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Objective To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. Methods In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients and obtained data on their countries of origin, diagnoses and interventions. We surveyed 293 medical tourists to collect demographic characteristics and information on their expenditure and travelling companions. To help understand the impact of medical tourism ontheThai health system, we also interviewed 15 hospital executives and 28 service providers from the private hospitals. Findings We obtained 911 913 records of hospital visits, of which 324906 came from 104830 medical tourists. We estimated that there were 167 000 medical tourists in Thailand in 2010. Of the medical tourists who attended our study hospitals, 67 987 (64.8%) came from the eastern Mediterranean region or Asia and 109509 (34%) of them were treated for simple and uncomplicated conditions--i.e. general check-ups and medical consultations. The mean self-reported non-medical expenditure was 2750 United States dollars. According to the hospital staff interviewed, medical tourism in 2010 brought benefits to--and apparently had no negative impacts on--the Thai health system and economy. Conclusion We estimate that the total number of medical tourists visiting Thailand is about 10% of previous national government estimates of 1.2 million. Such tourists appear to bring economic benefits to Thailand and to have negligible effects on the health system. Objectif Etudier l'ampleur et les caracteristiques du tourisme medical en Thailande et l'impact de ce type de tourisme sur le systeme de sante et l'economie du pays. Methodes En 2010, nous avons examine les dossiers de toutes les consultations realisees dans cinq hopitaux prives qui recevaient, selon les estimations, 63% de l'ensemble des patients etrangers. Nous avons consulte les dossiers d'hospitalisation des patients etrangers et recueilli des informations sur leur pays d'origine, le diagnostic et les interventions pratiquees. Nous avons interroge 293 touristes medicaux afin d'en savoir plus sur leurs caracteristiques demographiques, leurs depenses ainsi que leurs accompagnateurs. Afin de mieux comprendre l'impact du tourisme medical sur le systeme de sante thailandais, nous avons egalement interroge 15 cadres hospitaliers et 28 prestataires de services de ces hopitaux prives. Resultats Nous avons examine 911 913 dossiers de consultations en hopital, dont 324 906 concernaient 104 830 touristes medicaux. Nous avons estime que 167 000 touristes etaient venus en 1 hallando pour raison medicale en 2010. Parmi les touristes medicaux qui se sont rendus dans les hopitaux de notre etude, 67 987 (64,8%) venaientde la region de la Mediterranee orientale ou d'Asie et T09 509 (34%) d'entre eux etaient traites pour des affections simples et sans complications--controles d'ordre general et consultations medicales. Les depenses moyennes declarees de nature autre que medicale s'elevalent a 2750 dollars des Etats-Unis. Selon le personnel hospitalier interroge, en 2010, le tourisme medical a eu des effets benefiques--et apparemment pas d'lmpact negatif--sur le systeme de sante et l'economie thailandais. Conclusion Nous estimons que le nombre total de touristes se rendant en Thailande pour raison medicale represente environ 10% des precedentes estimations nationales du gouvernement, qui etaient de 1,2 millions. Ce type de tourisme semble apporter des benefices economiques pour la Thailande, avec des effets negligeables sur le systeme de sante. Objetivo Investigar la magnitud y las caracteristicas del turismo sanitario en Tailandia y el impacto de dicho turismo sobre el sistema sanitario y la economia del pais. Metodos En 2010 se comprobaron los registros de todas las visitas a cinco hospitales privados que se estima que cubren el 63% de todos los pacientes extranjeros. Se revisaron los registros hospitalarios de los pacientes extranjeros y se obtuvieron datos de sus paises de origen, diagnosticos e intervenciones. Se encuesto a 293 turistas sanitarios para recopilar caracteristicas demograficas e informacion sobre sus gastos y companeros de viaje. Tambien se entrevisto a 15 ejecutivos de hospitales y 28 proveedores de servidos de hospitales privados para ayudar a entender el Impacto del turismo sanitario en el sistema sanitario tailandes. Resultados Se obtuvieron 911.913 registros de visitas hospitalarias, de los cuales 324.906 provenian de 104.830 turistas sanitarios. Se estimo que en 2010 hubo 167.000 turistas sanitarios enTailandia. De los turistas sanitarios que atendieron los hospitales analizados, 67.987 (64,8%) provenian de la region del Mediterraneo Oriental o Asia y 109.509 (34%) fueron tratados de condiciones simples y sin complicaciones. Es decir, chequeos generales y consultas medicas. El promedio de gastos autodeclarados en gastos no medicos fue de 2.750 dolares estadounidenses. De acuerdo con el personal hospitalario entrevistado, el turismo sanitario en 2010 trajo beneficios a (y aparentemente no tuvo un efecto negativo sobre) el sistema sanitario y la economia de Tailandia. Conclusion Se estima que el total de los turistas sanitarios que visitan Tailandia es cerca del 10% de las anteriores estimaciones del gobierno nacional de 1,2 millones. Esta clase de turistas parece traer beneficios economicos a Tailandia y no tienen efectos negativos en el sistema sanitario., Introduction Although reliable estimates of the annual number of people travelling abroad to purchase medical services--so-called medical tourists--are difficult to identify, there has been a rise in medical tourism in [...]

Background: Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. Methods: We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. Results: The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Conclusion: Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic. [ABSTRACT FROM AUTHOR]

A better understanding of serological data and risk factors for coronavirus disease 2019 (COVID-19) infection in healthcare workers (HCWs) is especially important in African countries where human resources and health services are more constrained. We reviewed and appraised the evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and its risk factors in HCWs in Africa to inform response and preparedness strategies during the SARS-CoV-2 pandemic. We followed the Preferred Reporting Items for systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines in this scoping review. Databases including PubMed, Embase and preprint servers were searched accordingly from the start of the COVID-19 pandemic to 19 April 2021. Our search yielded 12 peer-reviewed and four pre-print articles comprising data on 9223 HCWs from 11 countries in Africa. Seroprevalence varied widely and ranged from 0% to 45.1%. Seropositivity was associated with older age, lower education, working as a nurse/non-clinical HCW or in gynaecology, emergency, outpatient or surgery departments. Asymptomatic rates were high and half of the studies recommended routine testing of HCWs. This scoping review found a varying but often high SARS-CoV-2 seroprevalence in HCWs in 11 African countries and identified certain risk factors. COVID-19 public health strategies for policy and planning should consider these risk factors and the potential for high seroprevalence among HCWs when prioritizing infection prevention and control measures and vaccine deployment. [ABSTRACT FROM AUTHOR]

Abstract Background While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn. Methods In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011. Results Funding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce. Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics. Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced. Conclusions Whilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground and accurate costings for sustainable service delivery, building on existing community strengths, are needed before projects commence. This study highlights the importance of enabling and building the capacity of existing CBOs and community structures, rather than creating new mechanisms.