A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States

From the report at Plos Medicine

Summary Points

• Responding to the global human resource crisis requires systems thinking if a more comprehensive approach to human resource management and development is to be achieved.
• We present a comprehensive and visible framework for human resource system development. This has been derived from the lessons learned in supporting human resource system development in three fragile and post-conflict health systems in Afghanistan, the Democratic Republic of Congo, and Cambodia.
• The efforts of development partners and the government typically concentrate on the “production” and training of health personnel, but this approach neglects other elements and often the necessary linkages between them. While there is potential value in focused forms of support, they will be much less effective, with negative effects on both systems and population health, when they are unbalanced, incomplete, or miss the necessary linkages between them.
• While the “house model” contains elements similar to the World Health Organization HRH Action Framework, some functions are extracted in order to draw more attention to them. Issues such as the legal and regulatory framework, coordination, and monitoring are often neglected. We also place particular emphasis on the linkages among elements by highlighting some core functions of human resource management (production-deployment-retention), or by separating the foundation components (policy and planning, finances, legal) as primarily the responsibility of the government.

From the Background section

Responding to the global crisis in human resources for health (HRH) requires systems thinking if a more comprehensive approach is to be promoted. This differs substantially from the traditional emphasis on pre-service education, in-service training, and personnel management [1]. The elements to be included in a more comprehensive assessment and response to HRH system development need to be derived from experience and evidence from the field, and should be validated into the future in different settings.

In post-conflict situations, large numbers of development partners, including United Nations (UN) agencies, international and local non-government organizations (NGOs), and various others, literally “rush in.” The situation is often characterized by a weak health system, and is complicated by the limited quantity and quality of human resources [2]. New governments and emergent ministries typically have limited capacity to manage all the tasks necessary for reconstruction. ….

Related articles

• Restoring Health Systems In Countries After Conflicts (medicalnewstoday.com)
• A novel analytical framework could help to strengthen health systems in post-conflict countries (eurekalert.org)

Trending Now: Using Social Media to Predict and Track Disease Outbreaks (with links to related Websites & apps)

Image by rosefirerising via Flickr http://www.flickr.com/photos/69145729@N00/4438384922

[Abstract from Full Text Reports]

Source:  Environmental Health Perspectives

It’s winter, flu season, and you’re at your computer feeling a bit woozy, with an unwanted swelling in the back of your throat and a headache coming on. If you’re like millions of other people, you might engage in a moment of Internet-enabled self-diagnosis. You pop your symptoms into a search engine, and in the blink of an eye dozens of health-related websites appear on your screen. That search supplied you with information—some useful and some not—but in today’s hyper-connected world, it also supplied a data point for those who survey disease outbreaks by monitoring how people report symptoms via social media. In fact, social media, cell phones, and other communication modes have opened up a two-way street in health research, supplying not just a portal for delivering information to the public but also a channel by which people reveal their concerns, locations, and physical movements from one place to another.

That two-way street is transforming disease surveillance and the way that health officials respond to disasters and pandemics. It’s also raising hard questions about privacy and about how data streams generated by cell-phone and social-media use might be made available for health research. “There’s a challenge here in that some of these [data] systems are tightening in terms of access,” says John Brownstein, director of the computational epidemiology group at Children’s Hospital Boston and an associate professor of pediatrics at Harvard Medical School. “But we are seeing a movement towards data philanthropy in that companies are looking for ways to release data for health research without risking privacy. And at the same time, government officials and institutions at all levels see the data’s value and potential. To me, that’s very exciting.”
(Read the entire article for insights in improving surveillance, investigating social networks, and accuracy of social networks)

Excerpts from the ehp article

• A pioneer in this field, Brownstein worked with collaborators at Children’s Hospital Boston to launch one of the earliest social media tools in infectious disease surveillance, a website called HealthMap (http://healthmap.org/) that mines news websites, government alerts, eyewitness accounts, and other data sources for outbreaks of various illnesses reported around the world. The site aggregates those cases on a global map, with outbreaks displayed in real time. Brownstein’s team recently launched Outbreaks Near Me, an iPhone application that delivers HealthMap directly to cell-phone users.
• Flu Near You (https://flunearyou.org/), a website created with the American Public Health Association and the Skoll Global Threats Fund of San Francisco, California, which allows individuals to serve as potential disease sentinels by reporting their health status on a weekly basis.
• Google launched Google Flu Trends (http://www.google.org/flutrends/), a website that allows people to compare volumes of flu-related search activity against reported incidence rates for the illness displayed graphically on a map.

Related articles

• Twitter data accurately tracked Haiti cholera outbreak (guardian.co.uk)
• New study: Cholera in Haiti tracked more rapidly by social media than traditional methods (eurekalert.org)
• Social Media Trumps Traditional Methods In Tracking Cholera In Haiti (medicalnewstoday.com)
• Infographic: How Social Media affects our Brain? (buzzom.com)

Risks and benefits of direct access to lab results

From the 5 January 2012 posting by PATRICIA SALBER, MD  at KevinMD.com

Excerpt from the article

I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people.  I think the days when doctors were needed to control, interpret and dole out health data and information are waning.  There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health.

 

The Quantified Self (QS) people who use sensors, mobile apps, and other devices to collect data on themselves may be taking it to what some would consider extreme, but I think it is the wave of the future.

Now, no one would question who “owns” the data collected in this manner, but how about data collected via a medical laboratory?  Is that somehow different and something we, the patients, should not be allowed direct access to lest we harm ourselves by misinterpretation.  Interesting question!

The issue is explored in a commentary in the December 14, 2011 issue of the Journal of the American Medical Association.***  Traber Davis Giardina, MA, MSW and Hardeep Singh MD, MPH, ask the question:  “Should patients get direct access to their laboratory test results?”  They find that it is “an answer with many questions.”…

The reason to raise this question now is that there is a proposed rule by the Department of Health and Human Services in conjunction with the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and the Office for Civil Rights, that would allow individuals the ability to access their test results directly from the laboratory by written or electronic request. …

…

There are a number of reasons why direct access is a good idea:

• Between 8 and 26% of abnormal test results, including those suspicious for cancer, are not followed up in a timely manner.  Direct access could help reduce the number of times this occurs

Self-management, particularly of chronic illness has known benefits.  Just like the QS people, many folks with chronic illness obtain and manage to self-acquired lab results every day via glucometers, home pulmonary function tests, blood pressure measurements, and so forth.  Direct access to laboratory-acquired data, one could argue is a continuation of that personal responsibility…

…
The arguments against direct access discussed by Giardina and Singh include the following:

• Studies show that patients prefer their physicians contact them directly when they have abnormal test results, although the studies, published in 2005 and 2009, preceded the extraordinary use of the internet to access health information that exists today.
• There is concern over whether patients will know what to do when they receive the results – will they make erroneous interpretations or fail to contact their docs? …..

Read the entire article here

 

***Article available online to paid subscribers only.

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Related articles

• Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
• Proposal on access to lab tests should be revised, doctors say (kboreilly.com)
• Progress Made on Direct Patient Access to Lab Results (projecthealthdesign.typepad.com)
• Getting Lab Results Directly to Patients (blogs.wsj.com)
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• Dentists Could Screen 20 Million Americans For Chronic Physical Illnesses (medicalnewstoday.com)
• Support Your Right to Access Your Clinical Lab Results (spittoon.23andme.com)
• Docs Don’t Want Lab Results Going To Patients (informationweek.com)
• HHS wants to give patients test results straight from the lab (kboreilly.com)
• HHS Proposed Regs Would Give Patients Direct Access to Lab Results (physicianlaw.foxrothschild.com)