Gabriel Seidman

Bio: Gabriel Seidman is an academic researcher from Harvard University. The author has contributed to research in topics: Population health & Supply chain. The author has an hindex of 5, co-authored 6 publications receiving 282 citations.

Barriers and enablers of kangaroo mother care practice: a systematic review.

Abstract: Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: “Issues with the facility environment / resources,” “negative impressions of staff attitudes or interactions with staff,” “lack of help with KMC practice or other obligations,” and “low awareness of KMC / infant health.” Considering only publications from low- and middle-income countries, “pain / fatigue” was ranked higher than when considering all publications. Top enablers to practice were included “mother-infant attachment” and “support from family, friends, and other mentors.” Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

Abstract: Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries.

Abstract: Introduction Improving health systems performance, especially in low-resource settings facing complex disease burdens, can improve population health. Specifically, the efficiency and effectiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products has important implications for health system performance. Pharmaceuticals, vaccines and other health products make up a large share of total health expenditure in low-income and middle-income countries (LMICs), and they are critical for delivering health services. Therefore, programmes which achieve cost savings on these expenditures may help improve a health system9s efficiency, whereas programmes that increase availability of health products may improve a health system9s effectiveness. This systematic review investigates whether changes to supply chains and procurement processes can achieve cost savings and/or improve the availability of drugs in LMICs. Methods Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL and the Health Economic Evaluation Database to identify. Results We identified 1264 articles, of which 38 were included in our study. We found evidence that centralised procurement and tendering can achieve direct cost savings, while supply chain management programmes can reduce drug stock outs and increase drug availability for populations. Conclusions This research identifies a broad set of programmes which can improve the ways that health systems purchase and delivery health products. On the basis of this evidence, policymakers and programme managers should examine the root causes of inefficiencies in pharmaceutical supply chain and procurement processes in order to determine how best to improve health systems performance in their specific contexts.

Does SDG 3 have an adequate theory of change for improving health systems performance

Abstract: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well–being for all at all ages” [1]. Unlike the Millennium Development Goals (MDGs), SDG 3 takes a comprehensive view of health and well–being by expanding its focus beyond a core set of diseases. Given the global prominence of the SDGs for driving the development agenda, it is important to consider whether SDG 3 and the indicators it tracks are well–designed to achieve this intended goal. In order to examine whether SDG 3 can actually help achieve this goal, this article considers whether it has an adequate theory of change (ToC) for improving health systems performance. Such an analysis rests on two core assumptions: 1) in order to achieve the SDG 3 goal, one must improve health systems performance, and 2) in order to achieve this goal, the approach must have a strong underlying ToC. Each assumption is considered below. Since the launch of the MDGs, experience has shown that without improvements in health systems performance, progress on the MDGS was both limited and potentially unsustainable [2]. Bottlenecks in the health system limited nations’ ability to achieve progress on combatting specific diseases. In addition, theoretical and empirical work has argued that providing services which are not only clinically effective but also affordable and acceptable has intrinsic and instrumental value. Recognizing the importance of overall health systems performance, numerous organizations including WHO, the World Bank, Global Fund, and GAVI have focused on health systems strengthening (HSS) as an important component of public health programming. Therefore, since SDG 3 aims to improve both health and well–being for all populations in a sustainable way, achieving this goal will likely require broad improvements in health systems performance. With regards to the second assumption, theories of change (ToC) are standard practice in public health and development [3,4]. They help guide priority–setting, decision–making, monitoring and evaluation, budgeting, and resource allocation, among other activities. A strong ToC can ensure that all stakeholders work toward the same goal(s). The SDGs aim to improve both the coherence of development policies and their implementation at the national level, and the United Nations has offered formal guidance on ways that nations can integrate and tailor the SDGs into their national policies [5]. This guidance explicitly advocates for horizontal policy coherence (ie, coherence across different programs and sectors), vertical policy coherence (ie, coherence between different stakeholders), and linking national policies based on the SDGs to budgets [6]. Given that the SDGs aim to improve policy coherence and drive implementation at the national level, it is instructive to consider whether they have internal coherence and a strong underlying logic themselves. The ToC approach provides a useful approach to explore this question. If the inputs and outputs tracked under SDG 3 have clear linkages to improving its impact indicators, then working toward SDG 3 will allow countries to pursue a comprehensive program for improving health systems performance. On the other hand, if the inputs and outputs tracked do not link to each other or do not have logical connections to impact indicators, then aiming to improve all indicators under SDG 3 could lead to a haphazard and uncoordinated set of public health programs.

Aligning values and outcomes in priority–setting for health

Abstract: Numerous factors and competing interests shape policymaking and budget allocation for health and health systems. In particular, the values and outcomes prioritized by policymakers have important implications for health spending and the impacts they have on populations and countries. Based on Harvard’s Ministerial Leadership Program, this article provides an overarching and integrative framework that policymakers can use to explicitly consider the priorities shaping their decisions, the outcomes that result from their decisions, and processes for making these decisions. The framework includes four key questions: 1) What values underlie the government’s priorities for the country? 2) Based on these values, what goals for the health care system does the government hope to achieve? 3) Based on these goals, where should the government allocate its financial resources for health? 4) How should the government allocate its financial resources for health? The framework also takes into consideration health system, economic, and political outcomes that result from budget allocations.

Supply chain

Abstract: Some aspects of research supply chains problems are proposed in this regular session.

Sustainable care for children with cancer: a Lancet Oncology Commission

Abstract: We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020–50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.

The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care.

Abstract: There is increasing recognition that parents play a critical role in promoting the health outcomes of low birthweight and preterm infants. Despite a large body of literature on interventions and models to support family engagement in infant care, parent involvement in the delivery of care for such infants is still restricted in many neonatal intensive care units (NICUs). In this article, we propose a taxonomy for classifying parent-focused NICU interventions and parent-partnered care models to aid researchers, clinical teams, and health systems to evaluate existing and future approaches to care. The proposed framework has three levels: interventions to support parents, parent-delivered interventions, and multidimensional models of NICU care that explicitly incorporate parents and partners in the care of their preterm or low birthweight infant. We briefly review the available evidence for interventions at each level and highlight the strong level of research evidence to support the parent-delivered intervention of skin-to-skin contact (also known as the Kangaroo Care position) and for the Kangaroo mother care and family integrated care models of NICU care. We suggest directions for future research and model implementation to improve and scale-up parent partnership in the care of NICU infants.