Current Guidelines for Protecting Health Workers from Occupational Tuberculosis Are Necessary, but Not Sufficient: Towards a Comprehensive Occupational Health Approach

Health workers globally are at elevated occupational risk of tuberculosis infection and disease. While a raft of guidelines have been published over the past 25 years on infection prevention and control (IPC) in healthcare, studies in different settings continue to show inadequate implementation and persistence of risk. The aim of this commentary is to argue, based on the literature and our own research, that a comprehensive occupational health approach is an essential complement to IPC guidelines. Such an approach includes a health system framework focusing on upstream or mediating components, such as a statutory regulation, leadership, an information system, and staff trained in protective disciplines. Within the classical prevention framework, primary prevention needs to be complemented by occupational health services (secondary prevention) and worker’s compensation (tertiary prevention). A worker-centric approach recognises the ethical implications of screening health workers, as well as the stigma perceived by those diagnosed with tuberculosis. It also provides for the voiced experience of health workers and their participation in decision-making. We argue that such a comprehensive approach will contribute to both the prevention of occupational tuberculosis and to the ability of a health system to withstand other crises of infectious hazards to its workforce.

Medical education reform: a catalyst for strengthening the health system

Key points: Medical education reform of Canadian specialist doctors presents a unique opportunity for designing parallel health systems interventions. Applying a Health System Framework reveals wider implications of Competence by Design (CBD) and provides impetus for health system strengthening. CBD implications may include staffing shortages in academic hospitals, annual variation in medical education financing needs, new roles for clinician teachers, and greater demand for human health resource surveillance and patient outcome monitoring and analysis. Each implication provides an opportunity to strengthen Governance and Leadership processes, namely by increasing coordination, harmonization, and system responsiveness.

Time for Order in Chaos! A Health System Framework for Foreign Medical Teams in Earthquakes

The number of reported natural disasters is increasing, as is the number of foreign medical teams (FMTs) sent to provide relief. Studies show that FMTs are not coordinated, nor are they adapted to the medical needs of victims. Another key challenge to the response has been the lack of common terminologies, definitions, and frameworks for FMTs following disasters.In this report, a conceptual health system framework that captures two essential components of health care response by FMTs after earthquakes is presented. This framework was developed using expert panels and personal experience, as well as an exhaustive literature review.The framework can facilitate decisions for deployment of FMTs, as well as facilitate coordination in disaster-affected countries. It also can be an important tool for registering agencies that send FMTs to sudden onset disasters, and ultimately for improving disaster response.

Market Pitfalls and Economics of New Health Technologies in Developing Economies

The objective of this chapter is to provide evidence on “how” market processes are not fully helping developing economies benefit from new health technologies. This is achieved based on publications related to economics of health and impacts of new technologies. Patenting, anti-commons tragedy, neglected health hazards, risks, and limited research constitute the major sources of market pitfalls discussed in this chapter. A special emphasis is placed on developing countries where a series of pitfalls lead to market failures that affect access to new technologies and thus to better health systems. The related risks at both levels of developed and developing economies are discussed even though emergent and developed countries have generated new instruments to limit the negative effects of these constraints. Examples and cases are used to illustrate the pitfalls and the on-going continuing emergence of old diseases, among others. Finally, the expansion of access to new health technologies is suggested to be achieved within the world global health system framework with a more active involvement of countries.