Mediaboss Marketing

Keely Jordan, Todd P. Lewis & Bayard Roberts

Abstract

Background

There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings.

Methods

This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain.

Results

We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety.

Conclusion

The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

Read more:
Quality in crisis: a systematic review of the quality of health systems in humanitarian settings - World - ReliefWeb

Ministers swell with pride as they speak of profound ties of history and friendship, while polling shows that a substantial majority of Britons are in favour and newspaper headlines are overwhelmingly positive.

Immigration has always been a contentious issue in Britain. So why, as the UK opens a path to citizenship for millions of Hong Kong residents, is it different this time?

Hong Kong Chinese are seen as a model minority, successors to the status of Ugandan Asians: a thrifty, entrepreneurial and family-oriented community who will skimp to send their children to private schools and boost Britains economic fortunes, while quietly demonstrating that other ethnic minorities could be equally successful if they worked a little harder.

Journalists have been briefed that Priti Patel, daughter of Ugandan Asians, sees this as personal, and a headline in the Times made the link explicit: Hong Kong crisis: Ugandan Asians offer golden example.

Britain is doing the right thing. But the good migrant narrative coalescing around the Hong Kong Chinese is risky for them as well as for other British people of colour.

The impulses behind this narrative combine the imperial nostalgia that helped power Brexit, an importing of US conservative politics, and a racialised caricature of why the Asian tiger economies Hong Kong, Taiwan, Singapore and South Korea have been so successful.

First, the imperial element. Hong Kongs achievement is seen as an extension of empire, based on the attractions of the English language and rule of law. As the Adam Smith Institute fellow Sam Bowman put it: under British rule, it enjoyed property rights and the rule of law, which made it a magnet for Chinese refugees fleeing the communist regime.

There is a grain of truth in this account, though it ignores the crucial geographic and economic facts that underpin Hong Kongs position today. The territory is the conduit between global capital and Chinas largely closed financial system. This role will continue to fuel Hong Kongs economy even if many of its people leave for Britain, and it is not a business they can export with them.

Both Hong Kong and Singapore adapted elements of their colonial heritage and made them work for their economic benefit. Both places have also deployed colonial laws to repress their people. Last September, the Hong Kong democracy activist Tam Tak-chi, a former radio presenter known as Fast Beat, was charged under a sedition law, the Crimes Ordinance, brought in by the British to curb dissent. If were going to remember imperial history, lets do so in full.

Second, being generous to Hongkongers neatly complements the Conservative partys new obsession, a hawkish attitude to China. The China Research Group, launched last year by a group of Conservative MPs, makes valid criticisms of Chinas human rights abuses and Beijings cavalier attitude to international law. But the launch of this group is also a signal of a pricklier and more combative turn in British conservative attitudes to Beijing, echoing the hostility to China in US Republican circles.

Third, there is a simplified version of the tigers story that emphasises the natural abilities of hardworking people allied to Confucian culture. This is a modern-day version of old-fashioned stereotypes about colonial races.

In 1915, an Australian management consultant who had just toured factories in an Asian country fretted about the quality of its workforce. The workers, he concluded, were a very satisfied easy-going race who reckon time is no object. The country in question was Japan, and the story, told in Ha Joon Changs Bad Samaritans, is a reminder of the fluidity of the cultural narratives we use to explain the world.

The success of places like Hong Kong and Singapore has to do with effective governance and astute economic policy decisions, such as containerising their ports earlier than competitor nations and focusing on export-oriented industrialisation. Harnessing the talent and efforts of their labour force is a part of this story. But this, too, is a consequence of policy rather than innate genius. An exceptional education is part of the answer here: Hong Kong, Singapore and South Korea all rank among the highest-performing school systems in the world, according to the Organisation for Economic Co-operation and Development.

Hongkongers will reshape our societies in ways that we cant predict. Postwar Commonwealth migration, including the arrival of Ugandan Asians, helped bring about a reckoning with race relations that sought to tackle Britains deep-seated racism. More recently, eastern European migration was exploited to drum up anti-EU sentiment.

One of my closest friends is the son of migrants from Hong Kong and Singapore. His Hong Kong Chinese mother fulfilled one part of the immigrant dream by working as a nurse to put her son through the best (private) education she could afford. She was baffled, to put it mildly, when my friend pursued an erratic career as a film-maker and visual artist rather than choose a more secure and lucrative profession.

The point of this anecdote is that people are people, with all of the complex desires and varied talents that this implies. It is risky to assume that an infusion of Hong Kong migration will give Britain an entrepreneurial rocket boost. Worse, a handful of cherrypicked success stories could easily become a stick to beat others with.

Hongkongers seeking a new life in Britain are not economic assets. The reason to welcome them is, simply, because it is just. And their freedom should include the freedom to be a slacker.

See the original post here:
Britain should welcome Hongkongers, but not the 'good migrant' narrative - The Guardian

Politics, and media coverage of politics, is powered by conflict and spectacle. But social scientist Andrew Markus wants to focus on something quieter: the resilience and optimism of Australians during a crisis; a country under duress that chose not to fracture.

Markus is principal researcher on the Scanlon Foundations annual Social Cohesion report a project that has mapped a migrant nation since 2007. The report published on Thursday is a snapshot of a country managing a once-in-a-century crisis.

The research (sample size 3,090 respondents) is normally conducted in July. Given Australia was at that time about to tip into a second wave of coronavirus infections in Victoria, and had slipped into the first recession for 30 years, the Monash University emeritus professor was puzzled when many of the snapshots of community sentiment were positive.

That seemed counterintuitive.

To be certain of the findings, a second survey of 2,793 respondents was conducted in November. In November, we again got very positive data, he says. By positive data, this is what Markus means. Stepping through his findings, a supermajority was on board with Scott Morrisons response to the crisis, and the level of trust in government in Australia hit the highest point in the history of the survey.

People had confidence in the public health response. More than 90% of respondents in the five mainland states said lockdowns to suppress transmission were definitely or probably required. While the Victorian premier, Daniel Andrews, endured a period of being flogged by the Murdoch media for locking down the state, 78% of respondents backed Andrews, and when they were asked whether the lockdown was required, 87% said yes.

While America and Britain battled resurgent nativism, the inward turn triggered by the global financial crisis of a decade ago, Australians, walled in behind a preemptive international border closure, and marooned periodically behind hard state borders, continued to look to the world.

The survey asked respondents whether globalisation was good or bad. More than 70% of respondents in the two surveys said good. While protectionism was back in vogue, and the global economy convulsed because of a trade war between a real autocrat in Beijing and an aspirational one in Washington, in 2020, Australians looked through the static and continued to believe trade with the world was good for the country.

As governments put businesses into hibernation around the country during the first wave, the economy tanked and consumption stalled, one in four respondents had their jobs impacted jobs lost, hours wound back.

This cohort was more inclined to pessimism about the future than other respondents, and less sanguine about the health of their household balance sheet. But 73% of respondents remained satisfied or very satisfied with their financial outlook a result up almost 10 points on that recorded in mid-2019. Canberra rolled out income support and the household savings ratio notched up a record rise.

Young people bore the brunt of the crisis. Reflecting that reality, Australians under 24 in the survey were less optimistic about the future than people over 24. A couple of indicators bear this out: 58% of respondents aged between 18 and 24 say they are optimistic compared with more than 70% of respondents aged from 25 to 74, and less young respondents agree with the proposition that Australia is a land of economic opportunity where hard work yields a better life (61% compared with 72% of the 25-34-year-old cohort).

But rather than blame outsiders which is a common default during times of high unemployment young Australians remain more positive about immigration, multiculturalism and ethnic diversity than older Australians. Only 18% of people aged between 18 and 24 agree with the idea that immigrants take away jobs from Australians, while 30% of people in older cohorts agree.

Australians continue to support multiculturalism. The idea that multiculturalism has been good for Australia is strongly supported, with 84% of the sample agreeing in 2020, up four points in a year. But while Australians strongly support a diverse society at a time when multiculturalism is regarded as a failed project in some parts of the world, there is a flipside. We profess to support multiculturalism but Australians can also harbour negative sentiment about Africans, Asians and people from the Middle East. The survey terms this a hierarchy of ethnic preference.

With Donald Trump adding the Chinese virus to the lexicon, 59% of Chinese Australians surveyed observed that racism in Australia during the Covid crisis was either a very big problem or a fairly big problem. The Scanlon Foundation also undertook a separate survey between May and June, tapping sentiment from 500 Chinese Australians on WeChat. Asked whether they had experienced discrimination during the crisis, 27% said yes and a further 20% declined to answer the question.

Markus says he has reflected on why many Australians have experienced one of the toughest years of their lives, but have remained largely positive. Australia was not in such a bad position prior to the pandemic when you compare Australia with England and the United States."

Both of those societies were seriously fractured prior to the pandemic. Brexit sharply divided England, as did Donald Trump in the United States, he says.

There have been times when Australia has been much more fractious under the leadership of Tony Abbott as opposed to the leadership of Scott Morrison, and I think Anthony Albanese can struggle to position himself but he is basically a consensus figure.

This made it possible for Australia to respond to the pandemic quickly and in a cohesive way. To me this is the key point: we possibly undervalue the good things about Australia and how Australians will respond in a crisis, Markus says.

This, for me, is a really big takeaway and its important because it is probably not acknowledged. What we get in the media is the cut and thrust of politics rather than the long-term fundamental understanding of what works in Australia and what doesnt work.

Visit link:
Toughing out Covid: how Australias social fabric held together during a once-in-a-century crisis - The Guardian

Covid-19 is a crisis like no other. And, expectedly, it has wreaked havoc on the Government of India (GoI)s financial arithmetic as it struggled to deal with collapsing tax revenues and increased expenditure pressures. Therefore, there are two questions that need to be asked of the FY 2021 budget.

How did the Union government reorient its macro-fiscal position to counteract the economic fallout of the pandemic and what does this reveal about the nature of the policy choices made by the government to respond to the Covid-19-induced economic crisis? Second, what does the budget offer as a policy pathway to nurture the economy back to health in FY 2021-22?

In FY 21, the lockdown-induced freeze on the economy expectedly resulted in a collapse in revenues while expenditure pressures increased. Revenue receipts collapsed from 20.2 lakh crore to 15.5 lakh crore, expenditure increased from 30.4 lakh crore to 34.5 lakh crore, as did the one number that the government has thus far worried about the most the fiscal deficit.

Finance minister Nirmala Sitharaman must be congratulated for breaking with tradition and being transparent about the fiscal deficit numbers while offering a path to fiscal consolidation by FY 2025-26. Importantly, she has discontinued the practice of off-budget borrowing for food subsidy. However, a closer look at the numbers reveals a more complex picture.

First, while tax revenues fell, the real hit to the Centres finances came from a fall in disinvestment receipts and bringing off budget expenditure back on to the budget. The fall in net tax revenue to the Centre is responsible for a mere 1% of the rise in fiscal deficit numbers. Second, most of the increase in expenditure outlays is driven by the food and fertiliser subsidy (around 80%). Increases in health accounted for 3.88%. Third, the share of states in the divisible pool of taxes fell from 32% in the budgeted estimates to 28.9% (Revised Estimates 2020-21).

Three facts emerge about the macro fiscal picture. First, the government has increasingly relied on the assumption that proceeds from disinvestment will fund its expenditure commitments. In good times, this is bad fiscal management. But in times of pandemic, this can be seriously damaging. The governments reluctance to adopt an expansionary fiscal stance in response to the pandemic is a consequence of historical fiscal mismanagement rather than the Covid-19-induced economic shock. The emphasis on disinvestment in this budget, while welcome, risks a similar fate. The government will have to urgently double down in FY 22 to meet these targets.

Second, expenditure increases in FY 21 were limited to subsidies and essential relief through the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). Overall, in FY 21, expenditure increased from a 13.53% of GDP Budget Estimates (BE) to 17.74% in RE. However, because GDP contracted significantly in FY 21, these numbers overstate the magnitude of increase in expenditure. It is important to note that transfers from centrally-sponsored schemes (including MGNREGS whose allocations increased by 81% over budget estimates) increased by 14%, suggesting significant contraction in expenditure for other schemes in FY 21. Finally, state governments, at the frontlines of the Covid-19 battle, have been forced to rely on market borrowing as their share in the central government taxes fell significantly. The consequences of this on state budgets, that have displayed far greater fiscal discipline than the Centre will be significant, in the long-term.

As this column noted in a pre-budget piece, the post-lockdown economic recovery is showing signs of deepening structural inequality. Economic activity has reached near pre-pandemic levels, but this is largely profit-led. Large listed firms have profited at the cost of small firms and the informal sector. And the scars in the labour market, particularly informal labour, run deep. Reversing this trend is both a moral imperative and good economic sense after all, if purchasing power remains low for the bulk of the economy, demand will collapse.

In this context, the FY 22 budget ought to have increased expenditure for welfare, provided for an inclusive social protection architecture that protects vulnerable groups especially migrant workers, and increased capital expenditure. At first glance, the government has only done the last.

Several important announcements have aimed at reforming what economist Arvind Subramanian has called the software a bad bank, the proposal for a DFI, and bank recapitalisation. All of these are steps in the right direction. However, these increases will not immediately translate into employment and increased wages for the poor.

There are continuing governance challenges, which will not be addressed overnight. In this context, it is a mistake to assume that FY 22 will present space to the government to curtail its welfare expenditures. But the FY 22 budget cuts allocations to food subsidy and MGNREGS. It offers no comfort that the government, in response to the migrant crisis, will address the extreme vulnerabilities faced by Indias informal sector and urban workers. Expenditure in FY 22 will see little planned growth over FY 21.

The pandemic has disproportionately impacted Indias poor and vulnerable. The hope was that this budget would, by adopting an expansionist fiscal stance, respond to their needs while putting the economy back on track. It has not.

Yamini Aiyar is president and chief executive of the Centre for Policy Research

The views expressed are personal

View post:
Decoding the budget and the economics of welfare - Hindustan Times

The past year did not end as much as it was ending. Steeped in a crisis that continues to rage, it unfolded like pages of a dystopian novel where the paranoia of a climactic collapse overtook luxury of any foreshadowing. Suddenly, everyone across the world was tethered to a reality that seemed incredulously remote and frighteningly close. As if at long last all were equal, if only in their fears. It is this ubiquity of horror and deathly wait for an end that makes Arati Kadavs 55 km/sec a short film anticipating the destruction of the world due to an incoming meteor straight out of the times we are inhabiting.

Art draws from life, adapts it. It also re-frames existence, transforming occurrences into stories and circumstances into plot points. Art then is associated with excess. But when reality is unprecedented and disproportionate, art ceases to be just about representation. Instead, it becomes a site of possibilities. In the last year alone, pandemic and the unique danger it posed, served as a premise for multiple creative outings.

In the lockdown thriller The Gone Game (streaming on Voot), imperative isolation and initial constrictions are weaponised to showcase the ease with which preventive measures, in place to protect us, can be manipulated to fake death if need be. In Unpaused (streaming on Amazon Prime), pandemic-ridden disruption is fleshed out across five segments by different directors. They touch upon a host of issues, all stemming from the present halt we are participants of. One envisions a futuristic world were living with the virus leaks into the way people date, going as far as to suggest virtual meetups as the way out. And more than one emphasises on the parallel reality lockdown inadvertently led to: migrant crisis. But both series identify the pervasive crisis as a hindrance to the way of life, an inconvenience. The creativity then, is reflected in what they make out of that obstacle.

Kadav seemingly roots her film in this territory, choosing her characteristic sci-fi genre as the medium. It is not a virus but a meteor coming towards the earth for 25 days which withholds the possibility of a complete collapse. Its effects are cataclysmic: the shock will kill people and those surviving will perish from the consequences. Even though the threat differs, the results are strikingly similar: equality of dread counterpoised by inequality of access. Those privileged will be staying in space stations, news anchors inform. Government has created bunkers for the common people but there are too few and some are already crumbling. 55 km/sec then is a succinct critique on the present rampant capitalisation of misery, inefficiency of the government and widening chasm between the have(s) and have-not(s).

But the short in its 23-minute runtime also looks where other lockdown dramas failed to. Through it, Kadav trains her lens beyond the affluent and afflicted, to those sitting quietly in their rooms long before the staying in was a necessity. She looks at loners who, so used-to not drawing attention to themselves, were overlooked by those telling stories of the pandemic as well. She represents them.

At the core, 55 km/sec is an uneven love story where an introverted boy (Suraj) finally musters courage to confess his feelings to his erstwhile college mate over a Zoom call. As a final goodbye, a group of ten friends come together to share their last thoughts, seconds before the complete collapse (Kadav, too, makes an appearance). Suraj (Mrinal Dutt) is one of them, so is Srishti (Richa Chadha), the woman he loved and who is now married with a kid. The admission comes out of desperation, of letting her finally know, now since there can be no consequences. But it is their phone conversation later (the meteor collision time was miscalculated) that stayed with me.

When asked if he is scared, Suraj answers he isnt. Being a recluse, he never felt connected with anybody else. Ironically it was the prospect of being confronted with a similar threat, of dying with everybody that gave him a sense of togetherness. And this remains my biggest takeaway from Kadavs short its acknowledgement of perpetual loners who find a sense of acceptance in the unlikeliest of situations. It underlines that despite the hazard it entailed, the common catastrophe enabled some to truly belong, if for the first and last time.

So much of the lockdown has been about the way it curbed mobility and upended possibilities of meetings. So much of its depiction has been about the inconvenience it posed. But for many who have been lonely, this also became a strange time when for once they felt together in their loneliness. In Olivia Laings exquisite The Lonely City where the author viscerally describes urban loneliness with all its shame and embarrassment, the feeling of being alone is captured in a gut-wrenching line: What does it feel to be lonely? she asks, and then answers, It feels like being hungry: like being hungry when everyone around you is readying for a feast. If there is one perverse silver lining to these horrific times it is this: the ravaging hunger is now shared, and for some, this is the closest they have come to feeling satiated.

(55 km/sec is streaming on Disney + Hotstar)

For more lifestyle news, follow us: Twitter:lifestyle_ie|Facebook:IE Lifestyle| Instagram:ie_lifestyle

Excerpt from:
55 km/sec by Arati Kadav: An unlikely crisis drama that looks beyond the afflicted and the affluent - The Indian Express