Despite notable scientific and medical advances, broader political, socioeconomic and behavioural... more Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven preve...
Well-Being: Expanding the Definition of Progress, 2020
This chapter explores the relationship between well-being and equity, and makes the case for well... more This chapter explores the relationship between well-being and equity, and makes the case for well-being approaches as a powerful pathway to advance equity. In a world without equity, well-being is impossible. Inequities in income, health, education, environmental conditions, access to opportunity, and other factors hinder individual, community, and civic well-being. Pursuing a well-being approach centered on equity—from what gets measured and how, to the way stories are told and the voices that tell them, to what gets prioritized and acted upon and by whom—can reduce these inequities. And in the symbiotic relationship between well-being and equity, as well-being improves, so does equity; likewise, as equity improves, so does well-being. The chapter addresses three intersecting components of well-being and equity: economic equity, human rights, and social cohesion. Through these lenses, it looks at implications and opportunities for social and policy change and illuminates work that ...
Annals of Tropical Medicine And Parasitology, 2001
A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analy... more A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'magic clients' (i.e. researchers pretending to be looking for treatment for relatives who had one of three 'tracer' diseases), interviews with 4469 pharmacy users as they left the same 191 pharmacies, and a comparison of the quality of advice offered by public and private pharmacies in Guatemala (based on exit interviews with 150 users). The contributing factors were explored using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mexican pharmacies, and a review of the national drug policies in both countries. Although only about 11% of all drug treatments were recommended in pharmacies (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received drugs recommended by pharmacy staff. Much of the pharmacy advice was revealed to be poor: > 80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or dangerous drugs. Few of those who worked in the pharmacies based their advice on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The factors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staff, commercial pressures (particularly in the large-chain pharmacies of Mexico), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more aware that the selling of drugs should involve provision of healthcare (as well as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatment of common diseases, be undertaken. This process will be challenging and slow.
Health and Human Rights: An International Journal, Apr 8, 2010
La participación social se ha entendido de muchas formas y existen tipologías en la literatura qu... more La participación social se ha entendido de muchas formas y existen tipologías en la literatura que la clasifican por los niveles de control por parte de la población en la toma de decisiones. Así, la participación puede ser un hecho simbólico, sin toma de decisión, hasta procesos en los cuales es el principal instrumento para redistribuir el poder entre la ciudadanía. Este artículo sostiene que entender qué es el poder es una primera tarea y analizar la participación social desde una perspectiva de relaciones de poder requiere ...
Library has French version: Une vie saine pour les femmes et les enfants vulnerables : applicatio... more Library has French version: Une vie saine pour les femmes et les enfants vulnerables : application de la recherche sur les systems de sante
'leaving behind' a phenomena of contemporary development and global health processes, and how can... more 'leaving behind' a phenomena of contemporary development and global health processes, and how can these issues be addressed through a CEI approach, albeit with limitations?
Appropriate deployment or posting and transfer (P&T) of health workers – placing the right people... more Appropriate deployment or posting and transfer (P&T) of health workers – placing the right people in the right positions at the right time – lies at the heart of fostering communities ’ faith in government health services and cementing the role of the health system as a core social institution. The authors of this paper have been involved in an ongoing transnational dialogue about P&T practices and determinants. This dialogue seeks to call attention to the importance of P&T as a health system function; to urge donors and policy-makers working in health systems, HRH and public administration governance to consider how to address issues around P&T; and to suggest avenues and approaches to research. P&T is a vexed and unresolved issue in many low- and middle-income countries that requires, above all, political commitment to improving public sector services and to new thinking and research. It holds promise as a focal point for inter-disciplinary collaboration in research and implementa...
We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a ... more We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF’s mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to he...
Version anglaise dans la bibliotheque: Healthy lives for vulnerable women and children : applying... more Version anglaise dans la bibliotheque: Healthy lives for vulnerable women and children : applying health systems research
Power is a critical concept to understand and transform health policy and systems. Power manifest... more Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We...
their governments. Indeed, a new paradigm for development assistance sees it catalysing accountab... more their governments. Indeed, a new paradigm for development assistance sees it catalysing accountability of governments, as opposed to directly saving lives. 4 Research strategies need to measure the connection between development spending and improved accountability. To that end, it is important to highlight that only a small amount of the global $8982 billion health-care budget is devoted to improving the responsiveness and capability of health systems to promote health. 5 The future goal of investments in development assistance should be to catalyse reforms in health systems to help people achieve better health with the money that they are spending. We declare no competing interests.
Despite notable scientific and medical advances, broader political, socioeconomic and behavioural... more Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven preve...
Well-Being: Expanding the Definition of Progress, 2020
This chapter explores the relationship between well-being and equity, and makes the case for well... more This chapter explores the relationship between well-being and equity, and makes the case for well-being approaches as a powerful pathway to advance equity. In a world without equity, well-being is impossible. Inequities in income, health, education, environmental conditions, access to opportunity, and other factors hinder individual, community, and civic well-being. Pursuing a well-being approach centered on equity—from what gets measured and how, to the way stories are told and the voices that tell them, to what gets prioritized and acted upon and by whom—can reduce these inequities. And in the symbiotic relationship between well-being and equity, as well-being improves, so does equity; likewise, as equity improves, so does well-being. The chapter addresses three intersecting components of well-being and equity: economic equity, human rights, and social cohesion. Through these lenses, it looks at implications and opportunities for social and policy change and illuminates work that ...
Annals of Tropical Medicine And Parasitology, 2001
A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analy... more A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'magic clients' (i.e. researchers pretending to be looking for treatment for relatives who had one of three 'tracer' diseases), interviews with 4469 pharmacy users as they left the same 191 pharmacies, and a comparison of the quality of advice offered by public and private pharmacies in Guatemala (based on exit interviews with 150 users). The contributing factors were explored using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mexican pharmacies, and a review of the national drug policies in both countries. Although only about 11% of all drug treatments were recommended in pharmacies (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received drugs recommended by pharmacy staff. Much of the pharmacy advice was revealed to be poor: > 80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or dangerous drugs. Few of those who worked in the pharmacies based their advice on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The factors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staff, commercial pressures (particularly in the large-chain pharmacies of Mexico), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more aware that the selling of drugs should involve provision of healthcare (as well as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatment of common diseases, be undertaken. This process will be challenging and slow.
Health and Human Rights: An International Journal, Apr 8, 2010
La participación social se ha entendido de muchas formas y existen tipologías en la literatura qu... more La participación social se ha entendido de muchas formas y existen tipologías en la literatura que la clasifican por los niveles de control por parte de la población en la toma de decisiones. Así, la participación puede ser un hecho simbólico, sin toma de decisión, hasta procesos en los cuales es el principal instrumento para redistribuir el poder entre la ciudadanía. Este artículo sostiene que entender qué es el poder es una primera tarea y analizar la participación social desde una perspectiva de relaciones de poder requiere ...
Library has French version: Une vie saine pour les femmes et les enfants vulnerables : applicatio... more Library has French version: Une vie saine pour les femmes et les enfants vulnerables : application de la recherche sur les systems de sante
'leaving behind' a phenomena of contemporary development and global health processes, and how can... more 'leaving behind' a phenomena of contemporary development and global health processes, and how can these issues be addressed through a CEI approach, albeit with limitations?
Appropriate deployment or posting and transfer (P&T) of health workers – placing the right people... more Appropriate deployment or posting and transfer (P&T) of health workers – placing the right people in the right positions at the right time – lies at the heart of fostering communities ’ faith in government health services and cementing the role of the health system as a core social institution. The authors of this paper have been involved in an ongoing transnational dialogue about P&T practices and determinants. This dialogue seeks to call attention to the importance of P&T as a health system function; to urge donors and policy-makers working in health systems, HRH and public administration governance to consider how to address issues around P&T; and to suggest avenues and approaches to research. P&T is a vexed and unresolved issue in many low- and middle-income countries that requires, above all, political commitment to improving public sector services and to new thinking and research. It holds promise as a focal point for inter-disciplinary collaboration in research and implementa...
We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a ... more We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF’s mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to he...
Version anglaise dans la bibliotheque: Healthy lives for vulnerable women and children : applying... more Version anglaise dans la bibliotheque: Healthy lives for vulnerable women and children : applying health systems research
Power is a critical concept to understand and transform health policy and systems. Power manifest... more Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We...
their governments. Indeed, a new paradigm for development assistance sees it catalysing accountab... more their governments. Indeed, a new paradigm for development assistance sees it catalysing accountability of governments, as opposed to directly saving lives. 4 Research strategies need to measure the connection between development spending and improved accountability. To that end, it is important to highlight that only a small amount of the global $8982 billion health-care budget is devoted to improving the responsiveness and capability of health systems to promote health. 5 The future goal of investments in development assistance should be to catalyse reforms in health systems to help people achieve better health with the money that they are spending. We declare no competing interests.
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Papers by Walter Flores