The Health Systems Agenda: Prospects for the Diagonal Approach

Frenk, Julio; Gómez‐Dantés, Octavio; Knaul, Felícia Marie

doi:10.1002/9781118509623.ch23

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…The ideal being to be able to draft health service delivery programmes aimed at specific diseases in a manner that at the same time may drive improvement in the wider health system—a diagonal approach. 35 …”

Section: Discussionmentioning

confidence: 99%

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

et al. 2021

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IntroductionAntiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension.MethodsThe framework for scoping reviews developed by Arksey and O'Malley and updated by Peter et al was applied for this review. The databases PubMed, Web of Science and Cochrane library were searched. Broad search terms for HIV, NCDs (specifically type 2 diabetes and hypertension) and healthcare integration were used. As the review aimed to identify definitions of patient perspectives, they were not included as an independent term in the search strategy. References of included publications were searched for relevant articles. Titles and abstracts for these papers were screened by two independent reviewers. The full texts for all the publications appearing to meet the inclusion criteria were then read to make the final literature selection.ResultsOf 5502 studies initially identified, 13 articles were included in this review, of which 11 had a geographical origin in sub-Saharan Africa. Nine articles were primarily focused on HIV/diabetes healthcare integration while four articles were focused on HIV/hypertension integration. Patient’s experiences with integrated care were reduced HIV-related stigma, reduced travel and treatment costs and a more holistic person-centred care. Prominent concerns were long waiting times at clinics and a lack of continuity of care in some clinics due to a lack of healthcare workers. Non-integrated care was perceived as time-consuming and more expensive.ConclusionPatient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. There is a paucity of evidence and further longitudinal and interventional evidence from a more diverse range of healthcare systems are needed.

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Section: Discussionmentioning

confidence: 99%

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

et al. 2021

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“…Second, the learning acquired from digital health and telemedicine innovations iii [28, 29] will have a role in maintaining social distance, efficient triaging, referral, and follow-up. Third, it is time to go beyond the dichotomous approach of horizontal and vertical integration and to learn from the experience of the diagonal approach [30] to the health system. All changes have to be customized taking into account concerns of health care providers to prepare the health system to be better equipped for any future crisis.…”

Section: Resultsmentioning

confidence: 99%

The adequacy of health system measures in reducing vulnerability to COVID-19 among the health care providers working in primary health care in Rajasthan, India: A Cross-sectional Study

Das¹,

Srivastava²,

Ghosh

et al. 2020

Preprint

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Background This paper examines the role of individual, facility and system level preparedness in reducing the physiological and psychological vulnerability among primary-level health care providers (HCPs) of COVID19 pandemic in Rajasthan, India. Method and Material Online and telephonic interviews are conducted among 274 HCPs working in 24 PHCs (17 rural and 7 urban), across 13 districts of Rajasthan. Five dimensions of vulnerability covering awareness, exposure to infection (daily contact; contact with high risk individuals), physical and mental health conditions, while three aspects of preparedness at individual (personal care) and facility (provider safety; management and supervision) level are measured by employing factor analysis. Generalized ordered logit regression model is used to measure the effect of preparedness on COVID19 related vulnerability. Result: Among the 274 HCPs, majority of the staff are from rural PHCs (76 %), less than 35 years (87%), female (57%) and married (57 %). Almost half have high level exposure to COVID19, with mean contact rate is 90. Overall, 26% have comprehensive knowledge on COVID19, and 32% have any mental health issues. Although more than 70% of HCPs have reported more than one individual level preparedness, mental health measures adopted by the HCPs are comparably low. The facility level preparedness for enhancing safety are high such as social distance (79%) and maintaining record of each visitor (75%). However, management related measures adopted by the PHCs are perceived to be lower than the safety measures. The regression analyses suggest that safety related preparedness is significantly associated with reduction of vulnerability by 50%. The management-level preparedness has statistically no significant effect in explaining the variations in level of vulnerability. Conclusion: The facility-level safety measures, which lowers chances of acquiring infection has a positive effect on reducing vulnerability of COVID19. However, the HCPs do not have adequate preparedness at individual, facility management (PHC) and system level to reduce COVID19 vulnerability. Findings suggest that there is a need for a non-conventional approach of monitoring and supervision, in the absence of such measures there is a chance of moral injury that will make the HCPs at the primary level vulnerable to both physiologically and psychologically.

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“…Second, the learning acquired from digital health and telemedicine innovations 3 (eHealth, 2018; The Hindu, 2020) will have a role in maintaining social distance, efficient triaging, referral and follow-up. Third, it is time to go beyond the dichotomous approach of horizontal and vertical integration and to learn from the experience of the diagonal approach (Frenk et al, 2014) to the health system. All changes have to be customised taking into account concerns of HCPs to prepare the health system to be better equipped for any future crisis.…”

Section: Discussionmentioning

confidence: 99%

The Adequacy of Health System Measures in Reducing Vulnerability to COVID-19 Among the Health Care Providers Working in Primary Health Care in Rajasthan, India: A Cross-sectional Study

Das,

Srivastava,

Ghosh

et al. 2024

Journal of Health Management

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This article examines the role of individual, facility and system-level preparedness in reducing physiological and psychological vulnerability among primary-level health care providers (HCPs) during the COVID-19 pandemic in Rajasthan, India. Online and telephonic interviews are conducted among 274 HCPs working in 24 primary health centres (PHCs) (17 rural and 7 urban) across 13 districts of Rajasthan. Five dimensions of vulnerability, covering awareness, exposure to infection (daily contact; contact with high-risk individuals), physical and mental health conditions, while three aspects of preparedness—at individual (personal care) and facility (provider safety; management and supervision) level—are measured by employing factor analysis. Generalised ordered logit regression model is used to measure the effect of preparedness on COVID-19-related vulnerability. Among the 274 HCPs, majority of the staff are from rural PHCs (76%), less than 35 years old (87%), female (57%) and married (57%). Almost half have high level of exposure to COVID-19, with mean contact rate of 90. Overall, 26% have comprehensive knowledge of COVID-19, and 32% have any mental health issues. Although more than 70% of HCPs have reported more than one individual-level preparedness, mental health measures adopted by the HCPs are comparably low. The facility-level preparedness for enhancing safety is high such as social distancing (79%) and maintaining record of each visitor (75%). However, management-related measures adopted by the PHCs are perceived to be lower than the safety measures. The regression analyses suggest that safety-related preparedness is significantly associated with reduction of vulnerability by 50%. The management-level preparedness has statistically no significant effect in explaining the variations in level of vulnerability. The facility-level safety measures, which lower chances of acquiring infection, have a positive effect on reducing vulnerability to COVID-19. However, the HCPs do not have adequate preparedness at individual, facility management (PHC) and system levels to reduce COVID-19 vulnerability. Findings suggest that there is a need for a non-conventional approach of monitoring and supervision. In the absence of such measures, there is a chance of moral injury that will make the HCPs at the primary level vulnerable both physiologically and psychologically.

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The Health Systems Agenda: Prospects for the Diagonal Approach

Cited by 8 publications

References 19 publications

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

The adequacy of health system measures in reducing vulnerability to COVID-19 among the health care providers working in primary health care in Rajasthan, India: A Cross-sectional Study

The Adequacy of Health System Measures in Reducing Vulnerability to COVID-19 Among the Health Care Providers Working in Primary Health Care in Rajasthan, India: A Cross-sectional Study

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