Highlights
The moderate quantity and quality of evidence indicate benefits from community participation.
There was limited evidence on involvement of communities in framing problems or designing solutions.
There was inadequate engagement with the construct of community participation and power relations.
There was extremely weak evidence on participation by forcibly displaced communities.
Health system governance has been recognised as critical to strengthening healthcare responses in settings with conflict-affected populations. The aim of this review was to examine existing evidence on health system governance in settings with conflict-affected populations globally. The specific objectives were: (i) to describe the characteristics of the eligible studies; (ii) to describe the principles of health system governance; (iii) to examine evidence on barriers and facilitators for stronger health system governance; and (iv) to analyse the quality of available evidence. A systematic review methodology was used following PRISMA criteria. We searched six academic databases, and used grey literature sources. We included papers reporting empirical findings on health system governance among populations affected by armed conflict, including refugees, asylum seekers, internally displaced populations, conflict-affected non-displaced populations and post-conflict populations. Data were analysed according to the study objectives and informed primarily by the Siddiqi et al. (2009) governance framework. Quality appraisal was conducted using an adapted version of the Mixed Methods Appraisal Tool. Of the 6,511 papers identified through database searches, 34 studies met eligibility criteria. Few studies provided a theoretical framework or definition for governance. The most frequently identifiable governance principles related to participation and coordination, followed by equity and inclusiveness and intelligence and information. The least frequently identifiable governance principles related to rule of law, ethics and responsiveness. Across studies, the most common facilitators of governance were collaboration between stakeholders, bottom-up and community-based governance structures, inclusive policies, and longer-term vision. The most common barriers related to poor coordination, mistrust, lack of a harmonised health response, lack of clarity on stakeholder responsibilities, financial support, and donor influence. This review highlights the need for more theoretically informed empirical research on health system governance in settings with conflict-affected populations that draws on existing frameworks for governance.
Healthcare waste mismanagement constitutes a serious environmental and sanitary problem, especially in developing countries. This article describes the strategy and the methodology of the implementation of a national network for healthcare waste management by a non-profit organisation in Lebanon, taking into consideration environmental, social and economic issues. It presents a holistic description of the main aspects of this crucial sustainable development topic: the elaboration of the strategy and the selection of the optimal treatment technique based on an analysis of the context; the training on waste minimisation and waste management issues inside hospitals; the waste transportation and treatment procedures; the quality management of the process; the evaluation and the monitoring of the produced quantities and the established system; the optimisation of sterilisation parameters and process in order to reduce sterilisation time and fuel consumption.
ObjectivesThis study aimed to assess the capacities and governance of Lebanon’s health system throughout the response to the COVID-19 pandemic until August 2020.DesignA qualitative study based on semi-structured interviews.SettingLebanon, February–August 2020.ParticipantsSelected participants were directly or indirectly involved in the national or organisational response to the COVID-19 pandemic in Lebanon.ResultsA total of 41 participants were included in the study. ‘Hardware’ capacities of the system were found to be responsive yet deeply influenced by the challenging national context. The health workforce showed high levels of resilience, despite the shortage of medical staff and gaps in training at the early stages of the pandemic. The system infrastructure, medical supplies and testing capacities were sufficient, but the reluctance of the private sector in care provision and gaps in reimbursement of COVID-19 care by many health funding schemes were the main concerns. Moreover, the public health surveillance system was overwhelmed a few months after the start of the pandemic. As for the system ‘software’, there were attempts for a participatory governance mechanism, but the actual decision-making process was challenging with limited cooperation and strategic vision, resulting in decreased trust and increased confusion among communities. Moreover, the power imbalance between health actors and other stakeholders affected decision-making dynamics and the uptake of scientific evidence in policy-making.ConclusionsInterventions adopting a centralised and reactive approach were prominent in Lebanon’s response to the COVID-19 pandemic. Better public governance and different reforms are needed to strengthen the health system preparedness and capacities to face future health security threats.
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