Portal de Periódicos da CAPES

Redefining global health-care delivery

2014; Elsevier BV; Volume: 383; Issue: 9918 Linguagem: Inglês

10.1016/s0140-6736(14)60255-5

1474-547X

Mahiben Maruthappu, Ashton Barnett‐Vanes, Joseph Shalhoub, Alexander Finlayson,

Global Health Workforce Issues

Jim Yong Kim and colleagues1Kim JY Farmer PE Porter ME Redefining global health-care delivery.Lancet. 2013; 382: 1060-1069Summary Full Text Full Text PDF PubMed Scopus (199) Google Scholar provide an important framework for fostering integration and value in global health-care delivery. We, however, believe that greater emphasis could be placed on the breadth with which this framework is implemented. The provision of care in low-income and middle-income countries (LMICs) is burdened by several hurdles including shortages in trained personnel, insufficient access to and provision of resources, and limitations in infrastructure. These hurdles restrain all vertical care pathways. Integration might serve as a promising solution to maximise use of available personnel and resources. We advocate that this occur at the interspecialty level,2Henry JA Orgoi S Govind S Price RR Lundeg G Kehrer B Strengthening surgical services at the soum (first-referral) hospital: the WHO emergency and essential surgical care (EESC) program in Mongolia.World J Surg. 2012; 36: 2359-2370Crossref PubMed Scopus (21) Google Scholar combining infectious disease, primary care, and surgical care facilities, rather than intraspecialty collaboration alone, integrating for example HIV and tuberculosis care.3Hotez PJ Mistry N Rubinstein J Sachs JD Integrating neglected tropical diseases into AIDS, tuberculosis, and malaria control.N Engl J Med. 2011; 364: 2086-2089Crossref PubMed Scopus (45) Google Scholar Inter-specialty collaboration has already shown promise. In Mongolia, WHO-led integration of surgical care with primary health-care services enhanced surgical coverage and improved basic infrastructure.2Henry JA Orgoi S Govind S Price RR Lundeg G Kehrer B Strengthening surgical services at the soum (first-referral) hospital: the WHO emergency and essential surgical care (EESC) program in Mongolia.World J Surg. 2012; 36: 2359-2370Crossref PubMed Scopus (21) Google Scholar Similarly, in South Africa, integration of antiretroviral therapy services and antenatal care increased treatment initiation during pregnancy.4Stinson K Jennings K Myer L Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study.PLoS One. 2013; 8: e63328Crossref PubMed Scopus (38) Google Scholar Furthermore, although we agree that defragmentation of global health vertical care pathways is paramount, this should not be limited to health-care delivery and service-based research, but should apply to a substantially broader spectrum. Global health requires collaboration between basic, social and political sciences, epidemiology, health partnerships, and on-site services. On the basis of the already successful biomedical translational pipeline,5Zerhouni EA Translational and clinical science—time for a new vision.N Engl J Med. 2005; 353: 1621-1623Crossref PubMed Scopus (526) Google Scholar we believe that converging and structuring these efforts, forming a science-to-service, evidence-based, global health translational framework, might focus global health initiatives, aiding sustainability, avoiding waste, and improving efficacy. We declare that we have no competing interests. Redefining global health-care deliveryInitiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. Full-Text PDF