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Article ; Online: Understanding HRH recruitment in post-conflict settings

Maria Paola Bertone / Joao S. Martins / Sara M. Pereira / Tim Martineau / Alvaro Alonso-Garbayo

Human Resources for Health, Vol 16, Iss 1, Pp 1-

an analysis of central-level policies and processes in Timor-Leste (1999–2018)

2018 Volume 12

Abstract: Abstract Background Although human resources for health (HRH) represent a critical element for health systems, many countries still face acute HRH challenges. These challenges are compounded in conflict-affected settings where health needs are ... ...

Abstract	Abstract Background Although human resources for health (HRH) represent a critical element for health systems, many countries still face acute HRH challenges. These challenges are compounded in conflict-affected settings where health needs are exacerbated and the health workforce is often decimated. A body of research has explored the issues of recruitment of health workers, but the literature is still scarce, in particular with reference to conflict-affected states. This study adds to that literature by exploring, from a central-level perspective, how the HRH recruitment policies changed in Timor-Leste (1999–2018), the drivers of change and their contribution to rebuilding an appropriate health workforce after conflict. Methods This research adopts a retrospective, qualitative case study design based on 76 documents and 20 key informant interviews, covering a period of almost 20 years. Policy analysis, with elements of political economy analysis was conducted to explore the influence of actors and structural elements. Results Our findings describe the main phases of HRH policy-making during the post-conflict period and explore how the main drivers of this trajectory shaped policy-making processes and outcomes. While initially the influence of international actors was prominent, the number and relevance of national actors, and resulting influence, later increased as aid dependency diminished. However, this created a fragmented institutional landscape with diverging agendas and lack of inter-sectoral coordination, to the detriment of the long-term strategic development of the health workforce and the health sector. Conclusions The study provides critical insights to improve understanding of HRH policy development and effective practices in a post-conflict setting but also looking at the longer term evolution. An issue that emerges across the HRH policy-making phases is the difficulty of reconciling the technocratic with the social, cultural and political concerns. Additionally, while this study illuminates ...
Keywords	Human resources for health ; Health workers ; Recruitment ; Deployment ; Fragile and conflict-affected settings ; Timor-Leste ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2018-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries

David Peiris / Arpita Ghosh / Jennifer Manne-Goehler / Lindsay M Jaacks / Michaela Theilmann / Maja E Marcus / Zhaxybay Zhumadilov / Lindiwe Tsabedze / Adil Supiyev / Bahendeka K Silver / Abla M Sibai / Bolormaa Norov / Mary T Mayige / Joao S Martins / Nuno Lunet / Demetre Labadarios / Jutta M A Jorgensen / Corine Houehanou / David Guwatudde /

Mongal S Gurung / Albertino Damasceno / Krishna K Aryal / Glennis Andall-Brereton / Kokou Agoudavi / Briar McKenzie / Jacqui Webster / Rifat Atun / Till Bärnighausen / Sebastian Vollmer / Justine I Davies / Pascal Geldsetzer

PLoS Medicine, Vol 18, Iss 3, p e

A cross-sectional study of nationally representative individual-level survey data.

2021 Volume 1003485

Abstract: Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including ... ...

Abstract	Background Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. Methods and findings We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample ...
Keywords	Medicine ; R
Subject code	910
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

Maja E Marcus / Cara Ebert / Pascal Geldsetzer / Michaela Theilmann / Brice Wilfried Bicaba / Glennis Andall-Brereton / Pascal Bovet / Farshad Farzadfar / Mongal Singh Gurung / Corine Houehanou / Mohammad-Reza Malekpour / Joao S Martins / Sahar Saeedi Moghaddam / Esmaeil Mohammadi / Bolormaa Norov / Sarah Quesnel-Crooks / Roy Wong-McClure / Justine I Davies / Mark A Hlatky /

Rifat Atun / Till W Bärnighausen / Lindsay M Jaacks / Jennifer Manne-Goehler / Sebastian Vollmer

PLoS Medicine, Vol 18, Iss 10, p e

A cross-sectional study of nationally representative surveys.

2021 Volume 1003841

Abstract: Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for ... ...

Abstract	Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

Maja E. Marcus / Cara Ebert / Pascal Geldsetzer / Michaela Theilmann / Brice Wilfried Bicaba / Glennis Andall-Brereton / Pascal Bovet / Farshad Farzadfar / Mongal Singh Gurung / Corine Houehanou / Mohammad-Reza Malekpour / Joao S. Martins / Sahar Saeedi Moghaddam / Esmaeil Mohammadi / Bolormaa Norov / Sarah Quesnel-Crooks / Roy Wong-McClure / Justine I. Davies / Mark A. Hlatky /

Rifat Atun / Till W. Bärnighausen / Lindsay M. Jaacks / Jennifer Manne-Goehler / Sebastian Vollmer

PLoS Medicine, Vol 18, Iss

A cross-sectional study of nationally representative surveys

2021 Volume 10

Abstract	Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries

Justine I Davies / Sumithra Krishnamurthy Reddiar / Lisa R Hirschhorn / Cara Ebert / Maja-Emilia Marcus / Jacqueline A Seiglie / Zhaxybay Zhumadilov / Adil Supiyev / Lela Sturua / Bahendeka K Silver / Abla M Sibai / Sarah Quesnel-Crooks / Bolormaa Norov / Joseph K Mwangi / Omar Mwalim Omar / Roy Wong-McClure / Mary T Mayige / Joao S Martins / Nuno Lunet /

PLoS Medicine, Vol 17, Iss 11, p e

A multicountry analysis of survey data.

2020 Volume 1003268

Abstract: Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of ... ...

Abstract	Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2020-11-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health system performance for people with diabetes in 28 low- and middle-income countries

Jennifer Manne-Goehler / Pascal Geldsetzer / Kokou Agoudavi / Glennis Andall-Brereton / Krishna K Aryal / Brice Wilfried Bicaba / Pascal Bovet / Garry Brian / Maria Dorobantu / Gladwell Gathecha / Mongal Singh Gurung / David Guwatudde / Mohamed Msaidie / Corine Houehanou / Dismand Houinato / Jutta Mari Adelin Jorgensen / Gibson B Kagaruki / Khem B Karki / Demetre Labadarios /

Joao S Martins / Mary T Mayige / Roy Wong McClure / Omar Mwalim / Joseph Kibachio Mwangi / Bolormaa Norov / Sarah Quesnel-Crooks / Bahendeka K Silver / Lela Sturua / Lindiwe Tsabedze / Chea Stanford Wesseh / Andrew Stokes / Maja Marcus / Cara Ebert / Justine I Davies / Sebastian Vollmer / Rifat Atun / Till W Bärnighausen / Lindsay M Jaacks

PLoS Medicine, Vol 16, Iss 3, p e

A cross-sectional study of nationally representative surveys.

2019 Volume 1002751

Abstract: BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the ... ...

Abstract	BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS:We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS:The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2019-03-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Understanding HRH recruitment in post-conflict settings

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Article ; Online: Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

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Article ; Online: Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries

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Article ; Online: Health system performance for people with diabetes in 28 low- and middle-income countries

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