Thursday 25 January 2024
Session 1
13:00-13:15
Socioecological Factors Linked with Pharmaceutical Incentive-driven Prescribing in Pakistan
| Presenter | : | Muhammad Naveed Noor |
| Abstract ID | : | A033 |
Pharmaceutical marketing through financial incentivization to physicians is a poorly studied health system problem in Pakistan. Pharmaceutical incentivisation is seen to be distorting physicians' prescribing behaviour that can compromise the health and well-being of patients. We draw on a conceptual framework outlined in the ecological system theory to identify multiple factors linked with pharmaceutical incentivization to physicians in Pakistan. We conducted qualitative interviews with 28 policy actors to seek their views on the health system dynamics, how they sustain pharmaceutical incentivization, and their effect on the quality of care. Our analysis revealed four interlinked factors operating at different levels and how they collectively contribute to pharmaceutical incentivisation. In addition to influences such as the increasing family needs and peers’ financial success, sometimes physicians may naturally be inclined to maximise incomes by engaging in pharmaceutical incentivization. On the other hand, the pharmaceutical market dynamics that involve competition underpinned by a profit-maximisation mindset enable pharmaceutical companies to meet physicians’ desires/needs in return for prescribing their products. Inadequate monitoring and health regulations may further permit the pharmaceutical industry and physicians to sustain the incentive-driven relationship. Our findings have important implications for potential health reforms such as introducing regulatory controls, and appropriate monitoring and regulation of the private health sector, required to address pharmaceutical incentivisation to physicians.
Poster Slot
A01
13:00-13:15
Evaluation of Health and Poverty Alleviation Programs for Yunnan, China
| Presenter | : | Xizhuo Xie |
| Abstract ID | : | A032 |
Introduction
Health inequality in China, especially prominent in contiguous poverty-stricken areas, is exacerbated by conflicting social interests and values. Despite significant healthcare reform achievements, challenges persist, including imbalanced medical resources and inefficiencies. In the context of China's health poverty alleviation policies, top-down forces are crucial in supporting bottom-up project pilots. Our study, aligned with the Evaluation of Health and Poverty Alleviation Programs for Yunnan, China, aims to assess the impact of these policies, focusing on analyzing the self-payment ratio and catastrophic health expenditure before and after reimbursement, with a keen eye on the prevalence of financial catastrophic illness.
Methods
Public policy documents related to health and poverty alleviation have been analyzed at both central and provincial levels, with the evaluation incorporating data from three databases. To address data access challenges, a stratified random sampling method was employed in evaluating 88 impoverished counties in Yunnan Province.
Results
Critical illness insurance coverage was dynamically selected based on public feedback, financial burden, clear treatment pathways, and effective treatment outcomes. By the end of 2021, the number of covered illnesses increased from 9 to 30 and reached 36 in Yunnan province based on national requirements and local conditions. In 2019, Yunnan achieved an average reimbursement ratio of 89.71% for impoverished patients' hospitalization expenses, with an average out-of-pocket payment of 556 yuan, lower than the national average of 1062 yuan in 2017. Catastrophic health expenditure incidence significantly decreased from 33.25% to 2.88% after the insurance implementation.
Conclusion
Post-2015, China's improved health equality, attributed to the Health and Poverty Alleviation Policy, is tied to reduced disparities in western provinces. Our Yunnan evaluation underscores the impact of bottom-up strategies in inclusive policy implementation, addressing local challenges, and involving diverse stakeholders to tackle non-merit health inequalities.
Poster Slot
B01
13:00-13:15
Reorganized Primary Health Care through Community-based Engagement
| Presenter | : | Pradeep Jayawardana |
| Abstract ID | : | A073 |
The priority in the Sri Lankan healthcare system is the reorganization of PHC (Primary Health Care) over any other matter. A policy on primary healthcare reorganization was introduced in 2018. The threat to population health was caused by NCDs. HLCs were established as a counteractive mechanism to enhance the function and screening process. Simultaneously, a community involvement mechanism was introduced along with health promotion and a community-based participatory approach. Each primary medical care institution has been guided to establish a beneficiary supportive group called “Friends of Facility Committee”.
This arrangement has been launched across 1100 hospitals island-wide. Moreover, this mechanism is especially linked to the HLC program, initiating a guideline and reporting format to ensure progression. A minimum of 3 meetings per year must be conducted to establish an active group. Each group is comprised of a few hospital staff members and others from the community, including grassroots-level government service providers. FFCs can be involved in organizing community clinics, assisting in ensuring the highest number of empaneled population screenings and ensuring follow-up for identified high-risk groups.
In 1100 hospitals with the project involvement, 663 hospital FFCs were established. From that, 309 groups were selected for this assessment. They all conducted a minimum of 3 meetings per year. 160 groups yielded very good results, including hospital infrastructure development, drug and equipment donation, cleaning campaigns, facilitating mobile clinics, supporting follow-up patients, promoting NCD preventive habits, and advocacy campaigns. Few places have built new spaces for the hospitals of these groups costing around 6LKR million. This people-centered approach has screened more than 1.4 million populations aged over 35 for NCD risk nationwide
Poster Slot
C01
13:00-13:15
The Limits of Multilateralism: Myanmar as a Case Study of the Need to Go Local
| Presenter | : | Tom Traill |
| Abstract ID | : | A105 |
The authors examine the challenges of multilateral institutions in the context of Myanmar. They draw on firsthand experience, broad program data from one of the largest health and humanitarian NGOs in Myanmar and extensive discussions with key actors implementing health and humanitarian programs - both in collaboration with the UN and in partnership with local institutions. They emphasize the need for reform to delink (at least some of) international support for humanitarian aid and global health from these multilateral institutions towards local partners, particularly (not even) in humanitarian crises.
In the last two-three years, despite severe challenges, local and community driven institutions have managed to show resilience and effectiveness in the face of conflict, displacement and pandemics. Yet such is the strength of the traditional framework of institutions that the trusted institutions used for awareness raising and ongoing implementation remains broadly UN-focused. Empowering local organizations means giving up control from Western centres of power, but can lead to truly sustainable changes, as the people and organizations created will remain embedded in future societies. While there have been small steps in this direction, there is further to go. As the situation in Myanmar shows, rather than always trying to reform the institutions that are currently in place, it is sometimes better to go in a different direction.
Poster Slot
D01
13:00-13:15
Leaving No One Behind: Odisha’s Empowering March towards Universal Health and Gender Equity
| Presenter | : | Sudhashree Chandrashekhar |
| Abstract ID | : | A069 |
Background:
Biju Swasthya Kalyan Yojana (BSKY), a government-funded universal health coverage scheme in Odisha, India, was launched in August 2018. Currently, 9.6 million households are enrolled in the scheme, with 35.9 million individual beneficiaries with 49% female enrollment. The scheme provided annual financial protection of up to US$6000 to both male and female household members. BSKY then increased the coverage for women up to US$12000 to address the gender disparity in healthcare utilisation in August 2019. The paper explores how this policy change impacted gender-equitable healthcare services under the scheme.
Method:
This quantitative study uses BSKY enrollment and claims data to conduct a univariate analysis using descriptive statistical measures to examine gender disparities in healthcare utilisation.
Results:
Between FY 2018-19 and FY 2022-23, the BSKY scheme witnessed a substantial surge, with 1.12 million claims raised, totalling US$ 289.4 million. Notably, 47% of these claims were for female treatments, amounting to US$ 127.7 million (44%). However, there is a decline in the rate of female utilisation of non-gender-specific treatments from 48% in FY 2018-19 to 36% in FY 2020-21. Post policy change to increase coverage, a steady increase in utilisation was observed, reaching 41% in 2022-23. Interestingly, female-specific treatment claims experienced exponential growth, with an annual average factor of 7.83, surging from 9312 claims in the initial year to 0.09 million claims in 2022-23. The rise in female utilisation was pronounced in tertiary care treatments, increasing from 18% to 41% by 2022-23.
Conclusion:
Despite the pandemic delays, the policy intervention appears to be effective in increasing female utilisation. The study highlights the positive impact of the policy on doubling the BSKY coverage amount for women in promoting gender equity and underscores the positive strides made in fostering equitable access to healthcare services for all, in line with target 3.8 of SDG.
Poster Slot
E01
13:00-13:15
Decolonial Feminist Foresight: A Strategy to Address and Redress the Historical Injustice and Power Imbalance in Global Health
| Presenter | : | Tiffany Nassiri Ansari |
| Abstract ID | : | A048 |
Global health continues to reckon with its colonial underpinnings, which perpetuate power asymmetries and health inequities. Coloniality, conceptualised as an invisible power structure that sustains colonial relations of exploitation and domination, plays an ongoing role in shaping notions of evidence and expertise across the global health architecture, including research, implementation, decision-making, and governance.
To truly effect change, we must scrutinise and work against these power dynamics, especially those hinging on patriarchy which are often overlooked, in the past, present, and future. In this regard a decolonial feminist lens, integrating a futures/foresight approach, provides an opportunity to:
- Reflect on the past and identify patterns and trends that have led to the power imbalances in global health today;
- Collectively create visions of potential global health futures that are co-created and co-owned by and with those who are structurally excluded;
- Identify actions we can take in the present to realise a global health of the future that is equitable and supported by systems of governance that are anticipatory of future shocks and responsive to the needs of the most marginalised.
In June 2023, UNU-IIGH convened 30 cross-sectoral experts from 14 countries to envisage what gender equitable systems for health might look like in 2050. In this paper, we:
1. Outline principles of a decolonial feminist approach and the value its integration brings to (re)imagining global health futures;
2. Share how our integration of a futures/foresight approach and a decolonial feminist lens facilitated the convening of a diverse group of experts, generation of inclusive and equitable visions of potential global health futures, and identification of concrete next steps towards realising desired futures;
3. Reflect on lessons learned and the broader potential of this approach in dismantling global health's colonial structures, rebalancing power, and fostering equitable governance, research, and decision-making.
Poster Slot
F01
Session 2
13:15-13:30
Dietary Dichotomies: Quantifying the Impact of Global Commercial Determinants on Traditional Food Intake among China's Internal Migrants
| Presenter | : | Li Niu |
| Abstract ID | : | A083 |
Background: The Commercial Determinants of Health (CDoH) have considerably reshaped global dietary habits. China’s mid-west internal migrants, an inherently vulnerable segment, stand at the crossroads of traditional diets and the burgeoning global food marketplace. This research probes into the expansive influence of multinational food corporations on indigenous diets in Jiangxi and Guangxi province. Methods: Utilizing a mixed-methods approach, we undertook a year-long observational study (2022-2023) to delineate dietary preferences among internal migrants. Multivariate regression and principal component analysis (PCA) were deployed to gauge the magnitude and intricacies of the multinational food corporations' influence, contrasting the consumption of processed foods with traditional organic choices. Results: Multivariate regression analyses showed that exposure to global advertising significantly predicted a 70% inclination among migrants towards processed foods and beverages. Despite the agricultural prominence, only 15% of participants predominantly partook in traditional, healthier diets. Using PCA, two principal components were extracted, representing traditional dietary patterns and globalized dietary patterns. About 60% of migrants' dietary choices loaded heavily on the globalized component, indicating a preference for foods popularized by multinational corporations due to factors of perceived convenience and affordability. A logistic regression revealed that those aligning with the globalized dietary pattern had 2.5 times the odds of reporting non-communicable diseases compared to their counterparts. Discussion: The analytical depth reveals the multifaceted repercussions of CDoH on migrant dietary behaviors. The magnetism of globalization, while diversifying food options, potentially undermines indigenous and sustainable dietary conventions. The revealed relationships between commercial determinants, dietary patterns, and health outcomes highlight the urgency for tailored interventions. Conclusions: The intricate interplay between dominant commercial actors and longstanding health practices can profoundly sculpt health trajectories. Our study emphasizes the indispensability of harmonizing commercial dynamics with public health tenets to champion health equity and venerate traditional dietary paradigms.
Poster Slot
A02
13:15-13:30
Telemedicine and Elderly Care: The Impact of Caregiver Support and Digital Navigation on Access Perceptions
| Presenter | : | Pitchaya Chairuengjitjaras |
| Abstract ID | : | A092 |
Background and Aims: Telehealth has demonstrated the potential to enhance access to care and patient monitoring. Nonetheless, the influence of technology on medical care equity for elderly patients, contingent on their digital familiarity, necessitates investigation. This study assesses the feasibility, acceptability, and perceptions of the 'TeleCU' platform among elderly patients with chronic diseases. It also examines the impact of demographics and self-perceived digital familiarity.
Method: The 'TeleCU' platform, developed by King Chulalongkorn Memorial Hospital, is a mobile application encompassing registration, online appointment scheduling, and video conferencing. Demographic details and Internet usage profiles of 710 elderly chronic disease patients were collected. Participants were categorized by self-perceived digital familiarity. After engaging in telehealth visits using the platform, they completed satisfaction and perception surveys. Descriptive statistics and Fisher’s exact test were employed for analysis.
Results: Among 100 participants who completed the survey, 96.7% were satisfied with their telehealth visit. Elderly patients with high familiarity with the Internet (90.0%) and those who relied on caretakers for digital device usage (67.7%) were significantly more likely to agree that telemedicine improved access to healthcare, compared to those with limited digital familiarity (41.8%) (p = .003). No significant difference was found in overall satisfaction among patients with differing levels of digital familiarity (p = .195).
Conclusion: This study underscores the significance of addressing digital disparities in telemedicine adoption. A comprehensive approach, combining initiatives to enhance technology literacy with personalized support, can establish equitable access to telemedicine services, particularly for elderly individuals. Through such concerted efforts, healthcare systems can strive for enhanced and fair healthcare
Poster Slot
B02
13:15-13:30
Technology-Driven COVID-19 Information Dissemination and Its Impact on Mental Well-being of Medical Students in China: A Global Health Perspective
| Presenter | : | Hongye Luo |
| Abstract ID | : | A091 |
Objective
This research aims to expand the behavioral immune theory based on the perspective of emergency events, and provide solutions to the "health poverty" under global emergencies from the perspective of Chinese medical students in the post epidemic era.
Methods
We propose a comprehensive conceptual model based on behavioral immune system theory. The analysis of data were obtained from a cross-sectional survey, including 1015 participants from one Chinese medical university. It is sampled monthly according to the number of students in different grades based on the principle of multi-stage random sampling from September 2020 to June 2021.
Results
Our analysis shows that there is a significant association between the individual's emotional response, strong belief, behavioral immune response and psychological results, which can further significantly affect the individual's sleep quality (0.452), appetite (0.501) and seeking psychological knowledge (0.408). There are significant negative association in personal emotional response (-0.207), strong belief (-0.369), behavioral immune response (-0.357) and epidemic information dissemination. The spread of the epidemic is the most significant in shaping personal virtual beliefs. There are significant differences between individual emotional reaction (0.183), strong belief (1.124) and individual mental health. Addition to it, there is a significant negative correlation between behavioral immune response (-0.546) and individual mental health. Moreover, there is a significant positive correlation between individual emotional response and individual belief (0.660), and it can induce the establishment of individual virtual belief. Meanwhile, individual emotional response (0.724) and virtual belief (0.877) have significant positive correlation with the emergence of individual behavioral immune response.
Conclusion
The spread of the epidemic under the empowerment of network technology has greatly affected the physical and mental health of Chinese medical students and led to a potential "hidden crisis". This negative state may last for a long time and may induce a large number of countries in the world to fall into health poverty in the future. We further found that strong emotional perception and false belief can trigger behavioral immune response and strengthen the negative psychology caused thereby.
Poster Slot
C02
13:15-13:30
Feasibility of Implementing a Digital, Case-based, Real-time Malaria Surveillance System at the Township Level in Two States and Two Regions of Myanmar
| Presenter | : | Wah Wah Thaw |
| Abstract ID | : | A090 |
ABSTRACT SUBMISSION TO PRINCE MAHIDOL AWARD CONFERENCE 2024
TITLE: FEASIBILITY OF IMPLEMENTING A DIGITAL, CASE-BASED, REAL-TIME MALARIA SURVEILLANCE SYSTEM AT THE TOWNSHIP LEVEL IN TWO STATES AND TWO REGIONS OF MYANMAR
Authors: Wah Wah Thaw1, Day Naing Aung1, Khant Maung Maung2, Nu Nu Khin3, Gunawardena Dissanayake3, Danielle Awabdeh4, Ersin Topcuoglu4, Khin Zarli Aye1
1PMI-Eliminate Malaria, PATH, Myanmar
2PMI-Eliminate Malaria, University Research Co., LLC, Myanmar
3U.S. President’s Malaria Initiative, U.S. Agency for International Development, Myanmar
4 University Research Co., LLC, U.S.A
*Correspondence: wthaw@path.org
Abstract Theme: Sub-Theme 1 - Global Governance for Digital Health
Introduction: Real-time case-based surveillance is critical for timely response and effective transmission interruption to eliminate malaria in Myanmar. The President's Malaria Initiative Eliminate Malaria (PMI-EM) Activity supports this endeavour in Myanmar, where this study explores the feasibility of implementing a digital, case-based, real-time malaria surveillance system using the District Health Information Software 2 (DHIS2) platform.
Methods: A cross-sectional design using a structured questionnaire was conducted in May-June 2023 to assess telecommunications coverage (mobile and landline), internet accessibility, and digital literacy among township-level PMI-EM staff in 36 townships across two states and two regions in Myanmar.
Results: Findings revealed that all 36 townships had mobile telecommunications, and 34 were served by the country's four primary service providers. Thirty-five townships have access to the Internet. A total of 137 township-level staff exhibited a high level of digital literacy, with 80% proficient in the Android operating system and 95% adept in instant messaging. Notably, 55% reported using mobile applications such as Messenger, Viber, Telegram, and Signal. Most participants had experience in online survey participation and monthly digital reporting. Over 70% were skilled in web-based applications, including email usage, while approximately 60% could use Excel reporting and pivot tables, but 30% needed more specific data management and analysis capabilities. Though challenges such as limited internet connectivity in some villages, inadequate technical skills, and the burden of parallel paper-based and digital strategies must be addressed, high mobile network coverage, internet accessibility, and digital literacy indicated the feasibility of implementing a digital surveillance system at the township level.
Conclusions: The study highlighted the importance of specific technical and data management skills in the township-level staff’s continuous troubleshooting support and the possible feasibility of applying a digital, case-based, real-time malaria surveillance system at the township level.
Keywords: Digital health, District Health Information Software 2 (DHIS2) platform, Malaria, Myanmar, Real-time reporting
Word Count: 289
Poster Slot
D02
13:15-13:30
Global Governance for Health and Its Implication on Health Outcome: a Case Study from Pakistan
| Presenter | : | Sabeen Afzal |
| Abstract ID | : | A139 |
Pakistan is the fifth most populous country in the world yet ranks 161 out of 191 countries on the UNDP’s Human Development Index (HDI). Coupled with a very low HDI, high population growth rate of 2.1% per year is placing pressure on the country's resources. Being an integral part, healthcare is facing several challenges. Health is the devolved subject in Pakistan, providing greater autonomy for provincial governments, but there is need for greater investment in the health sector and improved governance and coordination structures.
The implications of global governance for health hold significant relevance, particularly in the era of poly-crises. As an emerging economy facing multiple challenges, including political instability, economic vulnerabilities, and security threats, Pakistan is deeply impacted by the shifting dynamics of global governance. The weakening of international law and norms may further exacerbate existing issues, affecting human security and health equity in the country.
By engaging with international efforts to reform health governance, the country can access essential resources and expertise to strengthen its healthcare systems. Thus addressing health disparities, ensure equitable healthcare access, and enhance preparedness for future pandemics and health crises.
However, geopolitical tensions and power struggles may also influence global health governance decisions, potentially leaving developing nations like Pakistan with limited representation. Therefore, it becomes imperative for Pakistan to actively participate in global health discussions and advocate for its health priorities. By doing so, Pakistan can contribute to shaping health policies that prioritize health equity and address the unique challenges it faces.
In conclusion, the implications of global governance for health in the context of Pakistan are multi-faceted. Addressing geopolitical dynamics, ensuring human security, and promoting health equity are essential components in navigating the challenges posed by poly-crises by actively engaging in global health governance reform efforts.
Poster Slot
E02
13:15-13:30
The Free Trade Agreements’ Impacts on Alcohol Consumption: A Guide for Government Decision
| Presenter | : | Chardsumon Prutipinyo |
| Abstract ID | : | A025 |
Alcohol is a major risk factor for NCDs, while free trade and investment agreements (FTIAs) are promoted for economic growth. Effective health policies for alcohol and tobacco control have been strongly opposed by trans-national alcohol and tobacco industries, through FTIAs. Limiting the influence of vested interests is necessary for good regulatory transparency. The objectives for this research are: 1) situation analysis of alcoholic beverages imported to Thailand from 2000 -2019. 2) correlation analysis of free trade agreements, and trade values of alcoholic beverages. 3) discussion on free trade agreements’ impacts on alcohol consumption, as a guide for government decision.
Results indicated that: 1) Thailand imported most alcoholic beverages from U.K. and France during 2000-2019 2) Correlation between Thailand and other countries are: consumption abroad, commercial presence, and various investments related to alcoholic service businesses.
Analysis by multiple regression indicated that influential factors on imported alcoholic beverages were: the first decade had an influence of 0.472, and Gross Domestic Products (GDP) had an influence of 1.02
3) Discussion of free trade agreements’ impacts, as a guide for government’s decision, were: Investor-State Dispute Settlement (ISDS), Technical Barrier to Trade, and Digital Trade as a new challenge
Conclusions: Integrated research, covering sophisticated areas of theory and scientific system, are necessary to monitor and evaluate free trade agreements’ impacts on health.
Secondly, government should require a frame for coherent of public health principles, for a common good.
Thirdly, health advocates should reframe procedural for negotiation, content and context, with the importance of society, environment, and health for all.
Fourthly, government leaders should not allow for the demand of government’s compliance to commercial goals.
Lastly, alcoholic beverages should be treated as “no ordinary” goods on negotiation table, and government should provide a remedy compensation for the damage caused by alcohol.
Poster Slot
F02
Session 3
13:30-13:45
An Analysis of the Bill and Melinda Gates Foundation’s Grants to the World Health Organization, 1998-2022
| Presenter | : | Jonathan Kennedy |
| Abstract ID | : | A076 |
The Bill and Melinda Gates Foundation (BMGF) is the World Health Organization’s (WHO) second biggest source of funding. There is, however, no systematic analysis of BMGF’s grants to WHO. Our study aims to fill this gap in the literature by examining how much money BMGF gives to WHO and what this money is spent on.We constructed a dataset of BMGF grants to WHO for the period 1998-2022 by extracting and coding data retrieved from BMGF's website. This dataset was analysed to examine the number and value of grants, and the diseases or health issues and activities that were funded. BMGF made 535 grants worth $4·7 billion to WHO, 5·9% of all the BMGF’s grants by value in the period. In terms of diseases and health issues funded, polio amount to 58·3% of all grants by value and all infectious diseases 82·3%. With regard to activities funded, specific vaccine-related programmes and projects account for 51·8% of BMGF grants to WHO by value, 93·7% of which focused on polio. A large proportion of funding for other activities supports vertical infectious disease-focused programmes and projects. $32.3 million (0·7%) went to health systems strengthening. Relatively small amounts went to NCDs: $35·9 million (0·8%) for tobacco control and $67·5 million (1·4%) to nutrition. Broader determinants of health like poverty and inequality, armed conflict and climate change are largely ignored. The majority of BMGF funding to WHO is spent on polio vaccination but polio accounts for an insignificant proportion of the global burden of disease. Relatively little BMGF money goes to strengthening health systems, non-communicable diseases and broader determinants of health, despite their importance to the WHO. WHO’s reliance on earmarked voluntary donations from organizations such as BMGF could undermine its ability to achieve its strategic priorities.
Poster Slot
A03
13:30-13:45
Reevaluating Global Health and International Law: The Relationship between Regime Interaction and Legal Fragmentation among Mechanisms Governing the Public Health Sphere
| Presenter | : | Matthew Carvalho |
| Abstract ID | : | A098 |
This research examines the relationship between legal fragmentation in international governance and conventions which regulate the space of global health. Theories regarding fragmentation in international law have been studied since the inception of the United Nations system, and with every new convention that enters into force, the fissures and overlaps of doctrine guiding the framework of global public health have grown. While this phenomenon causes various health issues and disputes to fall under multiple governance schemes, it has sometimes resulted in positive outcomes for health protections, including specialized treaties more precisely articulating legal guidelines for global response. Through analysis of these precedents and case studies, this investigation sought to answer whether the fragmentation of global health law actually benefits the regimes which these conventions attempt to cover, and determine if this fragmentation is an intentional diplomatic mechanism, or an unintended effect of a siloed international health field.
Poster Slot
B03
13:30-13:45
How Cultural and Spiritual Entities Leverage the Achievement of Global Health Agendas: Learned from Pandemic Control in Indonesia
| Presenter | : | Salamuddin Nasution |
| Abstract ID | : | A057 |
Globalization has opened up the boundaries between countries. The COVID-19 pandemic highlights how globalization drives the vast transmission of pathogens, followed by the rapid spread of information. Particularly in Indonesia and Asian Region, cultural and spiritual subjects were among the most influencing information hampering the control efforts of the pandemic and other global health agendas. On the other side, cultural and spiritual factors are entities to which the people still adhere and influence the social construct in daily lives. A literature study was conducted to elaborate on how cultural and spiritual components can be utilized to accelerate the achievement of the global health agenda in Indonesia. Studies found that religiosity positively correlates with people’s compliance, lowered distress, and social support, which is essential in developing people's healthier behavior. However, in Indonesia, some cultural and spiritual issues regarding non-halal vaccines, people’s perception of commercial motives of the vaccines, the violation of the restriction of cultural and religious events, and the community framing regarding the COVID-19 pandemic created hesitancy and rejection toward control measures. Thus, cultural and spiritual reasons can be a risk factor, and can also be utilized to leverage the health agenda. Ignoring these aspects means relieving the significant references people use in determining their behavior. Community with tight culture and religion will follow their leaders. In some communities in Indonesia, these important figures could encourage the acceleration of vaccination coverage, compliance with health protocols in public areas, and countering the negative information spread through social media. The study suggested that it is crucial for the government to invest more to increase literacy and the capacity of the leaders and involve them more in program implementation as trusted messengers in the community by delivering health information more respectfully to the target community.
Poster Slot
C03
13:30-13:45
Political and Economical Analysis of the Amending Process of The Tobacco Hazards Prevention Act in Taiwan
| Presenter | : | Feng Jen Tsai |
| Abstract ID | : | A061 |
Introduction: Due to the concern of increasing prevalence of e-cigarette use among teenagers and young adults, Taiwan amended and approved the Tobacco Hazards Prevention Act in January, 2023 and entered into force in March. Among the 7 issues amended this time, the regulation for e-cigarette and heated tobacco products (HTP) is the key focus. There are different stakeholders participating in the process of shaping such health policy. This study aims at analyzing the power dynamics of the amending process of the Act with experience sharing from the angle of government.
Method: In this study, we use political and economic framework of Sparkes et al. (2019) to analyze different stakeholders’ positions on e-cigarette and HTPs. In this framework, there are six major categories of influential stakeholders: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. We collected stakeholders’ positions on the government’s policy by searching keywords: e-cigarette, heated tobacco products and tobacco control law in Mandarin during 2020 to 2023 in google website.
Result: We found that the majority of the stakeholders support the government’s policy. Only the tobacco interest stakeholder group and the opposition political party were against the government’s policy. However, the interest stakeholder group had less influence on the public, and the opposition party accepted the government’s position after consultative discussion among political parties.
Conclusion: The position of various stakeholders regarding the banning of e-cigarette and strictly regulating of HTP has shown that the support is greater than the resistance.
Poster Slot
D03
13:30-13:45
Third-Party Validation (TPV) of Pakistan's Prime Minister's National Health Programme (PMNHP)
| Presenter | : | Muhammad Arshad |
| Abstract ID | : | A086 |
PMNHP, now recognized as the Sehat Sahulat Programme (SSP), is a significant Health Protection initiative in Pakistan, aiming to establish universal health insurance coverage. This study presents the outcomes of a comprehensive TPV designed to evaluate the PMNHP's efficacy, transparency, and accountability in achieving its intended objectives. Launched in December 2015 and overseen by the Ministry of Health, Government of Pakistan, the PMNHP offers cashless in-patient secondary and priority healthcare services. The research conducts a thorough assessment of diverse program facets, encompassing design, implementation, enrollment, community mobilization, service delivery, communication, and sustainability. The TPV utilized a sophisticated multi-method approach. It commenced with alignment meetings with stakeholders, followed by an extensive desk review of relevant literature. The fieldwork, involving data collection through tailored tools, from a sample of over 16,000 beneficiaries (5% of total). Collected data underwent rigorous analysis. Key findings underscore successful enrollment of a considerable portion of the target population, ensuring coverage for in-patient secondary and tertiary services. Beneficiaries display awareness of the program and healthcare facilities, expressing high satisfaction with healthcare quality. However, the enhancement of communication methods is necessary to effectively convey program benefits. Some beneficiaries encounter out-of-pocket costs, mainly associated with services beyond the benefit package and pre-diagnosis expenses, despite the program's cashless nature. The study highlights sustainability challenges stemming from escalating healthcare costs. Notable recommendations encompass program integration with primary healthcare services, intensified grassroots communication, and adjusted coverage and financial parameters to combat inflation. Emphasizing the need for cost contribution mechanisms, financial stability is accentuated. In conclusion, the PMNHP's positive impact on healthcare access and financial security is evident. Its success has reduced beneficiary out-of-pocket expenses. To ensure enduring sustainability and expansion, establishing a national health financing policy is essential. Despite challenges, the program's popularity and positive outcomes position it for a successful future.
Poster Slot
E03
13:30-13:45
Building towards a Decolonised Leadership Programme for Health Equity: The Tekano Journey
| Presenter | : | Tracey Naledi |
| Abstract ID | : | A078 |
Background
In 2016, the Atlantic Philanthropies (AP) established seven global Atlantic Fellows programmes of lifelong communities of health equity leaders. From 2017, Tekano Atlantic Fellows for Health Equity in South Africa was co-created and led by majority Black South African women who are public health leaders. Unlike the other Atlantic Fellows programmes based in academic institutions, Tekano was established as a non-profit organization. This was to ensure non-alignment to the neoliberal politics of academia and to facilitate access for those previously disadvantaged. Here we reflect on Tekano’s journey of developing a health equity leadership programme informed by decolonial, Pan-Africanist and feminist principles.
Methods
This is a case study of Tekano’s development were participatory, iterative approaches to programme design, monitoring, evaluation and learning were used.
Results
Since 2017; Tekano has graduated five cohorts of 75 fellows , aiming to advance health equity in South Africa. Fellows are demographically representative, diverse in religion, political affiliations, organisations, disciplines and ways of seeing and being. The Tekano journey has included four phases. Phase 1: An apolitical programme on theoretical concepts of social determinants of health. Phase 2: Addition of the concepts of visionary leadership and critical thinking (head), relational concepts (heart) and advocacy concepts (hands). Phase 3: An explicit addition of key political principles of decoloniality, Pan-Africanism and feminism, and Phase 4: Expanding to include fellowship support (body) and community and stakeholder management (feet). In the global relationship as part of the Atlantic Institute, Tekano has leveraged lessons for local action and negotiated its power and agency to amplify its advocacy actions for relevant issues.
Conclusion
The Tekano Fellowship provides useful insights from efforts to develop a leadership programme for health equity change makers who are legitimate knowledge holders and can influence change in their communities and globally.
Poster Slot
F03
Session 4
13:45-14:00
Governance Lessons from Nepal for Pandemic Preparedness and Response
| Presenter | : | Shanti Mahendra |
| Abstract ID | : | A074 |
Nepal is in a geopolitically delicate space between China and India. There are no travel restrictions for Nepalese and Indian citizens between the two countries. During the Covid-19 pandemic, the nearly 2000 Km border between Nepal and India posed a challenge, with lockdowns in both countries in 2020 prompting thousands of people to return home.
From a Nepal health systems perspective, cross-border and internal governance of the pandemic response, were complicated by Nepal’s 2015 transition to federalism. Responsibilities and coordination mechanisms for the health sector across the three new tiers of government were still evolving when the crisis began. Further, Nepal established additional structures for oversight of the pandemic response. Province and local level governments were not represented at the new High-Level Coordination Committee nor at the Crisis Management Center, despite their implementation roles. Local governments were responsible for setting up health desks at ground crossing points (GCPs), but a study led by a global governance partner, the International Organization of Migration (IOM), found that GCPs fell short of International Health Regulations (IHR) requirements.
The Federal Ministry of Health and Population adapted its approach to strengthen the pandemic response at all levels of the health system. The Nepal Health Sector Support Programme (NHSSP), funded by FCDO and led by Options Consultancy Services Limited had been in situ since 2010 and was well placed to support government at all levels, including analysis of data for planning and learning. NHSSP also provided specific support to protect the most vulnerable groups during Covid-19.
Three key lessons for future pandemic preparedness are to invest effort in coordination mechanisms for the devolved health system for everyday functioning and preparedness for the next pandemic; local government need to be lead actors from the outset; use the IHR self-assessment data to advocate for investment in health security.
Poster Slot
A04
13:45-14:00
Placing Child Health at the Center: A Case Study on Improving Global Health Governance
| Presenter | : | Jennifer Requejo |
| Abstract ID | : | A054 |
The global landscape has shifted to a multipolar world characterized by countries with divergent political and economic trajectories. The global development architecture crafted in the aftermath of World War II, including the United Nations (UN) system, was built on a liberal, rules-based order with human rights as an anchoring principle. To keep pace with global transitions and maintain its legitimacy as a global leader, the UN continues to undergo reforms to improve inclusive representation of member states.
Although there has been a rise in non-Western political philosophies, human rights principles remain embedded in development frameworks such as the Sustainable Development Goals (SDG). Central to the SDGs is achievement of universal health coverage, which is predicated on health equity. Modalities considered essential for reaching universal health coverage are working in partnership, promotion of peace and justice, and forging strong institutions including health systems – all practices that form the cornerstone of the UN.
Our research uses child health as a case study to examine the state of global governance for health, including the effectiveness of the UN system and its partners in implementing the above-mentioned modalities to reach every child with life-saving health services even as competing priorities such as climate change and pandemics capture the public’s attention. The case study takes a historical perspective on the integration of child health into global development frameworks, assessing how the level of prioritization for child health has changed and the implications of these changes on global development. It will illustrate through analysis of trend data that child health remains a salient marker of equity and the possibility of a brighter, more stable future. It also examines the country-centered model of the Global Financing Facility for Women’s, Children’s, and Adolescents’ Health as a way forward for improved global health governance for all.
Poster Slot
B04
13:45-14:00
Temporal Shifts in Mental Health Resource Equity and Efficiency in Guangxi, China: A 2015-2021 Assessment
| Presenter | : | Aihong Xie |
| Abstract ID | : | A108 |
Background: The “National Mental Health Work Plan (2015-2020)” and the “Guangxi Mental Health Work Implementation Plan (2016-2020)” sought to shape mental health resource allocation in Guangxi. This research offers an evaluative lens into the efficiency and equity transformations across this timeline, intending to inform subsequent mental health governance in Guangxi and comparable regions.
Methods: We engaged a trifold methodological approach: harnessing the DEA model to scrutinize efficiency shifts, and the Gini coefficient alongside the concentration index to parse equity changes in mental health resource allocation from 2015 to 2021 in Guangxi. Data pertaining to mental health institutions, available facilities, and licensed personnel informed this analysis. Spatial differentials were visually captured via ArcGIS 10.8, rendering concentration level distributions.
Results: Our juxtaposition between 2015 and 2021 elucidated two central themes: A noteworthy enhancement in resource allocation equity by 2021 vis-à-vis 2015, albeit marred by persistent regional imbalances. The efficiency landscape, conversely, demonstrated an overall regression since 2015, albeit sporadic pockets of growth. A spatial overview painted a higher resource concentration gradient within central and southern precincts, dwindling towards the northeastern and southwestern axes, with Nanning, Guigang, and Yulin emerging as core hubs.
Conclusion: To bridge these identified lacunae, there’s an exigency for government-led architectural recalibration: holistic planning, tightened regulatory oversight, and strategic resource positioning. Instituting a robust support mechanism can galvanize the languishing regions, compressing the identified equity chasm. Concurrently, hospital managerial prowess must be fortified, with a pronounced emphasis on nurturing human capital.
Poster Slot
C04
13:45-14:00
Global Solidarity and Political Determinants of Health: The Experience of Myanmar and Sudan
| Presenter | : | May Phyu Sin |
| Abstract ID | : | A123 |
The political turmoils ignited by conflicts between two military coup leaders in Sudan in April 2023 and a military coup in Myanmar in February 2021 are examples of how political determinants of health can significantly impact people’s lives, health, and well-being in many different complex ways. Beyond ongoing brutal attacks leading to direct wounds and lost lives, healthcare systems, access to healthcare services, and health governance can be severely disrupted including through power play and various political maneuvers.
Both Sudan and Myanmar are countries whose people have been experiencing civil wars for decades. Currently, the classic global response to humanitarian crisis, such as international or foreign aid agencies and donors, is facing complex challenges in both countries - including indications of aid hampering, limitation, or blockage. The similarity in patterns between the two countries can indicate how health can be highly political, and how power struggles play significant roles in determining health. However, while some geopolitical responses have been seen in both cases, global solidarity attempts to stop human rights violations in Sudan and Myanmar has been overshadowed by other crisis.
As both countries strive for democracy, in this commentary, we argue that global health communities, alongside geopolitical alliances, should not only coordinate business as usual through humanitarian aid in times of health crises experienced by countries like Sudan and Myanmar. There is a critical need to address the root causes of the problem - the political determinants of health - by building, sustaining, and acting on collective global solidarity against political power being wielded to harm, especially through peaceful but deliberate efforts to defend human rights. Moreover, it is especially important to direct this solidarity equitably for all people whose health is threatened by political crisis, including those who are not part of one’s own country, region, or alliances.
Poster Slot
D04
13:45-14:00
Exploring Co-production of Responses to Infectious Disease Threats With(in) Nepali Communities
| Presenter | : | Anna Durrance Bagale |
| Abstract ID | : | A005 |
Co-production between researchers, service providers, and affected communities is an old concept renewed by current efforts to decolonise academia, reduce exploitative practices, and ensure its relevance. Working for change with and within communities is central to healthcare improvement, but engaging with communities – what people know, feel, do, and what they would like to change – remains challenging for disease control professionals. Co-production helps ensure communities have some control over the design and implementation of any intervention, greater ownership of processes and outcomes, and, theoretically, some capacity to hold intervention providers to account. This multimethod study included interviews, focus groups and photovoice in five low-income communities across Nepal to identify how zoonotic diseases and their control are perceived and enacted: what people do, why, how this differed in the past or could be improved in future. We found that community participants, despite strong opinions and desire to participate in disease control interventions, had only been offered recipientship, with little or no attempts by intervention organisers to engage them in design, implementation, evaluation, or accountability. Participants highlighted the significance of working in ‘local’ languages, respecting religio-cultural realities, relating initiatives to lived experience, and ensuring that local leaders and influencers are involved, demonstrating that little has changed in the ways public health research is conducted. Meaningful co-production requires recognising communities – through legitimate leadership/representation - as the experts and equal partners who can ‘work alongside’ at all stages of any initiative. Much more needs to be done within global public health practice to achieve this.
Poster Slot
E04
13:45-14:00
Building Governance through a Regional Network and Assessment Tool
| Presenter | : | Jia Xin Foo |
| Abstract ID | : | A009 |
A robust monitoring and evaluation mechanism is essential to facilitate accountability of local governments. However, most cities in the South-East Asia Region (as classified by WHO) are lacking in data infrastructure. To build cities’ capacities, the Regional Laboratory on Urban Governance for Health and Well-being (RL-UGHW) partners with local governments in the region to build governance mechanisms that holistically assess cities’ social determinants of health. By building local governments’ ability to chart their cities’ health profiles, cities are better positioned to identify suitable policy interventions and to benchmark improvements.
Leveraging our position as an international organisation, RL-UGHW motivates cities in SEAR with the regional accreditation as a Healthy City. Through the SEAR Healthy Cities Network, RL-UGHW facilitates a regional platform for capacity building and joint learning, simultaneously conducting research to support cities’ development efforts.
The SEAR Healthy Cities Network’s comprehensive assessment tool is designed to support cities in identifying critical issues, while providing cities with the flexibility to develop according to their own needs. While similar platforms exist globally, the SEAR Healthy Cities Network is unique in its emphasis on both equity and governance. To mainstream equity, assessment indicators include the adequacy of coverage of policies and welfare for vulnerable populations in the city. Additionally, to highlight the importance of urban governance in advancing sustainable improvements in health, governance indicators are awarded with twice the weightage in the accreditation.
RL-UGHW launched the SEAR Healthy Cities Network in 2022 and is currently in the initial phase of engagement with cities in the region. Having established an understanding and political commitment of member cities, RL-UGHW works in continued partnership with cities to advance governance for health and well-being.
Poster Slot
F04
Friday 26 January 2024
Session 5
10:00-10:15
Strategic Health Financing to Primary Health Facility Investment in Low Resource Setting in Myanmar
| Presenter | : | Bawi Mang Lian |
| Abstract ID | : | A075 |
ABSTRACT
Amidst the ongoing humanitarian crisis in Myanmar, the allocation of resources for health facilities in rural areas has been a critical concern. Traditionally, rural health facilities were built by local communities, leading to an uneven distribution of infrastructure. With the shift towards democratic governance, the government began funding the capital budget for rural health facilities. However, the current distribution remains influenced by political and population density factors, raising questions about equitable allocation.
This study aims to assess the distribution of existing health facilities, understand stakeholder perspectives on equity in allocation, and evaluate the factors shaping planning processes. Employing a participatory approach, the study engaged high officials, health directors, parliamentarians, development partners, implementing partners, civil society organizations (CSOs), and local communities. Data collection involved nominal group techniques, focus group discussions, and key informant interviews.
Findings indicate sluggish progress in constructing new facilities in remote areas, and operational mismanagement poses a significant challenge consuming time and resources. Political influences also impact decisions, with stakeholders considering various factors. The study underscores the need for a consensus-building platform among stakeholders to ensure equitable distribution. Recommendations include reallocating health facilities for effective management, implementing multi-year infrastructure master planning, and establishing standardized norms for health facility distribution.
Key words: Health Facility, Equity, Resource Allocation, Norms, and Political Economy
Poster Slot
A05
10:00-10:15
Role of Health Equity in Health Technology Assessment in Asia: A Landscape Analysis of 13 Health Systems in Asia
| Presenter | : | Chanthawat Patikorn |
| Abstract ID | : | A088 |
Background: Health equity-informative health technology assessment (HTA) can help inform decision-makers on the efficient use of finite resources and equitable access to healthcare services. This landscape analysis aimed to explore the role of health equity in HTA processes and decision-making in Asia.
Methods: Targeted literature review and interviews with 22 key informants were performed in May-June 2023. Informants were academics, government officers, and policymakers, who represented 13 health systems in Asia, including Brunei Darussalam, Cambodia, China, Indonesia, Japan, Malaysia, Myanmar, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Descriptive and thematic analyses were performed to summarize the role of health equity in HTA and its facilitators and barriers.
Results: Consideration of health equity was recommended in the HTA assessment guidelines of five health systems. However, in most health systems, health equity was qualitatively and implicitly implemented in the deliberative HTA process. Equity-informative economic evaluations, e.g., distributional cost-effectiveness analyses (DCEAs) were in the infancy stage, as few health systems have begun to perform DCEAs to explore their application. Politics, evidence of health inequities, and HTA guideline recommendations were commonly described as key drivers to integrate health equity in HTA to align with the health systems’ philosophy and goal of achieving equitable healthcare. Barriers to comprehensively incorporating health equity in HTA were a lack of data on equity-relevant subgroups and insufficient methodological knowledge and human resources of analysts and policymakers.
Conclusion: Health equity is commonly considered in a qualitative manner in HTA in most health systems in Asia. We encourage that health equity should be explicitly considered in HTA, and improvement in data availability and capacity building are warranted to strengthen the role of health equity in HTA.
Poster Slot
B05
10:00-10:15
Do Electronic Health Literacy and Online Health Information Seeking Mediate the Effects of Socio-Demographic Factors on COVID-19 and Non-Communicable Disease (NCD) Related Behaviors among Myanmar Migrants in Southern Thailand?
| Presenter | : | Hein Htet |
| Abstract ID | : | A034 |
Introduction: Myanmar migrants in Thailand are vulnerable to COVID-19 and Non-Communicable disease (NCD) risk behaviors, influenced by socio-demographic factors. In the digital age, migrants can seek extensive health information online, and their ability to understand and use electronic health information, which is known as electronic health literacy (e-Health literacy), becomes critical in making decisions about their health behaviors. This study aims to investigate the potential mediating roles of online health information seeking and electronic health literacy in the associations between socio-demographic factors and COVID-19 and NCD-related behaviors.
Methods: Our study was conducted in 2022, involving 1,050 Myanmar migrants in two Southern Thailand cities. Data on socio-demographic factors, e-health literacy, online health information seeking, COVID-19 behaviors (adherence to COVID-19 Protective Behaviors [CPB], vaccination), and NCD risk behaviors (smoking, betel chewing, alcohol consumption, substance abuse) were collected. Structural equation modeling (SEM) was employed to analyze the hypothesized relationships.
Results: Nearly all migrants received the COVID-19 vaccination in two doses and above, with reasonable good adherence to CPB. Migrants exhibited risky NCD-related behaviors, including current smoking (26.8%), alcohol consumption (17.5%), and betel chewing (25.8%). Approximately three-quarters (73.4%) had limited e-Health literacy level and the vast majority did not search for online health information. Their COVID-19 and NCD-related behaviors were directly influenced by socio-demographic factors without the significant mediation roles of electronic health literacy and online health information seeking.
Conclusion: In conclusion, Myanmar migrant workers in Southern Thailand had reasonably good practices in COVID-19-related behaviors despite engaging in risky NCD-related behaviors. These outcome behaviors were directly influenced by their socio-demographic factors without the significant mediation roles of electronic health literacy and online health information seeking. The findings suggest that diverse interventions beyond e-Health strategies for future pandemic mitigation and enhancing their health behaviors are needed.
Poster Slot
C05
10:00-10:15
Revitalizing Ethnic Health Information Systems in Conflict-Affected Southeast Myanmar: A Scoping Review
| Presenter | : | Zarni Lynn Kyaw |
| Abstract ID | : | A037 |
The conflict in southeast Myanmar has a significant impact on the country’s Health Information Systems. The conflict has disrupted health services, damaged health facilities, and displaced people. Ethnic Health Information Systems (EHIS) in southeast Myanmar also face challenges due to armed conflict, resource limitations, and cultural and linguistic barriers. EHIS are essential for ensuring that the country has the information it needs to make informed decisions about health policy and to improve the health of the population.
The HOT-fit framework is a useful tool for conceptualizing the complex interplay of factors that influence the success or failure of EHIS. The framework is based on the idea that a successful health information system must be fit for purpose, which means that it must be aligned with the needs of the people who use it, the organization that uses it, and the technology that is used to implement it.
This scoping review aims to identify the determinants of success and failure of EHIS in conflict-affected ethnic communities in Southeast Myanmar. The review includes three phases:
• Developing a search strategy, inclusion and exclusion criteria to identify relevant studies.
• Conducting data extraction and analyzing and synthesizing the data by identifying themes, patterns, and gaps in the literature.
• Reporting via various channels.
Results
• Community engagement is essential for the success of EHIS. Communities need to be involved in the design, implementation, and monitoring of these systems.
• EHIS require resources such as funding, equipment, and trained staff.
• Improving data collection and management is essential for strengthening EHIS.
Conclusion
• Collaboration between ethnic groups, agencies, and development partners is important.
• Systems need to be flexible and adaptable to changing needs.
• There is a need for innovative solutions to the challenges facing EHIS. Developing new technologies or adapting existing technologies to meet the specific needs of the population.
Poster Slot
D05
10:00-10:15
Decolonizing Medical Education and Research: Perspectives from Young Healthcare Professionals in Kerala, India
| Presenter | : | Shaheer Aboobacker |
| Abstract ID | : | A072 |
Background
In recent years, there has been increasing discussions on decolonizing medical education and research especially in LMIC context. The colonial remnants are still part of medical education and research, causing health system challenges i.e., dependency on English language, overlooking traditional medicine systems and cultures. The perspectives of young professionals are rarely reflected in reformative decisions and policies regarding the same. This original research was conducted to enrichen wider discussion on decolonizing medical education through perspectives of young health professionals from Kerala.
Methodology
An online questionnaire focusing on opportunities, barriers and methods for decolonizing medical education was administered to fifty-two young healthcare professionals and students from Kerala during the period 01/08/2023 to 10/08/2023.
Results
Survey respondents included medical doctors, public health professionals and students. 70% respondents didn’t find the medical education up to their expectations while 56% stated that the curriculum wasn’t aligned to the population health needs. 24.5% were in support of decolonizing medical education, 38.8% were against it while the rest weren’t sure. While English is the prevailing medium of instruction and participants are mostly from allopathic background, more than half considered supplementary inclusion of local language (56%) and incorporation of traditional medicines (59.2%) as beneficial. 42.9% believed that decolonization efforts shall affect and harm their future career prospects.
Discussion
The study corroborates previous understandings on decolonizing medical education and research to better align with population health needs. The findings from the study are mixed highlighting both opportunities but also barriers towards these reforms. These views come from a state which has experienced high international migration over several decades. The study also points on how context, culture and socio-demographic dynamics influence viewpoints on high level political themes. Further discussions and research on the same shall make a huge impact in decolonizing efforts in medical education and research.
Poster Slot
E05
10:00-10:15
Global Health Governance Performance during COVID-19, What Needs to Be Changed? A Delphi Survey Study
| Presenter | : | Wafa Abu El Kheir-mataria |
| Abstract ID | : | A044 |
Background
Covid-19 is not the first pandemic to challenge GHG. Preceding outbreaks and epidemics were sources of continuous debate on GHG leadership and structure resulting in its current structure. However, Covid-19 proved the presence of many deficits in the current GHG. The response to the Covid-19 pandemic is a cumulative result of all policies and actions of different governments and agencies active in global health. Assessing how Covid-19 is being handled globally provides lessons for ensuring better performance in facing upcoming outbreaks. This study has three main objectives: first, to evaluate the performance of GHG during Covid-19 in general and in relation to Covid-19 vaccine equity in particular. Second, to identify the reasons behind this performance; and third, to propose prospective changes in GHG for better performance.
Methods
A cross-sectional research design using the Delphi method was applied. A panel of experts participated in the three-round Delphi surveys. Their scores were used to perform consensus, performance and correlation analysis.
Results
GHG performance limited the achievement of Covid-19 vaccines’ global equity. GHG performance is a product of the existing GHG system, its actors and legal framework. It is a collective result of individual GHG actors’ performance. The most influential actors in decision-making regarding Covid-19 vaccine are the vaccine manufacturers and governments. While the most invoked power to influence decision are economic and political powers. Covid-19 decisions underlying value, although had human right to health at the base, overlooked the concept of health as a global public good and was skewed towards market-oriented values. GHG mal-performance along with its underlying factors calls for four main changes in GHG structure: assigning a clear steward for GHG, enhanced accountability, centralized authority, more equitable representation of actors, and better legal framework.
Conclusion
GHG structure, actors’ representation, accountability system, and underlying priorities and value require future modification for GHG to achieve better future performance and higher health equity levels.
Poster Slot
F05
Session 6
10:15-10:30
South-to-South Collaboration: A Learning Model for Oxygen Ecosystem Strengthening
| Presenter | : | Quy Tran |
| Abstract ID | : | A126 |
At the peak of the COVID-19 epidemic in 2021, the United States Agency for International Development (USAID) pledged funding to Vietnam to expand liquid oxygen (LOX) infrastructure. Following the success of the first phase of funding in select countries, including Vietnam, USAID identified 10 countries to receive LOX infrastructure funding through the Meeting Targets and Maintaining Epidemic Control (EpiC) project, including Vietnam and Papua New Guinea (PNG).
EpiC Vietnam successfully installed 13 LOX systems in 2022 with plans to install 10 more this year. EpiC PNG received funding to install the first two LOX systems ever in the country. The Vietnam project hosted a learning tour for EpiC PNG colleagues and government representatives in April 2023 to view three completed LOX sites and meet stakeholders.
The visit began with a meeting to familiarize the PNG team with Vietnam’s processes for site selection, approvals, and system design. Discussion included roles, responsibilities, and technical details. The Vietnam team shared successes, challenges, and corrective actions. This created an opportunity for EpiC Vietnam to review and document experiences and learning to inform pivots for the second phase. PNG learned how Vietnam adapted partnerships, flexibly responded to evolving hospital needs, and how the country team managed the operationalization of LOX systems and vendors. Because of this exchange, EpiC PNG was able to expedite its scope and strategy for the inaugural LOX systems investment in the country. The visits also enabled the PNG delegation to observe system differences and gain insights from facility leaders that informed their planning.
The model of south-south learning boosted knowledge sharing and capacity building for PNG while codifying Vietnam’s understanding of LOX implementation and enhancing oxygen access and pandemic preparedness for both countries.
Poster Slot
A06
10:15-10:30
Assessing Policies for a Climate-Resilient Health Systems in Guyana: A Comprehensive Mixed-Methods Study
| Presenter | : | Cecil Boston |
| Abstract ID | : | A038 |
Background: Like other Small Island Developing States, Guyana is characterized by fragile health systems that are susceptible to the deleterious effects of climate change.
Design and methods: The study sought to critically evaluate Guyana's policies, over a 20-year period, for a climate-resilient health sector using a mixed-methods case study. Data were gathered through stakeholder engagement, literature review, quantitative surveys, semi-structured interviews, and situational analyses. The analysis utilised the WHO Operational Framework and provided a situational analysis of health system policy responses to climate change.
Results: The results showed multiple policies addressed climate change impacts on health, including the National Health Plan, Country Cooperation Strategy, and Climate Change Resilience Strategy and Action Plan. These proposed interventions sought to improve occupational safety, disaster preparedness, and vector control. However, implementation was hindered by limited resources, coordination issues, and the evolving nature of climate change policies, rendering progress incomplete to embryonic.
Conclusions: Despite these challenges, Guyana's 2023 budget shows its commitment to health impact mitigation with significant investments. The study also identified a knowledge-action gap, with respondents unaware of the specific health impacts of climate change or response initiatives, highlighting the need for better awareness. The findings, mapped to the WHO Operational Framework, noted leadership, governance, financing, and workforce issues. In conclusion, despite proactive strategies, implementation is hindered by resource, poor coordination, and knowledge-action gaps. Future studies should focus on financing mitigation efforts locally and effectively using potential oil industry revenue. The study calls for continuous critical assessments of climate change policies.
Poster Slot
B06
10:15-10:30
Collaborating for Resilient & Sustainable Health Systems in Asia Pacific
| Presenter | : | Syaru Shirley Lin |
| Abstract ID | : | A136 |
The world is emerging from the COVID-19 pandemic with a renewed focus on health. The Asia-Pacific region, bearing the initial brunt of the pandemic, remains vulnerable to ongoing challenges but offers valuable lessons for the global community.
As the Asia-Pacific Research Hub of the global Partnership for Health System Sustainability and Resilience (PHSSR), the Center for Asia-Pacific Resilience and Innovation (CAPRI) has coordinated reports on the sustainability and resilience of health systems in Malaysia, three of the Pacific Islands Countries and Territories (PICTs; specifically, Republic of Marshall Islands, Tonga, and Vanuatu), South Korea, and Taiwan. CAPRI’s regional report highlights the common trends in health and healthcare confronting the Asia-Pacific region, including an aging population, the impact of climate change on health, the rise of digital health technology, and critical workforce shortages. These trends impact the sustainability and resilience of health systems in the region, necessitating the continued engagement of communities, cross-sector stakeholders, and regional governments to address these multifaceted issues effectively.
PHSSR is a non-profit, multi-sector, global collaboration with a unified goal of building more sustainable and resilient health systems. The PHSSR is active in over 30 countries and has published 24 reports to date on its commissioned independent research, providing evidence-based recommendations to strengthen health systems. This work is conducted by experts around the world with first-hand knowledge and experience of their national health systems.
CAPRI is a nongovernmental, nonpartisan, international organization founded in 2022 to enhance global resilience and promote innovative governance by drawing on the experience of the Asia-Pacific region through comparative public policy research. Since May 2022, CAPRI has hosted the partnership’s first regional research hub and plans to expand the scope of health systems research to additional countries and territories in the coming years.
Poster Slot
C06
10:15-10:30
Transformative Leadership and Health Equity in the Context of Geopolitics and Power Asymmetries
| Presenter | : | Tanja Tomson |
| Abstract ID | : | A027 |
Transformative Leadership and Health Equity in the Context of Geopolitics and Power Asymmetries
The changing nature of global power structures and the number of players in global health (GH) call for updated governance mechanisms, as many international organizations were created under a different geopolitical scenario. These outdated mechanisms facilitate institutional stickiness and persistent power asymmetries which remain important obstacles to health equity. Simultaneously, transformative leadership (TL), emphasising purposeful moral leadership, and an understanding of power, has developed in line with transformation in social sciences, facilitating social change. TL also calls for a shift towards better supranational and equal forms in geopolitical order, which requires fundamental changes, including the redistribution of power. The power approaches employed in GH relationships should thus be realigned to ensure up-to-date power management mechanisms, while building transformative change.
Climate change and COVID-19 have emphasized the need for a geopolitical shift in GH, by highlighting the importance of the political determinants of health. Adapting to this new geopolitical framework requires cross sectoral governance for health. Restructuring GH through TL serves as an opportunity for decolonization, enabling the mitigation of power asymmetries.
The needed multi-level governance mechanisms for health must be recognised by all health actors. A new Bretton Woods Conference on GH could be a solution, but the challenge lies in aligning stakeholders’ interests related to TL. Solutions may lie in the establishment of new institutions integrating governance, financing and data access, facilitating interdisciplinary research and policy development, or the promotion of horizontal, cross sectoral governance leveraging existing institutions.
A reflection on the current GH restructuring needs will be presented, as well as recommendations for tackling these, based on a narrative literature review on power in the context of GH. Examples of barriers and enablers for intersectoral action facilitating health equity will also be highlighted.
Poster Slot
D06
10:15-10:30
Deconstructing Global Health Security and the Health-Security Nexus
| Presenter | : | David McCoy |
| Abstract ID | : | A046 |
The past four decades have seen a steady rise in the number of references to ‘global health security’ as well as an increasing entanglement between health and security sector agendas and actors. However, the scope and meaning of health security remains contested while the growing entanglement between health and security sector agendas and actors has remained largely unassessed despite the potential for certain forms of entanglement to be harmful to health.
We present two frameworks to help structure conversations about both these two issues. First, we present two contrasting approaches to health security - neo-colonial and universal – as a way of surfacing certain key tensions in the way global health security may be conceptualised and operationalized. In particular, we question dominant conceptualisations of health security that are focused upon the threat of infectious disease outbreaks and which over-consider conceptualisations of security as perceived by populations and economic interests in high-income states.
Second, we present a novel heuristic that delineates five scenarios representing different interactions between health and security actors and agendas. This seeks to broaden the common understanding of how health and security sectors may interact. This framework is then used to consider how different configurations and practices may result in three types of potential harms: first through unintended or inadvertent consequences; second through the erosion of global health norms and values; and third through the risk of health actors being inappropriately co-opted by the security sector.
Poster Slot
E06
10:15-10:30
Patients’ Perspectives on the Consequences of Incentive-linked Prescribing
| Presenter | : | Zahida Azizullah |
| Abstract ID | : | A042 |
Incentive-linked prescribing (ILP) is a widespread but poorly documented form of corruption that occurs when doctors accept personal benefits from pharmaceutical companies in return for prescribing medicines that are often unnecessary and overly costly. PDs may prescribe unnecessary and/or expensive medications to meet pharmaceutical sales targets, which has negative consequences for patients. ILP directly aligns with sub-theme 2, given the roles the (inter)national pharmaceutical industry and health care professionals play in many countries to uphold this practice. We conducted a qualitative study with 25 primary care patients in Pakistan to explore their awareness of ILP and document their perspectives on its effects on patients' health and well-being. The interview data suggests that participants had a reasonable understanding of how PDs confront a conflict of interest when they accept incentives from pharmaceutical companies for prescriptions. Participants believed that incentive-linked prescribing affected their health and their financial and social standing. Most of the participants believed that the prescribing of expensive pharmaceutical brands when less expensive alternatives were available in the market, was a clear sign of incentive-linked prescribing. Due to the limited financial resources, many patients were unable to buy medications or had to borrow money from relatives or friends, which increased mental distress over their finances. Participants held several beliefs about how the prescribing of unnecessary medications could impact their physical health, which might/might not be biomedically correct. To conclude, for patients, incentive-linked prescribing was a public secret, and it contributed to the deterioration of their trust in PDs. Health system reforms such as PDs’ education on the consequences of incentive-linked prescribing, clear guidelines on the relationship between PDs and pharmaceutical companies, and regulatory controls are critical, to improve PDs’ prescribing practices, which are in patients’ best interests.
Poster Slot
F06
Session 7
12:30-12:45
Strengthening Myanmar’s TB Response by Investing in Local Ownership
| Presenter | : | Phyo Wai Tun |
| Abstract ID | : | A035 |
Title: Strengthening Myanmar’s TB response by investing in local ownership
Authors: Phyo Wai Tun, Lisa Stevens1, Aung Ko Ko1, Hay Mhan Chit Su Phyo1, Aung Kaung Khant, Chan Nyein2
Background and Challenges to Implementation
In Myanmar, a tuberculosis (TB) high burden country, widening inequality due to persistent political instability and the unprecedented effects of the COVID-19 pandemic has hindered TB service access. Within this compromised national health system, grassroots leadership is required to revitalize TB elimination efforts, including TB active case finding, treatment support, and prevention.
Intervention or response
To foster local leadership, the USAID Local Action Toward TB-free Myanmar (LATT-M) project, led by local organization, Pyi Gyi Khin, in partnership with FHI 360 and Phoenix Association, completed participatory, contextualized Organizational Capacity Assessments (OCA), as a first step intentionally aimed at empowering a community network of people affected by TB including 90 civil society organizations (CSO) and self-help groups (SHG) from across the country. The process and findings of OCA built CSO and SHG shared awareness and momentum on self-reliance and the importance of collective action and networking to drive TB elimination locally. PGK, in collaboration with other consortium partners responded to these demand-driven capacity-strengthening needs by facilitating platforms for information sharing and tailored technical assistance on TB awareness, advocacy and communication.
Results/Impact
Post-training, organizations developed locally led action plans for delivering TB services in their communities with approximately 80 organizations raising TB awareness and 26 organizations finding TB patients and providing treatment support. These efforts accelerate the TB elimination response, although the yield of TB cases has yet to be evaluated.
Conclusions
LATT-M empowers local grassroots organizations to lead and own elimination efforts through TB community networks and provide patients with support to take action themselves shifting power away from those who traditionally control health programming. This example showcases a best practice enabling more proactive and coordinated ways of decolonizing global health via accelerating the transition from national and international initiatives to local civil society.
Poster Slot
A07
12:30-12:45
From Crisis to Coverage: Global Lessons for Achieving Universal Health Coverage
| Presenter | : | Brooke Hunsaker |
| Abstract ID | : | A010 |
Background:
The Chatham House Commission for Universal Health, launched in 2022 and chaired by Rt Hon Helen Clark and H.E. Jakaya Kikwete, responds to escalating global challenges. With 47 commissioners and a technical secretariat, the commission investigates the intricate relationships among crises, Universal Health Coverage (UHC) reforms, and outcomes. Its primary goal is to identify health reform opportunities, propose policy solutions for coverage gaps, strengthen health systems, and advance global progress towards UHC and economic growth for a more equitable world. The study underscores UHC's pivotal role in global health governance and geopolitics, emphasizing its ability to address access disparities, improve health outcomes, and promote equitable resource distribution and health security.
Approach:
The research focuses on understanding the connection between Universal Health Coverage (UHC) and crises by pinpointing key questions. Using Kingdon’s multiple-streams analysis, the study explores how context, shocks, and their impacts interact. A quick review of post-crisis UHC literature highlights factors that help or hinder reforms, learning from effective strategies. Additionally, the commission creates detailed case studies for six countries (China, Cyprus, Rwanda, Thailand, Ukraine, Uruguay) to provide historical context on crises and UHC reforms. Ongoing meetings with commissioners actively contribute insights, shaping the study's messages through four working groups.
Conclusion:
Events, context, and individual actions play pivotal roles in shaping health policy. Political changes and crises emerge as significant drivers of UHC reforms, leading to substantial policy shifts, including health reforms and alterations in stakeholder alignments. These findings offer valuable insights for future movements towards Universal Health Coverage, emphasizing the dynamic relationship between crises, political changes, and the evolution of global health policy. UHC, as demonstrated, strengthens health systems, fosters international collaboration, and contributes to social and political stability, ultimately creating a healthier and more equitable world.
Poster Slot
B07
12:30-12:45
Global Health Finance in the Era of Polycrises - Stronger and Aligned Governance System for Sustainability
| Presenter | : | Kalipso Chalkidou |
| Abstract ID | : | A106 |
The landscape of global health financing, influenced by geopolitical changes, calls for more aligned approach for addressing the complex challenges in global health governance. A shift from the colonialist mindset of ODA is critical to promote country ownership and effective alignment of global health initiatives. To accelerate the Sustainable Development Goals, the traditional health financing is no longer viable. The reform of Multilateral Development Banks (MDBs) has taken center stage as it has a potential to achieve equitable coverage and financial protection.
Facing these challenges, the Global Fund (GF) has proactively responded by establishing a specialized health financing team composed of experts. This team is dedicated to ensuring the sustainability of disease programs and promoting domestic investments that contribute to Universal Health Coverage. Their collaborative efforts encompass a thorough review of health budgets, strengthening of public financial systems, and promoting alignment with other initiatives.
The GF’s Sustainability, Transition and Co-Financing Policy encourages countries to augment their public health budgets and engage in meaningful policy dialogues with fiscal authorities. Particularly for resource-limited nations, co-financing becomes an avenue for investing in health systems, including Primary Health Care and Pandemic Preparedness and Response. Leveraging blended financing models in conjunction with MDBs facilitates the creation of aligned and on-budget fiscal space. This enhances efficiency by harmonizing health initiatives within the national framework.
The GF aims to strengthen country systems, prioritize on-budget financing, and enhance the transparency of financial flows. The process of supporting domestic financing and sustainability is a step towards decolonization. Facilitating the expansion of pooled transactions through national systems becomes imperative. Structural reforms that transform organizational culture to align incentives and introduce external accountability are necessary for aligned governance system. The lessons learned from financing for global public goods enhances the importance of sustainability and equity in shaping the trajectory of global health financing.
Poster Slot
C07
12:30-12:45
Spatial-Temporal Dynamics and Influencing Factors of Health Human Resources in Guangxi Counties: Insights from the MGWR Model
| Presenter | : | Chengcheng Li |
| Abstract ID | : | A093 |
Background: Understanding spatiotemporal nuances in the allocation of health human resources across counties in Guangxi, China, alongside the driving determinants of such distributions, can refine accessibility to foundational health services. This study aims to illuminate these dynamics and inform strategic health policy decisions.
Methods: Utilizing health human resource data spanning 111 county-level cities in Guangxi from 2009 to 2020, we employed the Moran index, nuclear density analysis, and the standard deviation ellipse to decode the temporal-spatial evolution patterns. The multi-scale geographic weighted regression model (MGWR) was further harnessed to identify variables influencing spatial disparities in health human resource allocations.
Findings: Our insights unveiled a robust growth in health human resources, from 245,600 in 2009 to 472,200 in 2020. This talent influx exhibited a pronounced spatial agglomeration, intensifying over the period (Moran index for 2020: 0.221, p=0.003). A pivot from single-region to multi-point distribution was discernible. The predominant spatial trajectory followed a "southwest to northeast" vector, indicating increased dispersion yet a clear centripetal pull. Key determinants shaping these dynamics included: beds in health establishments (0.890, p<0.001), beds in social work institutions (-0.061, p=0.072), social consumer goods retail sales (0.122, p=0.016), and general public budgetary expenditure (-0.132, p=0.017).
Conclusion: With stark disparities in the growth rate and allocation of health resources at Guangxi's county level, there's a pressing need to synchronize developments between grassroots medical and social work entities. Central cities' high-caliber health assets should be leveraged to harmonize regional disparities. By finetuning county-level governance, the macro health policies' transmission effect can be maximized, thereby enriching grassroots health service accessibility.
Poster Slot
D07
12:30-12:45
Inequity in Government’s COVID-19 Mitigation Measures To Community Members During The Peak Of COVID-19
| Presenter | : | Maxwell Dalaba |
| Abstract ID | : | A029 |
Introduction: At the peak of COVID-19 in 2020, the government of Ghana received funds to support the pandemic. This led to the implementation of COVID-19 mitigation measures such as subsidised electricity, free water, $170million support to small-medium scale firms, extension of tax filing date, reduction in interest rate and a $510 million support facility for local industries and food distribution. This study examined the equity implications of these mitigation measures.
Methods: The study design was cross-sectional using mixed method in data collection. Data were collected from October to December 2020 among rural and urban-slum dwellers in Oforikrom Municipality in the Ashanti region and the Adaklu District of the Volta Region of Ghana. The quantitative arm involved 400 community members, while qualitative involved 46 In-depth Interviews with chiefs, elders, persons with disabilities and 8 Focus Group Discussion with community members. Quantitative data were analysed using STATA 16 while NVivo 12 was used to support thematic analysis for the qualitative arm.
Results: The pandemic negatively affected respondent’s ability to afford food (94%) and to seek health care (89%). The majority (76%) did not benefit from the government subsidies since these areas had insufficient access to businesses, water, power, and other necessities. Furthermore, there was an uneven allocation of the government's food supplies because the majority (69%) of people, especially women, the elderly and the disable who really need these supports were not reached. There were complaints that the package only got to affluent people and those connected to the ruling government.
Conclusion: Most vulnerable groups were marginalized in the government's COVID-19 mitigation measures. To ensure equity in governance, there is a need for proper needs assessments and effective community engagement to be able to identify vulnerable groups and to use appropriate techniques to reach these groups in situations like this.
Poster Slot
E07
12:30-12:45
Decolonization of Global Health: A Myanmar NGO Case Study
| Presenter | : | Han Win Htat |
| Abstract ID | : | A095 |
Background: Population Services International (PSI), a US-based NGO has been one of the longest and largest implementing agencies for health in Myanmar since 1995. In 2016, given the evolution of funding instruments and trends for localization, PSI has carefully crafted and designed a 5-year deconsolidation plan for its implementing units to become local entities.
Outcome: Finally, after the three times of postponements due to global pandemic in 2020 and military takeover in 2021, PSI’s Sun Quality Health, a network of over 1,000 franchised private community clinics and Community Health Services Network with over 5,000 community volunteers have been transitioned to a single local NGO named Sun Community Health (SCH) in January 2022. Today, SCH stands as one of the largest national NGOs, covering public health programs in almost two-thirds of the nation. In 2022, SCH supported and treated 1,780 PLHIV for ART, 21,000 TB cases, 14,000 malaria cases and over 150,000 couple-years of protection.
Challenges: While there are potentials for SCH to become a key contributor to the global health, significant challenges remain ahead as; 1) donors tend to be risk-averse with rigorous compliance measures which requires significant support and indirect costs, and for that local NGOs are not eligible to put in the budget, 2) since the general funding support to Myanmar is declined, it becomes harder to sustain the ongoing public health programs while the needs are enormous, and 3) organizational capacity building for functions previously covered by international HQ are needed to strengthen.
Way forward: INGOs have been dominant to govern the public health agenda even at the local level for far too long and now it is the time to rethink how the deconsolidation can shapeshift the sustainable development led by local entities with the meaningful support of the global community.
Poster Slot
F07
Session 8
12:45-13:00
Factors Influencing Diabetes Prevalence and Its Economic Disparities in Indonesia: An Analysis of National Health Insurance Participants
| Presenter | : | Mahlil Ruby |
| Abstract ID | : | A081 |
Indonesia faces a growing burden of non-communicable diseases (NCDs), with diabetes mellitus (DM) prevalence rising by 4% between 2013 and 2018 which has become a significant financial strain on the country's National Health Insurance (JKN). Influenced by multifaceted factors, this study aims to pinpoint the determinants affecting diabetes prevalence and to dissect its disparities across diverse economic strata. The insights derived from this research are envisioned to forge strategies that bolster health equity and tackle the overarching socio-economic factors impinging on health and well-being in Indonesia
A cross-sectional online survey was conducted with a total of 4059 participants from the non-wage recipients segment of JKN across various provinces. The independent variables assessed included age, marital status, gender, education, employment, and income levels. The dependent variable for this study was the prevalence of diabetes among participants covered under national health insurance. Descriptive analysis and logistic regression analysis were employed to assess the odds ratio of participants having a history of diabetes. Additionally, the concentration index was employed to examine socioeconomic inequality in DM.
The analysis further identified specific factors that significantly influence the risk of diabetes prevalence. Higher education levels were found to increase the risk, with the highest risk observed among those who only completed elementary school (OR 8.6; p=0.03). Marital status also played a role, with married individuals having a higher risk of diabetes (OR 7.2; p=0.07). Employment status was another significant factor, with those having a job showing a significant risk (OR 8.9; p=0.003). Insurance ownership and income levels were not found to correlate with diabetes prevalence. The concentration index, measuring socioeconomic inequality in diabetes prevalence, was found to be nearly equal at 0.03.
This study unravels the intricate web of factors shaping diabetes prevalence in Indonesia, specifically among participants of the JKN, affirming that DM transcends all socioeconomic boundaries. The findings accentuate the imperative for nuanced interventions that heed these specific determinants. Collaboration with JKN is essential in monitoring and combating DM, thereby contributing to the overarching aim of enhancing health and well-being across Indonesia's diverse socioeconomic landscape.
Poster Slot
A08
12:45-13:00
Civil Society in The Global South Acting for Pandemic Preparedness
| Presenter | : | Asha Jyothi |
| Abstract ID | : | A104 |
We’re living through a period of rising climatic disasters like floods and droughts, with research suggesting an increase in tropical cyclones with even a 1/10th degree rise in global temperature, which increases disease transmission and future pandemic risks. 80% of countries most affected by such disasters in 2019 were LMICs. Further, 30 out of 37 countries affected by conflict are either Low or Lower Middle Income (LIC and LMIC), and as a report by the G-20 Finance and Health Working Group of 2022 states, these are the countries with the highest financing gap (of about US$ 7.0 billion) in instituting a pandemic preparedness and response (PPR) architecture.
When COVID-19 struck, Precision Health, a multi-stakeholder preparedness platform, pioneered a realtime dashboard depicting local trends in virality and raised the alarm for an impending wave. The work it started through wastewater-based epidemiology has now expanded to include diverse forms of disease surveillance ( participatory and event-based) and deeper leveraging of GIS capabilities to map out localised risks based on topography and infrastructure. Our paper establishes the potential and possibility of operating a collaborative early warning system for climate-sensitive diseases in LMICs, which uses complementary disease surveillance tools to mitigate the limitations of each and triangulate data from the environment as well as vulnerable communities themselves. We advocate for continuous capacity building of community health workers in this process and for targeted risk communications that can be assimilated by marginalized groups on one level, and on another, incentivize policymakers to take timely public health action. As we wait in anticipation of the final shape of the Pandemic Accord facilitated by the WHO, we hope this paper motivates global health governance to take cognizance of civil society as an important actor in the bid to prevent and prepare for future pandemics.
Poster Slot
B08
12:45-13:00
Increasing the Quality of Malaria Detection through Microscopy and External Quality Evaluation at the Regional Level in Haiti
| Presenter | : | Edet Hamel |
| Abstract ID | : | A082 |
Background
The Haitian Ministry of Health policy reflects the global microscopy standard to detect plasmodium falciparum (PF) and the use of external quality assessment (EQA) to objectively assess laboratory performance. However, rapid diagnostic testing remains preferred over microscopy despite these guidelines. Moreover, due to poor governance and lack of necessary resources, testing panels have been unavailable for EQA since 2017.
Description of the activity
The LNSP and FHI 360 collected 13 malaria positive blood samples at seven regional hospitals with high malaria incidence rates and prepared 1,727 panels of thin smears and thick drops using the national standards. Parallel testing was carried out on the collected samples using two different test kits to confirm PF presence and to verify the robustness of those used at the sites.
Results
Parallel testing confirmed the sensitivity of the tests available at the site level and a subset of the testing panels was used to train 630 laboratory technicians on microscopy. Using the test panels, the LNSP has resumed EQA for malaria after a five-year break and plans to incorporate mentoring visits at the testing site that also received test panels to perform EQA.
Lessons learned
The elimination of malaria in Haiti will not be possible if regional laboratory technicians fail to apply the national standards for quality detection. This requires strong leadership and governance at the national level and implementation of a capacity building and mentorship plan for regional testing sites.
Conclusion
The availability of testing panels supports the resumption of EQA and confirmation of suspected cases by microscopy in Haiti. Low-income countries with high endemicity of malaria require support from the global community to ensure equitable access to testing supplies and support for capacity strengthening and mentorship to implement global standards at national and regional levels.
Poster Slot
C08
12:45-13:00
Decolonialising knowledge production to support equitable research partnerships: reflections from the ARISE consortium
| Presenter | : | Wafa Alam |
| Abstract ID | : | A141 |
Co-production requires dismantling existing power hierarchies. As such, it can support decolonising knowledge generation and fostering inclusive and equitable relationships with diverse (and at times) marginalised actors participating in health governance, research and decision-making. Decolonising knowledge production recognises that expertise lies with those communities directly affected by health inequities and challenges as well as other key actors.
The Accountability and Responsiveness in Informal Settlements for Equity (ARISE) consortium aims to enhance accountability and improve the health and wellbeing of marginalised populations living and/or working in informal urban settlements in Bangladesh, India, Kenya and Sierra Leone. ARISE uses Community Based Participatory Research (CBPR) to build the capacities of urban marginalised people to generate contextually grounded evidence to incite action and strengthen relationships with governance actors. This presentation will draw on experiences from co-researchers and researchers across the ARISE consortium. We will share reflections on the processes of decolonising knowledge production from the perspective of urban marginalised people and researchers. We will reflect on what works well, tensions and ethical dilemmas that have arisen, and how these are navigated in spaces of respect, trust and openness to learning from communities. We will draw on our experiences of using various differing participatory methodologies within ARISE. These include ripple effect mapping, a participatory monitoring and evaluation method that maps research activities and impacts, photovoice, geographic information system mapping and performing arts.
Key takeaways for participants will include distilled learning on co-production approaches to strengthen decolonised and equitable relationships between urban marginalised, researchers and governance actors, guidance notes on Ripple Effect Mapping and a summary sheet of core competencies for successful co-production in research partnerships to support accountability.
Poster Slot
D08
12:45-13:00
What does it take for success? Seven competencies to enhance the quality of community-based co-production research partnerships for health
| Presenter | : | Wafa Alam |
| Abstract ID | : | A142 |
Decolonising health research requires engaging communities as active participants in prioritizing, researching, and advocating for their own health needs and demands a move away from traditionally extractive research processes. One way to support this is through the co-production of knowledge and action. Getting co-production right, however, takes a lot more than methodological guidance and good intentions. Success is contingent on an active and continuous exploration of both the sociopolitical conditions and the hard and soft skills necessary for meaningful and impactful co-production in health research. The global interest in co-production research paradigms is expanding, and improving co-production skills, or competencies can support research quality and validity. Yet, there is a lack of frameworks and guidance highlighting the ideal competencies and conditions needed for community and external implementation partners to contribute meaningfully and equitably.
The Accountability and Responsiveness in Informal Settlements for Equity (ARISE) uses community-based participatory research in Bangladesh, India, Kenya, and Sierra Leone to support people living and/or working in urban informal settlements to claim their rights to health. We conducted a five-step process, which involved mapping literature together with experiential and applied knowledge of researchers, activists, and 10 local and international implementation partners and community researchers across ARISE. This process led us to develop seven core competencies needed for successful and quality co-production research partnerships. We will present the seven competencies alongside concrete examples of activities that support the development of these competencies to bring about action. These competencies can be used within research partnerships as a guide to explore multi-lateral competency and condition strengthening options, setting quality benchmarks, and collecting evidence to progress the quality of co-production projects across contexts.
Poster Slot
E08
12:45-13:00
The Role of Global Health Partnerships in Achieving Vaccine Equity: A Case Study of the COVAX Facility
| Presenter | : | Charnele Nunes |
| Abstract ID | : | A077 |
Background
COVAX was designed to support the discovery, development, and distribution of COVID-19 vaccines for the world at scale and pace. It isn’t the first global health partnership (GHP) so we might expect those creating it to have learned from experiences with previous GHPs, and if not, why not.
Methods
Informed by a scoping review of lessons learned from previous GHPs, we reviewed documentary evidence on COVAX and previous GHPs plus 23 key informant interviews with participants from academia, GHPs, civil society, and the private sector. Data were synthesised thematically using Rushton and Williams (2012) constructivist framework.
Results
We showed how the global health policy context shaped COVAX, including the influence of Gavi and CEPI in creating its governance structure. We highlighted weaknesses in transparency and accountability, limited engagement with civil society organisations [CSOs] and LMIC stakeholders), contested policy debates (e.g., different framing) and paradigms (e.g., prioritisation of technical and financing mechanisms over political solutions).
Conclusions
COVAX largely replicated existing GHP approaches, subsidising research and development then paying for the resulting discoveries. While recognising how this reflects global power structures, in the inevitable next global health crisis, the health community must advocate for greater LMIC and CSO involvement in decision-making, sharing of intellectual property and technology transfer, and rebalancing of flows of costs and benefits of innovation to different actors.
Poster Slot
F08
Session 9
13:00-13:15
The Power of Equitable Partnerships in Advancing Power Shifting in Global Health
| Presenter | : | Goodness Odey |
| Abstract ID | : | A039 |
Colonialism and its legacy are part of our shared human history. The social structures, funding models, and knowledge generation practices that define global health are rooted in a history of inequality, exploitation, and racism. For the population health, there is a history of population control and eugenics. This history may not be un-done and calls to challenge this legacy continue to fall short.
Since November 2022, the International Conference on Family Planning (ICFP)’s Power ShiftingSubcommittee has co-conveneda series of dialogues both in person and virtually to identifyinformation, resources, and opportunities for action to shift power and advance equity.Aligned with aseries of conferences and other community events,we have brought people together to reflect on thelegacy of colonization, explore what it takes to create equitable partnerships, document inequities and operational barriers, and elevate priorities and evolving practices for shifting and sharing power. AsofJuly 2023, we have engaged with more than 1,200 people from 111 countries around the globe in theseconversations.Within each conversation we’ve been listening to the community and learning alongsideone another how to achieve more equitable funding arrangements, reimagine existing power dynamics,and identify actionable next steps.The sessionwouldexplorethe question what can we do to shiftand sharepower and advance equity inglobal health now? We aim to create an interactive space to discuss this question, starting bysharingwhat we have been learning and how these lessons apply to other areas of global health. Drawing on the expertise in the room, we will then engage participants to share their own experiences andidentifyactionable next steps that they can take to shift power and advance equity in their organizations and working relationships in global health.
Poster Slot
A09
13:00-13:15
Estimating the Impacts of Climate Change on Mortality and Morbidity
| Presenter | : | Loreta Rufo |
| Abstract ID | : | A143 |
The author will present the Climate and Health Economic Valuation (CHEV) methodology developed by World Bank to estimate the cost of health impacts resulting from climate change for 5 health risks: malaria, dengue, diarrhea, extreme heat, and stunting, and the initial findings of the study using the CHEV tool. The tool estimates the number of cases and deaths using 2030 and 2050 projections for population, GDP, and changes in temperature and rainfall assuming relatively high emission scenario (SSP3-7.0) in 75 low- and middle-income countries (LMICs) with a national population larger than 10 million. These countries account for 96 percent of the population of developing countries. The cost-of-illness (COI) approach and the value of statistical life (VSL) are used to estimate the economic costs of morbidity and mortality, respectively. Results showed that over the 5-year period 2026-2030, climate change alone will contribute approximately 558 million cases of the 5 diseases included in the assessment and will contribute to an additional 1.7 million deaths. Over the period 2031-2050, 5.9 billion cases and 19.5 million deaths will arise as a direct result of climate change. This assessment also confirms the uneven geographical distribution of this future burden, with Sub-Saharan Africa and to a lesser extent South Asia bearing the brunt of the projected increase in illnesses and deaths. The associated social costs of these mortality and morbidity cases provide a compelling argument for developing countries to prioritize healthcare investments and build resilient and sustainable health systems. Also, it provides quantitative evidence on why health agencies need to work closely with other relevant agencies and stakeholders like the private sector to strengthen programs that tackles health risks due to climate change.
Poster Slot
B09
13:00-13:15
Exploring the Global Health Equity Discourse: Learnings from the past decade of Research Analysed Using Large Language Models
| Presenter | : | Anton Van Pamel |
| Abstract ID | : | A117 |
Health Equity (HE) is as a critical objective for global health efforts; much attention is focused but is resource allocation matching the global needs? Achieving HE requires a balanced view across a wide spectrum of disparities in health across socio-demographic & -economic classes, societal, health system, & environmental determinants. Skews across these can indicate over/under-representation and a need for more inclusive approaches.
Recent advances in AI and Large Language Models (LLMs) allow for more comprehensive and objective analysis to analyze the HE literature landscape and highlight key focal points and connections in the present discourse. We have developed a Beta version of an LLM based approach that can help researchers easily analyze the scientific discourse on HE over the last decade. Our method is scalable to identify topics of interest, the geographic focus and origin of the research, and the diseases studied.
Analysis of a corpus of more than 300,000 documents across more than a decade shows HE research remains a dynamic landscape with shifting priorities, regional specificity, and increasing voice of Asia. Disease areas are well represented relative to their geographic burden although cancer and respiratory disease remain understudied. Topical trends across geographies reveal cultural and societal priorities that reflect the region's specific focus. We hope to collaborate with researchers and policy makers to refine the tool / model further and make it more widely available.
Poster Slot
C09
