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Background: Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods: Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results: The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion: The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs. Conclusion: The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability. Key message: • A hybrid governance model that combines top-down and bottom-up approaches effectively improves immunisation programs in conflict settings and promotes local ownership. • In conflict settings, immunisation programmes require strong and direct intervention from the WHO with central management and coordination of the vaccine activities. • In conflict areas, when the government is a party to the conflict or has limited access to some areas, United Nations institutions must intervene to manage or support vaccine activities in partnership with local entities, regardless of notions of national sovereignty. • In Syria, the reluctance of United Nations institutions to fill the void left by the state in areas outside its control and provide vaccines led to the emergence of many diseases, including polio in 2013 and measles in 2017. [ABSTRACT FROM AUTHOR]

Abstract Background Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods Using a mixed-methods approach, and adapting Siddiqi’s framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG’s role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG’s sustainability and integration into national programs. Conclusion The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program’s success and sustainability.

This article analyzes the state of social participation in health in the Region of the Americas, framing it within the regional context and commitments assumed by the Member States of the Pan American Health Organization. It aims to provide regional input to the discussion of a resolution on social participation for universal health coverage, health, and well-being at the 77th World Health Assembly in 2024. In the Americas, social participation has evolved from a utilitarian approach to a fundamental aspect of health system governance, enshrined within legal frameworks and recognized as a citizen’s right. Regional resolutions emphasize inclusive policies and intersectoral action to tackle health inequities, meanwhile the World Health Organization handbook on social participation underscores the need for inclusive governance mechanisms and addressing power imbalances. Informed by Member States’ recommendations and scientific literature, the article emphasizes the importance of addressing power imbalances, strengthening legal frameworks, and enhancing capacities of governments and populations. It stresses adapting social participation mechanisms to diverse cultural contexts and ensuring meaningful community involvement in decision-making. Finally, the article advocates for a comprehensive approach to social participation grounded in principles of equity, democracy, and human rights; and fundamentally as an essential component of the primary health care approach. It calls for integrating social participation into health system governance, policy dialogues, capacity- building, and evaluation to ensure effective participatory processes.

Against a backdrop of change in the French public health governance system, this article examines the dynamics of public-sector dispositives in managing livestock epidemics, situations that are typically fraught with doubt and often lead to crises of governance (‘mad cow’ disease, ‘bird flu’, foot-and-mouth, etc.). In such complex, interorganizational situations, marked by uncertainty and tight management time frames, fresh organizational and managerial activity is constantly required, making it a challenging task to characterize and understand the dynamics of the management dispositives that are activated along the way.In order to produce a detailed and dynamic mapping of dispositives, we draw on the theoretical framework of ‘dispositional analysis’, developed by recent rereadings of Michel Foucault’s concept of the dispositive. To this, we bring the micro and situated perspective of the ‘day-to-day administering’, introducing Jacques Girin’s concept of the ‘management situation’. We thus hypothesize that management situations are sites of intensive dispositive recombination and offer a useful interpretive frame for dispositive dynamics. Our methodology is based on a longitudinal and comparative analysis of three animal health disease management situations in a particular region (a health crisis, the reemergence of a disease, and an endemic disease situation).Our analysis reveals an architecture of health dispositives whose relationships change as the management situation evolves. Three modes of recombination are identified, produced through the mechanisms of problematization (reformulating the problem) and stakeholder participation. This article makes visible the complex links between the evolution of the situations and the dynamics of the dispositives and provides food for thought in building a more robust governance of public animal health problems, combining situational and planning approaches.

BackgroundCountries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country.ObjectiveTo analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana.MethodsThis qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes.FindingsData analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration.ConclusionThe results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.

Abstract Background Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018–2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Background One of the important reasons for the slow progress of hierarchical diagnosis and treatment since its implementation is the lack of comprehensiveness in the analysis of multiple subjects and stakeholders. Objective To explore mechanism innovation solutions that combine both top-down and bottom-up paths by analyzing the interest relationships among diverse stakeholders in the hierarchical medical diagnosis and treatment system, and facilitate collaborative governance among diverse stakeholders through policy innovation and path innovation, to optimize the order of hierarchical patient flow. Methods From October 10, 2022, to March 20, 2023, two advanced urban districts in China (S district in X city and H district in N city) were selected as typical research areas. A total of 36 different stakeholders (involving municipal health administrative departments, tertiary hospital administrators, tertiary hospital specialists, community health service center administrators, general practitioners, health social workers, and patients) were selected as the study subjects for the in-depth interviews through snowball and purposive sampling methods. The stakeholder theory analysis method was employed to analyze the interests and constraints among the seven major stakeholder groups and their constraints on the healthy development of the order of hierarchical medical diagnosis and treatment, and explore the dilemma of the mechanism of hierarchical diagnosis and treatment. Furthermore, textual analysis of interview records of typical stakeholders in the pilot and non-pilot areas of the implementation of health social workers and community smart health huts in S district in X city and H district in N city was conducted to compare the effects before and after the implementation. Results The results of the in-depth interviews showed that four main dimensions, including the degree of interest, willingness to implement, the extent of impact by implementation, and the influence on implementation, are the major factors affecting the implementation of hierarchical medical diagnosis and treatment by the seven major stakeholder groups. These seven stakeholder groups hold varying interest positions and play different roles in facilitating or obstructing the implementation of the hierarchical medical diagnosis and treatment. The difficulty of forming a collaborative mechanism among diverse stakeholders is the key to the problem. In pilot areas, through the implementation of the community smart health huts and health social workers, and the resulting medical-social collaboration, the relevance of the seven major stakeholder groups can be enhanced and the hierarchical medical diagnosis and treatment order can be improved. Conclusion The community smart health huts serve as a physical space for the new medical-social collaboration mechanism, while health social workers act as the connectors and enablers of this new mechanism. With the help of the new carrier of community smart health huts and the new power of health social workers, the construction of a new path of medical-social collaboration centered on health social work can realize the front entrance of medical treatment and play the role of"energy enhancer"to form the order of hierarchical medical diagnosis and treatment.

Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs’ recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN’ 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.

Background: Effective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018–2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods: This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results: The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes. Conclusions: Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. [ABSTRACT FROM AUTHOR]

Against a backdrop of change in the French public health governance system, this article examines the dynamics of public-sector dispositives in managing livestock epidemics, situations that are typically fraught with doubt and often lead to crises of governance ('mad cow' disease, 'bird flu', foot-and-mouth, etc.). In such complex, interorganizational situations, marked by uncertainty and tight management time frames, fresh organizational and managerial activity is constantly required, making it a challenging task to characterize and understand the dynamics of the management dispositives that are activated along the way. In order to produce a detailed and dynamic mapping of dispositives, we draw on the theoretical framework of 'dispositional analysis', developed by recent rereadings of Michel Foucault's concept of the dispositive. To this, we bring the micro and situated perspective of the 'day-to-day administering', introducing Jacques Girin's concept of the 'management situation'. We thus hypothesize that management situations are sites of intensive dispositive recombination and offer a useful interpretive frame for dispositive dynamics. Our methodology is based on a longitudinal and comparative analysis of three animal health disease management situations in a particular region (a health crisis, the reemergence of a disease, and an endemic disease situation). Our analysis reveals an architecture of health dispositives whose relationships change as the management situation evolves. Three modes of recombination are identified, produced through the mechanisms of problematization (reformulating the problem) and stakeholder participation. This article makes visible the complex links between the evolution of the situations and the dynamics of the dispositives and provides food for thought in building a more robust governance of public animal health problems, combining situational and planning approaches. [ABSTRACT FROM AUTHOR]

Policy piloting has become a popular form of organization in implementing public policies. However, the current literature surprisingly discusses little about its management. This study investigates how two policy-pilot attributes – ambiguity and compatibility – shape policy-pilot management. To accomplish this, we developed an analytic framework consisting of four management strategies: experimentation, refinement, upscaling, and institutionalization. We chose a representative policy pilot in Chinese health governance, the New Rural Cooperative Medical Scheme, to examine the adoption of these four strategies. Our finding that, at various junctures, the Chinese state adopted these four strategies to manage policy piloting demonstrates the applicability of the analytic framework constructed in this study. This study contributes to the existing public policy literature by providing new insights into policy implementation in temporary organizing settings. [ABSTRACT FROM AUTHOR]

This paper endeavours to unveil individual characteristics associated with an interest in One Health. Through the distribution of an online survey randomly distributed among the United Kingdom population, we discovered significant correlations between pre-existing attitudes towards and relationships with nature and animals and interest in One Health, which is quantified by the number of additional pages of One Health information participants agreed to view at the survey's conclusion. Additionally, individuals with poorer mental health demonstrated a higher level of interest in One Health. The findings suggest that interest in One Health and people's connections with nature and animals are driven by the same personal preferences. These insights point towards the potential for more targeted communication strategies to specific groups, facilitating more effective promotion of the One Health concept.

Abstract Despite a proliferation of the United Nations General Assembly high-level meetings on a range of health issues and developmental challenges, global funding continues to flow disproportionately to HIV and maternal, newborn and child health (MNCH). Using the experience of MNCH, this short article argues that successful human rights framing and the development of robust and regular reporting mechanisms in the international development architecture has contributed to these areas receiving attention. Taking non-communicable diseases (NCDs) as an example of a relatively neglected health area, we propose mechanisms that would improve integrated reporting of health issues in a way that aligns with the move toward cross-cutting themes and matching political and financial commitments with impact. As new frameworks are being developed to support multi-agency approaches to achieving SDG 3—including reporting and accountability—there are opportunities to ensure MNCH and NCDs jointly seek data collection measures that can support specific targets and indicators that link NCDs with early childhood development.

Background As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies.Methods This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and ‘enablers’ of healthy societies, the “how.”Results The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge.Conclusion Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.

Many children die of easily preventable or treatable diseases in developing countries. What are the relationships between corruption, patronage, and child mortality in low‐ and middle‐income countries? We argue that corruption and patronage affect child mortality outcomes for some causes of death, especially those that are more easily prevented or treated with affordable care. To test our hypotheses, we utilize cross‐national time‐series analysis of under‐five child mortality in developing countries between 1996 and 2016. Our study finds that patronage and corruption increase under‐five child mortality arising from easily preventable childhood diseases, but they have almost no effect on under‐five child mortality caused by more complex illnesses. Our study underscores the need to examine cause‐specific health outcomes rather than overall health outcomes in comparative health analysis, as the ability of governments to address specific health issues depends on the nature of the problems. Related Articles: Ireni‐Saban, Liza. 2013. "Give Me Children or Else I Die: The Politics and Policy of Cross‐Border Reproductive Care." Politics & Policy 41(1): 5–38. https://doi.org/10.1111/polp.12004. Lagunes, Paul F. 2012. "Corruption's Challenge to Democracy: A Review of the Issues." Politics & Policy 40(5): 802–26. https://doi.org/10.1111/j.1747‐1346.2012.00384.x. Tusalem, Rollin F. 2022. "Does Gendered Representation in National Legislatures Promote Substantive Representation and Human Development? Evidence from the Developing World." Politics & Policy 50(6): 1096–137. https://doi.org/10.1111/polp.12503. [ABSTRACT FROM AUTHOR]

Abstract: The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals’ serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.

This study aimed to evaluate the implementation of the Philippine Integrated Management of Acute Malnutrition (PIMAM) Program in Maguindanao Provincial Hospital (MPH), Dinaig Municipal Hospital (DMH), and South Upi Municipal Hospital (SUMH), Philippines. Employing a descriptive-evaluative design, data were gathered from 107 respondents comprising top management and hospital staff, selected via purposive sampling. A survey questionnaire was utilized as the primary data collection tool, supplemented by secondary data obtained from hospitals' PIMAM-ITP coordinators regarding the status of patients upon discharge from the Inpatient Therapeutic Program (ITP). Data were analyzed using mean and percentage. Results indicated high levels of implementation of PIMAM-ITP across the hospitals concerning guidelines, facilities, materials, screening, treatment, and discharge procedures. Notably, 74% of discharged patients from ITP hospitals were classified as "successfully treated," with the remaining categorized as defaulter (16%), deceased (8%), medically transferred (2%), or non-respondent (0%). The program demonstrated effectiveness in systematically addressing acute malnutrition. However, challenges persisted, particularly concerning caregiver compliance and funding allocation for training on the National Guidelines for the Management of Severe Acute Malnutrition among personnel involved in program implementation.

With the increasing dimension of medical sciences, nursing care is becoming more and more complex with its management services. This study aimed to evaluate the implementation of Nursing Service Operations in Maguindanao Provincial Hospital in terms of Emergency Room and In-patient services, the processes followed in terms of Triaging, Profiling, Admission, Treatment, and Discharging, and the patients’ status such as Admission to Ward and Discharge from Care. The study utilized a descriptive-evaluative method using a researcher-made survey questionnaire to 255 respondents comprising 107 hospital staff and 148 discharged patients. Data were analyzed using the weighted mean. Results revealed that Emergency Room (ER) and In-patient services were highly implemented. There was a very high implementation process for nursing services for triaging, profiling, treatment, and discharge, except for a high admission process. Also, the patient’s status regarding admission to the ward for emergency room services was high, while discharge from care for in-patient services was moderate. Regarding problems encountered, it was revealed that the MPH needed more staffed nurses, cultural health beliefs, language barriers, lack of continuous education, delayed salary, etc. Hence, the Maguindanao Provincial Hospital adhered to the guidelines in the DOH Administrative Order 2012-0012; however, certain provisions must be complied with to deliver emergency room and in-patient services effectively and efficiently.

Climate change impacts on the transmission and epidemics of vector-borne diseases (VBDs), hence an understanding of the institutional determinants that influence the response of national health systems is important. This study explored how institutional determinants influence health outcomes of malaria and bilharzia using the case study of Gwanda district, Zimbabwe, in the advent of climate change. Qualitative data were collected using in-depth interviews from representatives of public and private institutions; and organisations involved in the prevention and control of malaria and bilharzia. Results from the study showed that the Ministry of Health and Child Care of Zimbabwe and other relevant government ministries and departments involved in environmental and social issues, constituted the primary network in the control and prevention of malaria and bilharzia. Non-governmental organisations (NGOs) formed the secondary network that mainly mobilized resources or complimented the primary networks in the delivery of services. It was noted that there was an institutional structure primarily responsible for responding to malaria and bilharzia but it was not adequately prepared to address climate change-induced VBDs changes. Based on our findings, a framework for reducing vulnerability and enhancing resilience among populations affected by VBDs in the context of climate change was developed.

This study aimed to evaluate the implementation of the Philippine Integrated Management of Acute Malnutrition (PIMAM) Program in Maguindanao Provincial Hospital (MPH), Dinaig Municipal Hospital (DMH), and South Upi Municipal Hospital (SUMH), Philippines. Employing a descriptive-evaluative design, data were gathered from 107 respondents comprising top management and hospital staff, selected via purposive sampling. A survey questionnaire was utilized as the primary data collection tool, supplemented by secondary data obtained from hospitals' PIMAM-ITP coordinators regarding the status of patients upon discharge from the Inpatient Therapeutic Program (ITP). Data were analyzed using mean and percentage. Results indicated high levels of implementation of PIMAM-ITP across the hospitals concerning guidelines, facilities, materials, screening, treatment, and discharge procedures. Notably, 74% of discharged patients from ITP hospitals were classified as "successfully treated," with the remaining categorized as defaulter (16%), deceased (8%), medically transferred (2%), or non-respondent (0%). The program demonstrated effectiveness in systematically addressing acute malnutrition. However, challenges persisted, particularly concerning caregiver compliance and funding allocation for training on the National Guidelines for the Management of Severe Acute Malnutrition among personnel involved in program implementation. [ABSTRACT FROM AUTHOR]

With the increasing dimension of medical sciences, nursing care is becoming more and more complex with its management services. This study aimed to evaluate the implementation of Nursing Service Operations in Maguindanao Provincial Hospital in terms of Emergency Room and In-patient services, the processes followed in terms of Triaging, Profiling, Admission, Treatment, and Discharging, and the patients' status such as Admission to Ward and Discharge from Care. The study utilized a descriptive-evaluative method using a researchermade survey questionnaire to 255 respondents comprising 107 hospital staff and 148 discharged patients. Data were analyzed using the weighted mean. Results revealed that Emergency Room (ER) and Inpatient services were highly implemented. There was a very high implementation process for nursing services for triaging, profiling, treatment, and discharge, except for a high admission process. Also, the patient's status regarding admission to the ward for emergency room services was high, while discharge from care for in-patient services was moderate. Regarding problems encountered, it was revealed that the MPH needed more staffed nurses, cultural health beliefs, language barriers, lack of continuous education, delayed salary, etc. Hence, the Maguindanao Provincial Hospital adhered to the guidelines in the DOH Administrative Order 2012-0012; however, certain provisions must be complied with to deliver emergency room and in-patient services effectively and efficiently. [ABSTRACT FROM AUTHOR]

Foundation: leadership represents an important trait that must be presented by every person in charge of directing a group of people. The organizational changes generated in pharmaceutical offices must be assumed through a leadership style that allows achieving the objectives and goals set, in order to ensure and optimize health care. Objective: to determine the Chemist-Pharmaceutical professionals' leadership styles who work in public and private establishments in the city of Trujillo (Peru). Methods: a descriptive cross-sectional study that included 94 collegiate professionals who work as technical directors. In data collection, the survey was used as a technique and the Multifactor Leadership Questionnaire (MLQ) as an instrument, which consisted of 36 questions on a Likert scale, distributed in three dimensions: transformational, transactional, and corrective/avoidant leadership. Results: 82.9 % of the professionals work as technical directors in the private sector; 57.4 % are female and more than 60 % have a high level of leadership. Together both sectors, the high-level transformational and transactional leadership styles were present in 28.7 % and 61.7 %, respectively; mid-level corrective/passive/avoidant leadership was present in 72.3 % of the professionals. Likewise, high-level transformational leadership was present in 62.5 % of those who work in the public sector and in 56.4 % of those in the private sector; the corrective/passive/avoidant leadership style at a medium level was present in more than 60 % of the professionals in both sectors. Conclusions: the most predominant leadership style was transactional. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has augmented discourses of individual citizen responsibility for collective health. This article explores how British Columbia, Canada's widely praised COVID-19 communication participates in the development of neo-communitarian "active citizenship" governmentalities focused on the civic duty of voluntarily taking responsibility for the health of one's community. We do so by investigating how public health updates from BC's acclaimed Provincial Health Officer Dr. Bonnie Henry articulate this civic imperative through the rhetorical constitution of the "good covid citizen." Our rhetorical analysis shows how this pro-social communication interpellates citizens within a discourse of behavioral, epistemic, and ethical responsibilisation. The communal ethos constituted through this public health communication significantly increases the burden of personal responsibility for health beyond norms of self-care. Making the protection of community health primarily the responsibility of individual citizens also presumes a privileged identity of empowered, active agency and implicitly excludes citizens who lack the means to successfully fulfill the expectations of good covid citizenship. [ABSTRACT FROM AUTHOR]

The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 key informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research. [ABSTRACT FROM AUTHOR]

Abstract Background There has been considerable progress in developing global health education and research in China. Nevertheless, evidence of the progress of Chinese universities’ contributions to global health research is limited. More efforts are needed to depict the progress Chinese universities have collectively made in advancing the field of global health. This study aimed to examine Chinese universities’ collective contributions to global health research by describing the longitudinal trends in global health research publications, uncovering research themes in global health, and exploring collaboration patterns. Methods A comprehensive bibliometric analysis was conducted for original research studies of the ten founding members of the China Consortium of Universities for Global Health, one of the largest networks of global health research and education in China. Results We found that (1) the number of research publications in the field of global health has steadily increased from 2014 to 2020, (2) non-communicable disease was the most popular research topic, accounting for over one-third of total publications, followed by maternal and child health and neurological and mental disorders and diseases, (3) less than one-fifth of papers involved primary data collection, with the majority of the study populations from low-income and lower-middle-income countries in Asia and Africa, and (4) a sizable collaboration network has been established with co-authors from over 200 oversea universities or organizations, with about one third from the US. Conclusions Despite a variety of challenges and barriers, Chinese universities have been playing an increasingly important role in global health research as assessed by peer-reviewed publications over the last decade. More concerted efforts by multiple stakeholders, including government, private sectors, funding agencies, academic institutions, and researchers, are needed to advance the development of global health research in China.

Background: Tunisia has been engaged in the Societal Dialogue (SD) for Health process since 2012, a participatory health governance process aimed at bringing in people's voice into health policy-making. Its first success was the recently released National Health Policy 2030. This paper aims to document the SD process and to bring out the lessons learned to inspire other countries. Methods: This study was based essentially on a qualitative analysis of semi-structured interviews with citizen jury members and health experts that took place from May to September 2018. The qualitative analysis adopted an inductive-deductive approach according to a cross-matrix between the themes of the interview of the two groups of interviewees. Results: The qualitative analysis of the data highlighted that the Societal Dialogue created a health democracy dynamic with inclusive dialogue spaces for the population, communities, and civil society to participate in health system design. It constituted a multi-actor and multidisciplinary coordination platform to increase consensus building among actors. Initial government support and high levels of volunteer commitment allowed the process to achieve a certain level of sustainability. However, this process faced and still faces many challenges such as overreliance on volunteers; a crisis of trust; political instability and the lack of an effective communication strategy. These challenges negatively influence the policy uptake of recommendations made by the Societal Dialogue for Health. Conclusion: The Tunisian societal dialogue experience highlights both the successes and challenges of a structured participatory platform, as well as the effort and perseverance it takes to keep such a process functional and relevant. A key lesson from this study is that this model of participatory health governance eventually reaches a stage where population, community, and civil society participation needs to be more institutionalized within the government routine so that it can credibly feed into health policy review processes and inform decision-makers on a regular basis. [ABSTRACT FROM AUTHOR]

A long-recognized problem of healthcare devolution in many developing countries is its inextricability from the influences of local politics. This has been particularly self-evident in the Philippines, where, since the adoption of the Local Government Code of 1991, the devolution of health governance, planning, administration and service delivery has placed the health system largely under the control of individual provinces, cities, municipalities and villages or barangays. In this article, we utilize the notion of 'kontra-partido' (the Filipino term connoting 'oppositional politics') to concretize local, oppositional politics as a lived experience of health workers, government officials and ordinary citizens in the country. Through multi-sited qualitative fieldwork, we demonstrate how 'kontra-partido' politics ultimately worsens health outcomes in any locality. We show how such politics figures in the relational dynamics of health governance, often resulting in petty infighting and strained relationships among local health authorities; how it leads to the politicization of appointments and prevents the local workforce, especially those at the grassroots, from doing their jobs efficiently amid environments rife with hostile patronage; and how it impedes service delivery as politicians prioritize 'visible' projects (over sustainable ones) and selectively deliver health care to their known supporters. In turn, health workers and ordinary citizens alike have been actively negotiating their roles within this political milieu, either by joining the so-called political frontlines or by engaging in the transactional relationships that develop between politicians and their constituents during perennial election seasons. We conclude with a reflection on the vulnerability of health to politicization and the visceral consequences of 'kontra-partido' politics to health workers, as well as an identification of possible areas of intervention for future policy reform, given the deepening political polarization in the country and the upcoming implementation of the recently passed Universal Health Care Law. [ABSTRACT FROM AUTHOR]

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Lacy-Nichols and Williams provide important new insights into the ongoing contest over policy space and consumer behavior. I attempt to situate these insights in relation to government mandates and governance norms and situate these norms and mandates in the prevailing economic order. This approach is necessary to understand how corporate practices persist and why governments are receptive to the approaches outlined in the analysis conducted by Lacy-Nichols and Williams. This approach can help explain why governments are often receptive to corporations positioning themselves as ‘part of the solution’. Governments want strong economies and big food positions itself as contributor to this end. The point I attempt to articulate is that we often conceive of corporate power as power over, while I suggest that corporate power is rather power within and through a system that is oriented towards profits and economic growth.

Background The World Health Organization (WHO) has engaged in consultations with the alcohol industry in global alcohol policy development, including currently a draft action plan to strengthen implementation of the Global strategy to reduce the harmful use of alcohol. WHO’s Framework for Engagement with Non-State Actors (FENSA) is an organization-wide policy that aims to manage potential conflicts of interest in WHO’s interactions with private sector entities, non-governmental institutions, philanthropic foundations and academic institutions. Methods We analysed the alignment of WHO’s consultative processes with non-state actors on “the way forward” for alcohol policy and a global alcohol action plan with FENSA. We referred to publicly accessible WHO documents, including the Alcohol, Drugs and Addictive Behaviours Unit website, records of relevant meetings, and other documents relevant to FENSA. We documented submissions to two web-based consultations held in 2019 and 2020 by type of organization and links to the alcohol industry. Results WHO’s processes to conduct due diligence, risk assessment and risk management as required by FENSA appeared to be inadequate. Limited information was published on non-state actors, primarily the alcohol industry, that participated in the consultations, including their potential conflicts of interest. No minutes were published for WHO’s virtual meeting with the alcohol industry, suggesting a lack of transparency. Organizations with known links to the tobacco industry participated in both web-based consultations, despite FENSA’s principle of non-engagement with tobacco industry actors. Conclusion WHO’s consultative processes have not been adequate to address conflicts of interest in relation to the alcohol industry, violating the principles of FENSA. Member states must ensure that WHO has the resources to implement and is held accountable for appropriate and consistent safeguards against industry interference in the development of global alcohol policy.

Copyright of Journal of Management & Health / Revista Gestão & Saúde is the property of Revista Gestao e Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Shanghai Physical Education Institute / Shanghai Tiyu Xueyuan Xuebao is the property of Shanghai Physical Education Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As the most basic public service, healthcare service is a necessary support to cultivate and strengthen the sense of national identity. This article utilizes the linear regression model based on data from the Comprehensive Survey of Chinese Social Conditions in 2021（CSS2021）to study the public awareness of the macro system of healthcare services and the physical practice in the treatment process on national identity. The study found that there was a significant positive correlation between the public perceptions of the macro system of healthcare services and national identity, which means the better the public perception of healthcare safety, healthcare equity and local government’s quality of healthcare services, the higher the public satisfaction of healthcare insurance, lead to higher sense of national identity. In terms of the physical practice in the process of public treatment, the choice of public medical institutions has a significant impact on national identity, and those who choose to go to public hospitals for treatment have a higher sense of national identity. The study did not find a significant relationship between the perceptions of medical institutions and national identity. We should consider healthcare governance as an essential window to test the modernization of the national governance system and governance capacity, starting from the public health promotion that continues to improve healthcare system capacity. We should also focus on ensuring fairness within the healthcare system and vigorously promote humanistic care, allowing the public to feel a sense of attainment, happiness and security in healthcare services, thus constantly generating national identification. [ABSTRACT FROM AUTHOR]

Before the COVID-19 pandemic, a French epistemic community has forged and promoted a Biodiversity/Health nexus, which legitimizes biodiversity as a health issue. The relationship between biodiversity and health is now part of French local government agendas, after being included in new international programs. Based on observation of this nexus's epistemic community and 35 semi-structured interviews conducted in France between 2017 and 2020, this article aims to show which actors and groups have been forging and promoting this nexus, and to understand how such an emergent environmental nexus challenges the governance of the present biomedical- and technical expertise-based health system. This article discusses environmental nexus from the perspective of building a new cause by reconstituting chains of causality to "demonstrate" the new problem (Barthe, Politix, 23(91), 77–102, 2010), and the growing importance of integration of concepts as a new ideal of policy-making (Cairns & Krzywoszynska, Environmental Science and Policy, 64, 164–170, 2016). As well as a justification (Boltanski & Thevenot, 1991) of their effectiveness in legitimizing the cause of defending biodiversity, environmental nexuses contain a challenge to recognize knowledge, calling for a change in governance methods in a One Health approach. [ABSTRACT FROM AUTHOR]

One Health (OH) and Global Health (GH) are interconnected perspectives that may contribute to subsidizing GH policies. This scoping review aims to map the volume, nature, and characteristics of studies focused on the interface of OH and GH concepts. We used PubMed (MEDLINE), Embase, Scopus, and The Virtual Health Library (BVS) as the literature data sources for the review. The search strategy used the descriptors “one health”, “one health concept”, “one medicine”, “global health”, “international health”, and “planetary health” in title and abstracts. We included original research presented as articles in scientific journals, book chapters or conference papers written in English, Spanish, or Portuguese, exploring the intersections between OH and GH concepts, not necessarily as their primary objectives, and published up to December 31, 2021. A total of 1.060 references were identified in the databases after removing duplicates, 139 publications selected for full-text evaluation and 45 publications were included for analysis. All included publications were published between 2011 and 2021, with the highest concentration in 2014 (22.2%). First authors were most frequently from the United States (35.6%), followed by the United Kingdom (15.6%). Overall, seven key themes were identified zoonosis, emerging infectious diseases, antimicrobial resistance, food safety, policy, human resources, and Sustainable Development Goals (SDG). The majority of the included publications employed OH concepts based on the United States Centre for Disease Control and Prevention, and the American Veterinary Medical Association definitions. We observed a common understanding of OH as an area of knowledge involving multiple disciplines and professionals and recognizing that both humans' and animals' health and the environment are interdependent. Although most authors demonstrated that health issues transcend national boundaries, a formal definition for GH was frequently not clearly identified. OH and GH interfaces are essential for accomplishing the 2030 Agenda and its SDG.

شرعت الحکومة المصرية على مدار السنوات القليلة السابقة في تنفيذ برنامج لإصلاح نظام الرعاية الصحية القومي، کمشروع حيوي تؤکد من خلاله مکانتها المتميزة کمصدر لخدمات الرعاية الصحية في المنطقة، وکضمان حقيقي للتوزيع العادل للرعاية الصحية داخل المجتمع المصري، ومؤخراً ظهرت مطالبات بقيام المستشفيات الحکومية عامةً والجامعية خاصةً بتطبيق الحوکمة الرشيدة والاهتمام بتفعيل سياساتها وآلياتها وممارساتها التي تقوم على الشفافية والمشارکة والمساءلة وسيادة القانون ومکافحة الفساد وتحقيق العدالة في تطبيق الخدمات الصحية وعدم التمييز بين المواطنين، وتقديم خدمة طبية ذات قياسات جودة عالية تُرضي المواطنين. وتُعَد مستشفى جامعة طنطا التعليمي العالمي من أهم المشروعات الطبية في وسط الدلتا، حيث حرصت الدولة على الانتهاء منها وبداية تشغيلها في أوائل عام 2014، وتجهيزها بکافة المعدات الطبية والإمکانات اللازمة لتقديم خدمة طبية عالية الجودة لمواطني الدلتا، حيث تکلفت الدولة استثمارات في بناء وتجهيز المستشفى ما يُقارب من مليار جنيه. ومن خلال هذه الدراسة، حاول الباحث تَتَبُع خدمات الرعاية الصحية في المستشفى التعليمي جامعة طنطا، وما آلت إليه وما تواجهه من مشاکل وقضايا رئيسة مازالت تؤثر في تقديم خدمات الرعاية الصحية وجودتها وکفاءتها، والتي تعکس منهجية وأهداف الدولة المصرية في المنظومة الصحية ومدى قدرة ذلک الصرح الطبي العلمي التابع لجامعة طنطا من السير وفقاً لهذه الأهداف والتي على رأسها عدالة توزيع الخدمات الصحية ورفع جودتها والعدالة الاجتماعية في تقديم العلاج الطبي. Abstract Over the past few years, the Egyptian government has embarked on implementing a program to reform the national health care system, as a vital project through which it confirms its distinguished position as a source of health care services in the region, and as a real guarantee for the equitable distribution of health care within the Egyptian society. Applying good governance and paying attention to activating its policies, mechanisms and practices that are based on transparency, participation, accountability, rule of law, combating corruption, achieving justice in the application of health services, non-discrimination among citizens, and providing a medical service with high quality measurements that satisfy citizens. The International Teaching Hospital of Tanta University is one of the most important medical projects in the middle of the Delta, as the state was keen to complete it and start its operation in early 2014, and to provide it with all the medical equipment and capabilities necessary to provide a high-quality medical service to the citizens of the Delta, where the state has made investments in building and equipping the hospital. Approximately one billion pounds. Through this study, the researcher tried to track the health care services in the teaching hospital at Tanta University, and what they have achieved and the main problems and issues that still affect the provision of health care services, their quality and efficiency, which reflect the methodology and objectives of the Egyptian state in the health system and the extent of the capacity of that medical edifice. The scientific community of Tanta University is able to proceed in accordance with these goals, foremost of which is the fair distribution of health services, raising their quality and social justice in providing medical treatment.

Loss of a loved one is deeply emotional. This obituary paper is about Professor Gregory G. Maskarinec (May 16, 1951-June 16, 2022), a true friend, an academic intellectual and an honest researcher of medical anthropology. Working with him and sharing ideas with open mind was a great opportunity for me and many scholars in Nepal. Based on collaborative work, interaction and the interview with Professor Gregory, in his remembrance, I have highlighted his academic background and work experiences, friendship and collaborative work, my privilege and opportunities to write about him for his professorship and some of the dreams that could not happen due to his sudden demise. My deepest sympathies are with his family. [ABSTRACT FROM AUTHOR]

In this article, we examine the role and effectiveness of the Centers for Disease Control and Prevention in the USA and Europe and consider possible lessons for future pandemic planning in Australia. We also 'map' the interjurisdictional communication pathways that have been secured since the election of the new Commonwealth government. We suggest a number of steps that could be taken to upgrade the collection, distribution, accessibility and timelines of key information required to improve pandemic management and national health outcomes. While it may be hard to contemplate a move to a fully integrated National capacity when we are only just emerging from the pandemic, we do have a unique opportunity to at least start the process of review. We should use the lessons we have learned to transform our systems, rather than 'tinker' with them and ensure we are better prepared for next time. What is known about the topic? Much has been reported on the challenges of coronavirus disease 2019 presented to everyone at a global and country level. The pandemic highlighted the often dysfunctional decision making at all levels that impacted on the responses of govenments. What does this paper add? This paper reviews in particular the responses of the Centers for Disease Control and Prevention (CDCs) and 'maps' the interjurisdictional pathways that exist or have been proposed in Australia and outlines the opportunity that the new Government has to ensure a proper process of review of these responses. It also provides some suggestions and priorities for consideration in the planning of an Australian CDC as recently canvassed in the discussion paper released by the Department of Health and Ageing. What are the implications for practitioners? An understanding of the complexities of our health 'governance' systems and the opportunity to commence a discussion on how we might transform our systems rather than work around the 'edges' to ensure we are better prepared for the next pandemic. [ABSTRACT FROM AUTHOR]

In Brazil, 67.7% of the municipalities are characterized as small, with a population of less than 20 thousand. The objective of this article is to systematize the experience and identify the challenges and lessons learned in the implementation of the model for strengthening regional governance and organizing the health care network (HCN) in a region of Brazil composed of these municipalities, which present low technical and budgetary capacity, in addition to various fragilities related to the organization of the HCN. With a view to strengthening regional governance and the organization of the primary health care (PHC) work process and, consequently, the workflow with other levels of care, a strategy entitled More Care More Health (Mais Cuidado Mais Saúde) was proposed, developed in partnership with the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Health. The project was developed through permanent health education and institutional capacity building in the region of Ivaiporã, state of Paraná, based on workshops and addressing three priority axes: HCN integration, capacity building and information management. The target audience were the extended PHC teams. The project made it possible to develop local and governance capacities through joint reflections on the health care model, its components and the necessary changes in work processes for health promotion with a focus on the quality of life of users. Because it is an experience that considers the weaknesses, needs and autonomy of local actors, the project has a high potential for replication and customization for other regions with similar characteristics inside and outside Brazil. [ABSTRACT FROM AUTHOR]

Climate change impacts on the transmission and epidemics of vector-borne diseases (VBDs), hence an understanding of the institutional determinants that influence the response of national health systems is important. This study explored how institutional determinants influence health outcomes of malaria and bilharzia using the case study of Gwanda district, Zimbabwe, in the advent of climate change. Qualitative data were collected using in-depth interviews from representatives of public and private institutions; and organisations involved in the prevention and control of malaria and bilharzia. Results from the study showed that the Ministry of Health and Child Care of Zimbabwe and other relevant government ministries and departments involved in environmental and social issues, constituted the primary network in the control and prevention of malaria and bilharzia. Non-governmental organisations (NGOs) formed the secondary network that mainly mobilized resources or complimented the primary networks in the delivery of services. It was noted that there was an institutional structure primarily responsible for responding to malaria and bilharzia but it was not adequately prepared to address climate change-induced VBDs changes. Based on our findings, a framework for reducing vulnerability and enhancing resilience among populations affected by VBDs in the context of climate change was developed. [ABSTRACT FROM AUTHOR]