Without Negative Influences of the Past

Regardless of the existing situations,economic crises,epidemics,or causes determined by the effects triggered in the foreign policy of the European Union states,health becomes a factor of maximum urgency in the state of a state,in order to have a healthy population.Ro mania now has both funding sources and revenues allocated to the establishment of the Single National Health Insurance Fund,major conditions for having an efficient health system.The National House of Health Insurance becomes the binder in the establishm ent and use of the Single National Health Fund,in the organization and coordination of projects for the development of the public and private health system,so that through the framework contract,legally constituted,we can look at the health system from needs up to the consumption of health services.No matter how much we analyze the health system in the country,it becomes efficient in the future,even if we have an aging population with pressing needs from a demographic point of view.Through a consist ent monitoring of the management in the health system and the attraction of medical personnel,after graduation,in hospital units,the balance of medical personnel vs.patient can become favorable.Family doctors must have the most important role in the h ealth system,in the existing conditions considering that the prevention and elimination of waiting time in hospitals are strictly related to the urgency of the medical services provided in time by them.Hospital units can reduce the degree of illness of t he population in the shortest possible time through monthly reporting of existing problems,including nosocomial infections.When there are well-established funding resources,the ways of their use and distribution are known,there are qualified medical pe rsonnel who can provide medical services to the population,upon returning to the country after specialization in other countries,we can clearly discuss that Romania has development levers of the public and private health system,in any condition.We must think that a transparent and prepared health system can therefore affect any country to have a healthy people,when the medical act is viewed through the lens of seriousness,humanity,professional values.

International Conference on Environment and Human Health Systems Engineering 2017 Held in Xi＇an

The first International Conference on Environment and Human Health Systems Engineering was held on July 8,2017 in Northwestern Polytechnical University（NPU）,Xi’an.This conference was jointly held by the School of Life Sciences of NPU,the Office of International Cooperation of NPU and the China Aerospace Academy of Systems Science and Engineering（CAASSE）.

History and Logical Progression of China's Public Health System——From the Perspective of the Protection of the Right to Health

A public health system generally refers to public utilities oriented toward protecting and improving health. It is intended to protect the health of the general public. Since the founding of the People’s Republic of China, China has constructed the largest healthcare system in the world. The 20th National Congress of the Communist Party of China(CPC), stressed that China will improve its public health system. Looking back at the history of China’s public health system from its inception to the reform and development and then improvement, it can be found that its development has always revolved around the theoretical logic of unifying rights and obligations and the practical logic of balancing the protection of the right to health and the regulation of state power. The fundamental goal is to protect the right to health of the people. The increasing health risks in modern society have changed require that efforts be made to construct a crisscrossing legal framework for public health, improve early-warning and emergency response mechanisms for public health emergencies,and integrate the health concept into all policies to further improve the public health system.

Reform of Health System for People's Right to Health——An interview with Gao Qiang,Minister of Health

EDITOR＇S NOTE： In an interview given of late to our staff reporter, Gao Qiang, Chinese Minister of Health, spoke on the achievements made by China in medical and health work during the Tenth Five-Year Plan period （2001-2005）, the soaring medical costs that have invoked much public complaint, ways of carrying to depth the reform of the medical service system, development of the rural cooperative medical system and community-based medical services in cities, as well as prevention and control of AIDS. Following is a transcript of the interview.

National Nutrition and Health Systematic Survey for Children 0–17 Years of Age in China

The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China(CNHSC)was to collect basic data on the nutrition,development,and health status for children in different regions across China using evidence-based,reliable,and cost-effective approaches.Children and their parents or guardians from seven regions(south,southwest,north,northwest,eastern,central,and northeast China)in China were recruited.A multi-stage stratified randomized sampling method was used.Two provinces were randomly sampled from each of the seven regions,from which one urban district and one rural country were also randomly sampled,resulting in a total of 28 survey counties/districts.Dietary surveys,health examinations,laboratory testing,and questionnaires were used to collect dietary intake,nutritional status,child development,and health status information.Nutrition,health,and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice(KAP)survey.Greater than 100,000 children(38,000 children<6 years of age and 66,000 children6-17 years of age)completed the survey.The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.

mHealth as a health system strengthening tool in China

Over the past 70 years,there was a rapid epidemiological transition in disease burden in China,from infectious disease to non-communicable diseases(NCDs),which requires long-term prevention and management.Rapid growth in mobile phone use,internet connectivity and digital health technology,presents new opportunities for improvement in NCD healthcare delivery and population-based outcomes.Although there were a growing number of research to evaluate the feasibility and effectiveness of the mobile health(mHealth)interventions for NCD management,the extent to which mHealth contributes towards the health system strengthening in China remains unknown.In this paper,we provided a high-level overview of mHealth in China and its role for Chinese health system strengthening.We conclude with several recommendations for the future of mHealth research in China based on existing evidence identified.

Performance of the health system in China and Asia as measured by responsiveness

Objectives: To examine differences in health system responsiveness across different sectors in China and to compare to other Asian countries. Methods: The World Health Survey was implemented in a nationally representative sample in China and 10 additional Asian countries from 2002-2003. Face-to-face interviews were conducted to gather health care utilization and health systems responsiveness data. Results: Overall health system responsiveness in China was better for the inpatient than the outpatient health system. Differences were seen by domain, with prompt attention and respectful treatment performing better than the other domains. Differences in responsiveness were seen by socio- demographic characteristics, with women and younger respondents rating inpatient systems, whereas men and higher educated respondents rated outpatient systems, more responsive. Conclusions: As populations age, health care systems will come under more pressures – responsiveness can be used by governments to guide policy and system improvement efforts when resources are limited. In China, reforms might prioritize outpatient system responsiveness.

Fragility and challenges of health systems in pandemic: lessons from India's second wave of coronavirus disease 2019 (COVID-19)

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacity-building measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.

Volunteering in the United Arab Emirates’ Health System—Motivations and Challenges

Background: The volunteer role has been cited as an important in supporting healthcare organizations in diverse areas such as contributing to research, health professional’s education, health care delivery, health policy development and patient administration. Proper motivation of volunteers is required for sustaining volunteer performance, while encumbrances to optimal engagement in health systems need to be addressed. This study aimed to investigate the main factors that motivate volunteers to participate in the UAE healthcare system, along with exploring the barriers and challenges being faced. Methods: This study was designed as a quantitative cross-sectional study in United Arab Emirates (UAE). A purposive sample of the Adult citizens and residents using purposive sampling directed at all major health volunteer recruitment agencies in UAE, who have volunteered at least once in the health system over the preceding 12 months. Participants Adult UAE residents were selected by a purposive sampling method from February to April 2017. Data were collected through electronic questionnaires using modified Volunteer Motivation Inventory (VMI). Data were analyzed from 667 adults’ residents who were reported to volunteer at least once in healthcare opportunities. Results: About 53% (n = 290) of the volunteers in this sample were full time employed individuals. Almost 63% (n = 422) were female. Overall, assessed self-reported motivations of volunteer participants were high. The main motivation for volunteering in healthcare opportunities in the UAE was Understanding dimension (Mean = 4.68), followed by self-esteem dimension (Mean = 4.60). Eight elements of volunteer motivation showed no statistically significant differences between male and female respondents. Organization/system barriers dimension was the highest among respondents (Mean = 2.9), followed by individual barriers (Mean = 2.6), interpersonal (Mean = 2.06) and contextual (Mean = 2.04). Conclusion: UAE health sector volunteers who participated in this study appeared to be highly motivated. The main motivation factor was understanding dimension which allowed volunteers in healthcare to gain a new perspective on things, through practical training and learning new things, dealing with different groups in the health sector, for example doctors, nursing, patients. What makes the health sector volunteer understand them self and the world around them. Therefore the organization should focus on volunteer motivation to ensure future intensions of them. The four main barriers to volunteer were Individual barriers, Interpersonal barriers, contextual barriers and organizations system barriers. Concerted efforts are needed to raise awareness about available volunteer opportunities, and optimally align the motivations of volunteers with organizational objectives in the UAE health sector.

Assessing the Relative Efficiency of Health Systems in Sub-Saharan Africa Using Data Envelopment Analysis

We assess the relative efficiency of health systems of 35 countries in sub-Saharan Africa using Data Envelopment Analysis. This method allows us to evaluate the ability of each country to transform its sanitary “inputs” into health “outputs”. Our results show that, on average, the health systems of these countries have an efficiency score between 72% and 84% of their maximum level. We also note that education and density of population are factors that affect the efficiency of the health system in these countries.