Health systems, communicable diseases and integration

Intrinsically flawed health systems by design.

AimThis study aimed at examining factors influencing uptake of cervical cancer screening services among women in Tanzania.DesignExploratory qualitative study.MethodsIn‐depth interviews were used to obtain information from 10 key Informants. Of these, three were officials (policy makers) from the Reproductive Health‐Cancer Unit of Ministry of Health and Community Development, Gender, Elderly and Children (MoHCDGEC), three were health managers working at Kinondoni Municipal health system reproductive and child health section and four were health workers from the Ocean Road Cancer Institute (ORCI). The study participants were purposively selected since they hold the responsibility of planning, coordinating and implementing the Tanzania cervical cancer prevention strategies at different levels of health system. The qualitative data analysis was done manually using thematic analysis.ResultsThe national health system factors influencing the early uptake of cervical cancer screening services include poor flow of information from national to lower level and inadequate availability of tools and instruments and shortage of skilled and competent staff. The district level health systems factors influencing uptake of cervical cancer screening services include inadequate number of partners, poor flow of information, poor collaboration with the private sector, no adequate provision of cervical cancer screening services due to lack of prioritization, poor creation of awareness and failure to use the health information system effectively.

BackgroundThe response to the COVID-19 pandemic saw a significant increase in demand for the voluntary, community, faith and social enterprise (VCFSE) sector to provide support to local communities. In Greater Manchester (GM), the VCFSE sector and informal networks provided health and wellbeing support in multiple ways, culminating in its crucial supportive role in the provision of the COVID-19 vaccination rollout across the GM city region. However, the support provided by the VCFSE sector during the pandemic remains under-recognised. The aims of the study were to: understand the views and experiences of marginalised communities in GM during the COVID-19 pandemic; explore how community engagement initiatives played a role during the pandemic and vaccine rollout; assess what can be learnt from the work of key stakeholders (community members, VCFSEs, health-system stakeholders) for future health research and service delivery.MethodsThe co-designed study utilised a participatory approach throughout and was co-produced with a Community Research Advisory Group (CRAG). Focus groups and semi-structured interviews were conducted remotely between September-November 2021, with 35 participants from local marginalised communities, health and care system stakeholders and VCFSE representatives. Thematic framework analysis was used to analyse the data.ResultsLocal communities in GM were not supported sufficiently by mainstream services during the course of the COVID-19 pandemic, resulting in increased pressure onto the VCFSE sector to respond to local communities’ need. Community-based approaches were deemed crucial to the success of the vaccination drive and in providing support to local communities more generally during the pandemic, whereby such approaches were in a unique position to reach members of diverse communities to boost uptake of the vaccine. Despite this, the support delivered by the VCFSE sector remains under-recognised and under-valued by the health system and decision-makers.ConclusionsA number of challenges associated with collaborative working were experienced by the VSCE sector and health system in delivering the vaccination programme in partnership with the VCFSE sector. There is a need to create a broader, more inclusive health system which allows and promotes inter-sectoral working. Flexibility and adaptability in ongoing and future service delivery should be championed for greater cross-sector working.

There is no cure without care.

The outbreak of a novel coronavirus in 2020 has brought great impact on the whole health system. Firstly, the existing medical system needs further integration and optimization to improve the abilities of supporting Internet of things and service-oriented cloud applications, thus optimize the overall system composition and operation, optimize the adjustment and application of various resources, and form a integrated disposal capacity, so as to prevent the medical system from being unable to deal with the extreme epidemic situation. On the other hand, with development of hierarchical diagnosis and collaborative medical system, higher requirements have been put forward for all levels of medical and health system, so that it can be effectively incorporated into the whole health system. At present, with help of service-oriented technology, combining service-oriented ideas and configuration methods, breaking through business barriers and integrating business functions is an important method to build multi-type application groups into cloud applications. Therefore, based on the application of configurable microservice system, this paper designs a new generation of smart medical and health system integrating various business functions, and provides corresponding solutions.

Background Health equity is a commonly asserted goal of health systems. However, there is limited understanding on appropriate equity-promoting strategies within system reform initiatives. To address this knowledge gap, we conducted a scoping review to (1) identify and characterise strategies that promote health equity during the implementation of health reform initiatives; and (2) reflect on implications for reform implementation and research. Methods Using scoping review methodology, we systematically searched peer-reviewed literature from 2013-2022. A comprehensive search strategy captured literature inclusive of four domains: (1) health equity; (2) implementation; (3) health system; and (4) reform, policy, or theories. Thematic analysis was conducted, and findings reported according to the PRISMA checklist. Results Of 10,999 identified articles after duplicates were removed, 69 articles met the inclusion criteria. A vast number of health equity promoting themes derived from individual strategies was identified, with a median of 10 strategies (interquartile range 7, 15) per article. Two a priori conditions were observed: (1) the need for health equity promoting strategies to be made explicit, and (2) the need for alignment and complementarity of strategies at community, regional, state, and national health system levels. Themes identified, such as accountability, leadership commitment, shared power, adaptability, and trust, present opportunities to support strategy selection and alignment across health system levels. Underpinning strategies were present across a range of governance domains, although emphasis varied by health system level. Conclusions The review recognises that different strategies may be applicable in different contexts; however, it may help to be explicit toward health equity strategies and align across health system levels. In future, reform implementation reporting should be made more consistent to promote a shared language. Key messages • A comprehensive review identified two a priori conditions to support equity promoting strategies within reform implementation; being explicit towards equity, and alignment across system levels. • Our research identified health equity-promoting strategies within health reform implementation. Common across system levels included accountability, leadership commitment, shared power and monitoring.

While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.

PRUANJE ZDRAVSTVENE SKRBI -trend SAETAK. Digitalne zdravstvene tehnologije (

IntroductionPublic trust in the health system is essential to control the Covid-19 pandemic. It can influence the extent to which interventions to combat a pandemic are accepted by citizens. The objective of this review was to map the evidence of measurements of the concept of public trust in the health system with a focus on health system institutions.MethodsWe performed a systematic literature search in the databases Web of Science and Embase in March 2020. Quantitative studies measuring trust on a system level with regard to healthcare were eligible if they addressed the general public and were published in English or German. We excluded studies that measured trust on an interpersonal level, in a single health profession, or a single treatment. We extracted data to map the characteristics of measurements.ResultsOf initially 7137 identified articles, 87 studies were included in the mapping. In 58 (67%) of the studies, trust was the outcome variable. Most studies (69%) measured the level of trust with single items, 27 studies (31%) used scales or indices to measure the concept of trust. Of these, 12 studies measured healthcare system trust, 7 trust in government and political institutions, 4 trust in healthcare organisations, 3 trust in health insurances, and 1 trust in health data management institutions. Most common domains of trust in the healthcare system refer to policies, quality of services, communication and provision of information, relationships with providers and their expertise, and quality of cooperation between providers. Theoretical dimensions of the concept of trust include fidelity, competency, trustworthiness, integrity and global trust.ConclusionsFew quantitative studies examine dimensions of public trust on a health system level. Future country-specific research on the concept of public trust may support the understanding of context-specific determinants for the tailoring of interventions to promote trust in health systems.Key messages Public trust is an important aspect for controlling a pandemic, as it is a precondition for accepting interventions, such as vaccination programmes.Country-specific research may promote the understanding of public trust and the tailoring of interventions to increase health system trust.

The COVID-19 pandemic has revealed critical vulnerabilities in Europe’s public health infrastructure, highlighting significant challenges faced in the European Union (EU’s) mission to strengthen health systems, and to increase security and preparedness. Key obstacles such as fragmented data systems, unequal access to care across EU Member States (MS), limited trauma system capacity, and the lack of real-time health surveillance and intelligence, hamper timely detection, assessment, and the deployment of coordinated response to cross-border health threats. These gaps have already been highlighted in the EU’s health preparedness agenda, yet its scope ought to widen beyond infectious disease outbreaks so as to address a wider spectrum of preventable non-communicable harms, incl. injury, violence, and occupational trauma. Moreover, evolving and interconnected pressures such as climate change, antimicrobial resistance (AMR), urbanization, and an extremely intense pace of technological advancement, demand a more integrated, agile, and forward-thinking approach to safeguard health systems and security across the Continent.As the EU seeks to align public health systems and security with environmental sustainability and digital transformation, it becomes clear that siloed preparedness strategies are insufficient. Instead, interoperability, cross-sector collaboration and data integration, and citizen empowerment, must form the foundation of future-proof health systems, and also health surveillance systems. A comprehensive approach ought to consider all levels of care and adopt an intersectoral prism, to ensure patient and citizen safety whilst safeguarding the interests of public health and a robust innovation ecosystem.This panel will convene representatives from the patient community together with public health experts to explore how Europe can enhance its capacity to anticipate, absorb, and adapt to health crises. The discussion will focus on integrating risk intelligence, cutting-edge technologies, and inclusive governance models to safeguard public health and promote safety throughout the life course. Additionally, particular emphasis will be given to access and accessibility, including the creation of inclusive environments for individuals living with disabilities or experiencing compromised access for other reasons. Key themes include the strategic opportunities emerging at the nexus of digital transformation, the potential of data integration across sectors, citizen engagement, risk intelligence, and multisectoral governance. The panel will examine how the next generation of European health systems can be co-created to be anticipatory, inclusive, interoperable and resilient.The session will explore how whole-of-society (WoS) approaches can drive comprehensive safety and prevention strategies across all levels of health systems, involving all stakeholders, from the local community to national and European institutions. Emphasizing the critical need for harmonized and interoperable data streams across sectors, including health, environment, transportation, education, and social services, the discussion will highlight how integrated data can be used to enhance reporting on short- and long-term health and societal outcomes, reduce system burdens, and support robust, evidence-informed policymaking in both high- and low-resource contexts.Resilient infrastructures must not only provide efficient emergency responses but also ensure equitable access, support mental health, adequately address trauma and injury, and reduce inequalities. The session will thus discuss how spaces that are designed inclusively, integrating accessibility, dignity, and psychological safety, can foster trust in health systems, improve patient and worker wellbeing, and support recovery and reintegration.A special focus will be placed on the transformative role of digital innovation in health governance. This includes the expanding use of real-time analytics, Artificial Intelligence (AI-) powered predictive modelling, and interoperable surveillance platforms that enable rapid, precise, and proactive decision-making. The panel will examine how the potential of these technologies can be responsibly harnessed to anticipate and identify emerging risks in real-time, how they ought to be evaluated so as to optimize resource allocation, and strengthen system responsiveness.Moreover, the panel will delve into the practical integration of One Health principles, promoting a holistic, interdisciplinary and intersectoral approach to health security. Central to this approach is embedding citizen and patient voices in the design and governance of health systems and of AI technologies to ensure that policies are grounded in lived experiences, foster public trust, and reflect community needs.Finally, the session will critically assess frameworks for evaluating the effectiveness, safety, and equitable value of emerging health technologies in detail. It will underscore the importance of ensuring that innovations translate into accessible, affordable, and timely tools that meet the diverse needs of populations, particularly in vulnerable or underserved communities, thereby advancing health equity alongside technological progress.Through moderated discussions and practical case studies, this panel aims to foster a shared understanding among European institutions, civil society, and scientific stakeholders on how to co-create health systems that are not only crisis-responsive but also sustainable, trusted, and safe for all populations.

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

Context: Population segmentation is a critical health system planning activity that enables more integrated, needs-responsive, and sustainable care. This paper describes the development and evaluation of a Systemic Health System Population Segmentation Model based on the person-centred and needs-based Unified Care Model by Yishun Health, a regional population health system in Singapore. We highlight three implications to enhance health systems operational relevance: (i) psychosocial factors as key determinants of outcomes, (ii) accountability and resource allocation across differentiated segments, and (iii) integration of lifelong and episodic care needs. Methods: Three interdependent models were developed, a Lifelong Care Segmentation Model, a Needs-Based Sub-Segmentation Model, and an Episodic Care Segmentation Model, all underpinned by the Unified Care Model. These models systematically stratify residents into mutually exclusive and collectively exhaustive population groups based on biopsychosocial needs across different health system levels. An expert-driven design process was used, supported by integrated administrative and clinical data. Model evaluation examined the ability to stratify patients into distinct risk groups using healthcare utilisation, costs, and readmission outcomes. Findings: In 2022, 78,810 residents were segmented into seven lifelong care segments, with 43,473 residents with chronic conditions further stratified into sub-segments reflecting varying complexity and psychosocial needs. Additionally, 14,335 emergency admissions were categorised into six episodic care segments. Healthcare utilisation and annual healthcare costs differed significantly across needs-based sub-segments (p < 0.001). Higher episodic care needs were associated with longer hospital stays, higher rates of emergency readmissions, and admission costs (p < 0.001). Psychosocial issues consistently emerged as a key determinant of poorer outcomes, underscoring implications for more systemic and systematic accountability assignment and more deliberate resource planning, especially for care integration horizontally. The integration of lifelong and episodic care needs further enabled operational redesign for vertically integrated health systems. Conclusions: By incorporating psychosocial drivers, focusing on clarifying accountability and resource allocation, and lifelong-episodic care integration, our Systemic Health System Population Segmentation Model strengthens the operational utility of segmentation as a foundation for population health system transformation and provided a robust framework for health systems governance and leadership system redesign globally.

Population ageing is both an achievement and challenge, an achievement as longevity is the result of successful prevention and control of diseases, decreasing fertility rates and overall socio-economic development. It is at the same time a challenge as the increasing number of older people and the resultant demographic shift are accompanied by the need to adjust and scale up the social and health care systems. The challenges are of particular relevance to the developing world where the demographic shift is occurring much faster. Comprehensive efforts based on country contexts are required in the following areas: (a) older persons and development, (b) health and well-being and (c) enabling and supportive environments to address population ageing needs. This article, however, focuses only on three most crucial issues, that is, livelihood, health care systems and care of the older dependent people. Measures to sustain the livelihood of older people, to align the health systems to provide care and to develop long-term care systems are highlighted. Person-centred care, integration and functional capacity are advocated. Further, ageing in place or living in one’s own home, community or a place with the closest fit with the person’s needs and preferences is considered very important for healthy ageing. In terms of enhancing livelihood, major policy changes and reforms to improve the social security systems and expanding coverage as well as increasing the amounts to minimum subsistence levels are highlighted. Another area which needs to be strengthened is the tradition of existing family support systems. The health systems alignment required are reflected for each health system building block, and focuses mainly on (a) developing and ensuring access to services that provide older-person-centred care; (b) shifting the clinical focus from disease to intrinsic capacity; and (c) developing or reorienting the health workforce to provide care as per alignment. Long-term care systems would best meet the needs of dependent older people if families, communities, civil society organisations and private sector are equally involved while governments play leadership roles in setting up and monitoring quality.

Medicines and universal health coverage: challenges and opportunities.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.