Background Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. Methods/ results To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as ‘state security’ not ‘human security’ or population health. Conclusion Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.
Background National and international strategies have increasingly promoted chronic patient participation at different levels of the health care system, building the image of an ‘active’ chronic patient engaged for example in his/her daily self-care and within associations dealing with service delivery and/or policy advocacy. Drawing upon examples of the fight against diabetes and HIV/AIDS in Mali, this article explores the factors that influence the engagement of patient associations at policy level. We focus on the openness of the institutionalised political system, and explore the role that public authorities, caregivers and donors give to diabetes and HIV/AIDS patients. Methods Data was collected between 2008 and 2014 in Bamako in the framework of a qualitative research. Thirty-eight actors fighting against diabetes were interviewed, as well as 17 representatives of donors. For HIV/AIDS, 27 actors were interviewed. In both cases, non-participant observation was carried out and documentary sources were collected. Based on theory of public and collective action, a historical and cognitive approach was adopted. Data analysis followed an inductive and iterative method. Results Partnerships between public authorities and diabetes patient associations have been intermittent over time and remained rather informal. In the case of people living with HIV/AIDS, the partnership between their associations and public authorities has steadily grown and was progressively institutionalised. Three political factors explain this difference: focus and extent of the commitment of public authorities, existing policy-making processes, and how the law frames patients’ roles. Moreover, opportunities for patient participation depend on the nature and extent of the support provided by international donors. Finally, the cognitive dimension is also at stake, notably in relation to the way the two diseases and patients have been perceived by public authorities, caregivers, and donors. Conclusions Chronic patients are intermittent partners for policy-makers. Despite the image of chronic active patients conveyed by national and international public health strategies, patient participation is not straightforward. Rather, political, economic, and cognitive factors underpin the presence of political opportunities that enable patient participation. Chronicity of the disease appears to play an ambiguous role in the shaping of these factors. Electronic supplementary material The online version of this article (10.1186/s12889-019-7453-2) contains supplementary material, which is available to authorized users.
The degradation of sulfamethoxazole (SMX) by several advanced oxidation processes (AOPs) is carried out in the presence of different catalysts. The catalysts used consisted of carbon nanotubes (CNT), titanium dioxide (TiO2), a composite of carbon nanotubes and titanium dioxide (TiO2/CNT), and iron supported on carbon nanotubes (Fe/CNT). SMX removal was evaluated by catalytic ozonation, photocatalysis, catalytic oxidation with hydrogen peroxide, and combinations of these processes. The evolution of the SMX concentration during reaction time, the mineralization degree, the toxicity of the treated solution, and the formation of organic intermediates and ions were monitored. Ozonation catalyzed by Fe/CNT and CNT and photocatalytic ozonation in the presence of CNT presented the fastest degradation of SMX, whereas photocatalytic ozonation with CNT showed the best results in terms of organic matter removal (92% of total organic carbon (TOC) depletion). Total mineralization of the solution and almost complete reduction of toxicity was only achieved in the photocatalytic ozonation with H2O2 and Fe/CNT catalysts. The compound 3-amino-5-methylisoxazole was one of the first intermediates formed during SMX degradation. p-Benzoquinone was only formed in photocatalysis. Oxalic and oxamic acids were also detected and in most of the catalytic processes they appeared in small amounts. Ion concentrations increased with the reaction time.
Currently there is a climate of high expectations within the international community with regard to producing demonstrable results of aid effectiveness in the health sector both at global and developing country level. Yet, measuring the results from aid effectiveness presents methodological challenges. Existing evaluation frameworks are not sufficiently geared toward whether and how practices have changed. This paper presents a framework for measuring results from implementing the aid effectiveness principles at three levels: implementation process, system strengthening, and outcomes/impact. We developed it in the context of the monitoring of the results from the aid effectiveness agenda in the health sector in Mali. Despite some changes in behavior resulting in increased aid effectiveness and improved results at system and impact level, these principles have not been fully implemented so far. Expectations in terms of health outcomes should thus be realistic.
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