Adding to official development assistance (ODA), private foundations have emerged as important donors to the global health agenda. Amid this increasing funder diversity and growing global health budgets, responsiveness to recipients' needs is a central concern. Merging datasets on ODA flows in 2005-2007, over 2,800 foundation grants, disease burden, and perceived priorities in 27 low-and middle-income countries, this study offers the first comprehensive national-level analysis of global health aid responsiveness. Our analysis shows that national patterns of disease burden explain neither public nor private aid flows during this period. While ODA committed during these years was weakly yet significantly correlated with health priorities, private grants' responsiveness was even weaker and did not achieve ODA significance levels either.
POEM-GMV may be a useful approach in the treatment of pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.
BackgroundAchieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement.ObjectiveTo demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control.SettingLynn Community Health Center, the third largest FQHC in Massachusetts, USA.Participants4762 adult patients with a diagnosis of hypertension.InterventionFirst, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation.MeasurementsThe primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention.ResultsHypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%.LimitationsDurability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented.ConclusionsSuccess factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.
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