Health policy and planning
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Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. ⋯ Instead, services that better fit the previous policy paradigm, like training and data-sharing, are common at site-level but provide diminishing returns. Together, our findings suggest opportunities for PEPFAR South Africa to revisit its model and increase service delivery intensity, in particular through community-based services. More broadly, this case illustrates the need for greater attention to the multiple actors with discretion in the policy system of health aid and the mechanisms through which political priority is translated into programming as policy shifts are made.
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Since the adoption of the Sustainable Development Goals in 2015, innovation in global healthcare delivery has been recognized as a vital avenue for strengthening health systems and overcoming present implementation bottlenecks. In the recent rapid development of the science of global health-care delivery, emergency care-a critical element of the health system-has been widely overlooked. Emergency care plays a vital role in the health system through providing immediately responsive care and serving as one of the main entry points for those with symptomatic disease. ⋯ Capitalizing on emergency care as a shared delivery infrastructure presents opportunities to increase efficiency not only in treatment of time-sensitive conditions, but also for secondary prevention through its capacity to promote early disease detection and enhance coordination of care. We propose an integrated emergency care delivery value chain, demonstrating emergency care's critical position as a point of access to the greater health system and its key connections to longitudinal care delivery, which remain under-developed in low- and middle-income country health systems. As emergency care systems are created within emerging and established health systems, this role can be more effectively leveraged by policy makers and healthcare leaders globally to promote progress towards the Sustainable Development Goals.
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The 2014-16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the aftermath of the 2014-16 Ebola outbreak with the aim of assessing their progress to date to illustrate the current state of the world's global health security architecture. ⋯ Operational progress has also been limited, revealing a need for continued investments to improve outbreak surveillance and detection capabilities specifically. Furthermore, our review highlighted the dominance of the USA and Europe in leading and financing efforts to coordinate long-term recovery efforts in West Africa, strengthen health systems across the continent, and enhance global preparedness for future epidemics, raising important questions about ownership of global health security efforts in non-Western regions of the world. Finally, the lack of transparency and available data on these initiatives' activities and budgets also complicate efforts to project their impacts on the global health security landscape.