3. SYSTEM BUILDING BLOCKS

2020 ◽  
pp. 39-60
Keyword(s):  
Building Blocks ◽  
System Building

scholarly journals Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fariba Mirbaha-Hashemi ◽  
Batool Tayefi ◽  
Zahra Rampisheh ◽  
Arash Tehrani-Banihashemi ◽  
Mozhdeh Ramezani ◽  
...  
Keyword(s):  
Action Plan ◽  
Scale Up ◽  
Newborn Care ◽  
Building Blocks ◽  
Neonatal Care ◽  
Patient Transfer ◽  
Analysis Tool ◽  
System Building ◽  
Bottleneck Analysis ◽  
Health System Building Blocks

Abstract Background Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.

scholarly journals Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Inge Petersen ◽  
André van Rensburg ◽  
Fred Kigozi ◽  
Maya Semrau ◽  
Charlotte Hanlon ◽  
...  
Keyword(s):  
Mental Health ◽  
Health System ◽  
Chronic Care ◽  
Mental Healthcare ◽  
Building Blocks ◽  
Scaling Up ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries ◽  
System Building

Background There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs). Aims To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs. Method Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks. Results Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation. Conclusions Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important. Declaration of interest None.

ENGINEERING CARBON NANOTUBES VIA TEMPLATE GROWTH

2002 ◽  
Vol 01 (03n04) ◽  
pp. 205-212 ◽  
Author(s):  
C. PAPADOPOULOS ◽  
B. H. CHANG ◽  
A. J. YIN ◽  
J. M. XU
Keyword(s):  
Carbon Nanotubes ◽  
Physical Properties ◽  
Building Blocks ◽  
Functional System ◽  
Practical Implementation ◽  
Controlled Growth ◽  
System Building ◽  
Research Activities ◽  
Device Applications ◽  
Cnt Arrays

Controlled growth and precise placement of carbon nanotubes (CNTs) are two vital capabilities for the practical implementation of CNT device designs. This article presents an overview of our research activities aimed at using CVD template growth to both structure and precisely align CNTs into functional system building blocks. Fabrication results on highly-ordered CNT arrays and Y-junction CNTs are described along with an outline of their novel physical properties that could lead to unique device applications.

scholarly journals Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Vaitiare Mulderij-Jansen ◽  
Izzy Gerstenbluth ◽  
Ashley Duits ◽  
Adriana Tami ◽  
Ajay Bailey
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
Entomological Surveillance ◽  
Vector Borne Diseases ◽  
System Building ◽  
Vector Borne ◽  
Dutch Caribbean ◽  
Health System Building Blocks

Abstract Background Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks. Methods From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data. Results This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance). Conclusions This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases. Graphical abstract

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